Car­ing for Her

De­vel­op­ing coun­tries in South Asia can em­u­late the ex­am­ple of Sri Lanka and take mea­sures to en­sure safer child­birth - the right of ev­ery woman.

Southasia - - Health - By Manam Iqbal

Over the last thirty years, two ap­proaches have been de­vel­oped for the pro­mo­tion of health­care in de­vel­op­ing coun­tries. One was for­warded at the Alma Ata Dec­la­ra­tion of the World Health Or­ga­ni­za­tion which rec­om­mended a com­pre­hen­sive ap­proach to pri­mary health­care in­clud­ing “Ed­u­ca­tion to in­form pre­vail­ing health prob­lems and mea­sures to con­trol them, food se­cu­rity and im­proved nu­tri­tion, sup­ply of clean wa­ter and san­i­tary ser­vices, ma­ter­nal and child­care ser­vices in­clud­ing fam­ily plan­ning, im­mu­niza­tion against com­mu­ni­ca­ble dis­eases, the con­trol of lo­cally en­demic disease, and the sup­ply of es­sen­tial drugs for crit­i­cal health prob­lems.”

The Rock­e­feller Foun­da­tion, to the con­trary, main­tained that com­pre­hen­sive pri­mary health­care would be ex­cru­ci­at­ingly costly to im­ple­ment for most de­vel­op­ing na­tions. There­fore, the smarter op­tion was to rec­og­nize those wide­spread health is­sues af­fect­ing the ma­jor por­tion of the pop­u­la­tion and de­velop ways to cure them.

Rec­og­niz­ing the core is­sues as be­ing Ma­ter­nal and Child Health, Sri Lanka be­ing a low-in­come coun­try, has made use of the Rock­e­feller model of health­care to have be­come the South Asian coun­try with the low­est mor­tal­ity rates in new­borns and moth­ers.

As re­li­gious be­liefs and cul­tural affin­ity play a huge role in the daily lives of peo­ple in most South Asian coun­tries, the Sri Lankan gov­ern­ment has taken a parochial ap­proach to ad­dress­ing the is­sues of ma­ter­nal and child health, halv­ing not just mor­tal­ity ra­tios ev­ery decade since 1960 but also cre­at­ing com­mu­nity con­scious­ness among its cit­i­zens.

Trained mid­wives, or the Pub­lic Health Mid­wife, are the front­line cadre of pro­fes­sion­als who are mak­ing this progress pos­si­ble by bridg­ing the gap be­tween health fa­cil­i­ties and com­mu­ni­ties in Sri Lanka. Be­cause of them, women in ru­ral set­tings and ge­o­graph­i­cally non-con­tigu­ous ar­eas also have ac­cess to a skilled at­ten­dant at birth.

These mid­wives go through an 18month train­ing pe­riod for the com­plete tech­ni­cal know-how of pre­na­tal, post­par­tum and an­te­na­tal care af­ter which they are as­signed par­tic­u­lar vicini­ties. Each mid­wife is re­spon­si­ble for ap­prox­i­mately 3000 to 5000 peo­ple in her par­tic­u­lar area with most women be­ing iden­ti­fied be­fore 12 weeks of preg­nancy.

Be­cause of this sys­tem, ma­ter­nal and child health has im­proved tremen­dously in the last six decades. This can be gauged from the fact that mor­tal­ity rates of 450 out of 100,000 live births went down to merely 43 in 2005. And the in­ter­est­ing part is that all this was achieved with­out any fi­nan­cial con­straints.

It is un­for­tu­nate that al­most 99% of all preg­nancy re­lated com­pli­ca­tions and deaths oc­cur in the de­vel­op­ing world par­tic­u­larly be­cause of low eco­nomic outreach of peo­ple. This is why Sri Lanka’s sys­tem is free of cost and eas­ily ac­ces­si­ble to all.

A Pub­lic Health Mid­wife (PHM) is not just trained for child­birth or com­pli­ca­tions re­lated to it. She also pro­vides reg­u­lar check-ups per­tain­ing to the gen­eral health of peo­ple. Com­pli­cated cases are al­ways re­ferred to the near­est health fa­cil­ity. To­day, few fam­i­lies are more then 1.4 km away from the near­est health fa­cil­ity.

Only re­cently, Lalitha Padi­mini has been rec­og­nized as one of the twelve most out­stand­ing health work­ers by Global Health Work­force Al­liance for her ef­forts in the Sri Lankan vil­lage of Medagama.

Along­side the health sys­tem put in place by the gov­ern­ment, the gen­er­ally high sta­tus of women along with the em­pha­sis on ed­u­cat­ing girls also has a role to play in achiev­ing low lev­els of mor­tal­ity rates in this South Asian nation.

Sri Lanka has of­ten been cited as a per­fect model of health­care ser­vices ri­val­ing the stan­dards of coun­tries with much higher per capita in­comes. Other de­vel­op­ing na­tions can also take mea­sures to en­sure safer child­birth which is the right of ev­ery woman. A gen­uine ef­fort on the part of lead­ers may ac­tu­ally help re­al­ize the Millennium De­vel­op­ment Goal of re­duc­ing in­fant mor­tal­ity across the world by three quar­ters till 2015. The writer is a com­mu­ni­ca­tions grad­u­ate and holds spe­cial in­ter­est in so­cio-eco­nomic is­sues in the re­gion.

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