Fri | Aug 17, 2018

Birth pangs! - EU $3b programme to reduce maternal and child mortality on ‘slow track’

Published:Sunday | December 10, 2017 | 12:00 AMNadine Wilson-Harris

Almost 200 mothers who gave birth in public-health facilities across Jamaica during the first three months of this year went home without a baby, but a programme funded by the European Union (EU) to the tune of $3 billion, aimed at reducing this painful reality, is experiencing its own birthing pains.

Jamaica recorded just over 6,800 births from January to March, with 101 of that number being stillbirths and 93 recorded as neonatal deaths not living for more than 27 days.

These numbers are in line with what the country has recorded in the past five years, and that prompted the European Union to allocate EU$22 million in 2013 to finance a programme for the reduction of maternal and child mortality (PROMAC).

Under the programme, the Government was given 48 months to improve newborn and emergency obstetrics by establishing 11 high dependency units (HDUs) in six hospitals across the island.

Jamaica was also tasked with improving primary healthcare services for high-risk pregnancies and enhance clinical knowledge and skills of health professionals through improved training programmes.

But just over one week ago, coordinator of PROMAC, Dr Simone Spence, told The Sunday Gleaner that the HDUs are yet to be established although the planning and development work was completed and contracts with design firms signed in October 2015.

The tender for the procurement of construction and engineering services to build the units was concluded last month.

"PROMAC is the first major EU-funded project that focuses specifically on the health sector in Jamaica, and is charting new territory in addressing the significant challenges of child and maternal mortality in Jamaica," Spence told The Sunday Gleaner.

"With five major components, the project is both complex and multidimensional, requiring ongoing consultation and collaboration among all participants to ensure achievement of implementation targets," added Spence.

She said the EU extended the operational implementation period to 84 months and commencement of construction of the HDUs is now projected for the second quarter of 2018.

The units, when completed, will enable mothers and newborns with life-threatening injuries and illnesses, including severe infections, to get constant attention by an integrated team of specially trained healthcare providers.

They will also allow detailed monitoring of patients with, or at risk of, developing major organ system failure and those who have undergone a major or complicated surgery.

While the HDUs have not yet been developed, Spence said under PROMAC they have been able to procure radiographic, laboratory and other specialised medical equipment to support the establishment of the units. They have also started the training of physicians, nurses, primary healthcare workers and community health aides to staff and sustain the HDUs.

"Some of this equipment, including six ambulances to improve the primary healthcare referral system, has already been delivered to Jamaica, and this is helping to support needed healthcare to mothers and neonates. The balance will be delivered in 2018," said Spence.




To date, 50 scholarships/fellowships have been awarded for training of specialist physicians and nurse educators under a contract with the University of the West Indies, and an additional 25 physicians started specialised training in neonatal ventilation in 2017.

More than 100 nurses have been trained in basic midwifery and 25 dietitians and nutritionists have completed training in neonatal nutrition.

Another 1,000 primary carehealth workers and 200 community health aides have been trained in areas including neonatal resuscitation, management of high-risk pregnancies and customer service.

The Government was hit with a 'dead baby scandal' in 2015 after 18 newborns died within a three- to four-month period following an outbreak of bacterial infections at the University Hospital of the West Indies (UHWI) and the Cornwall Regional Hospital.

The incident resulted in the reassignment of then health minister Dr Fenton Ferguson as many called for his resignation.

That same year, Jamaica failed to meet Millennium Development Goals four and five, as data provided by the World Health Organisation and the Ministry of Health in 2015 showed the infant mortality rate and the maternal mortality ratio higher than targeted.

The country must now work towards achieving the Sustainable Development Goal-3.1, which challenges countries to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and lower neonatal mortality to as low as 12 per 1,000 live births.

According to the Ministry of Health's latest quarterly report dubbed 'Vitals', the Percy Junor Hospital in Manchester had the highest rate of stillbirths in the first quarter of this year, followed by Cornwall Regional Hospital and May Pen hospitals. Meanwhile, the Mandeville Hospital had the greatest neonatal death rates, followed by Victoria Jubilee Hospital.

"It is expected that the Victoria Jubilee Hospital would have high rates of neonatal deaths, given that this hospital, along with UHWI, receives the more difficult cases nationally," the ministry explained in Vitals.