Health System Strategies for Improving Maternal & Newborn Care in Humanitarian Emergencies
Whether we define humanitarian emergencies as large-scale displacement, famine, natural disasters, or communities embroiled in political unrest and violence, these contexts have one thing in common: severe instability. And, in its wake, crumbling health systems that can do little to soften the burden of suffering. In these situations, women and children bear the brunt of disasters while facing continued discrimination and human rights abuses.
Every day, more than 800 women die from preventable complications related to pregnancy and childbirth. In countries such as Yemen, South Sudan, Somalia, and Nigeria, famine afflicts over 20 million people as drought conditions and political turmoil worsen. In these fragile settings, Management Sciences for Health (MSH) uses three key strategies to improve the health of women and children. These successful interventions serve as a testament to the value of health systems strengthening to mitigate the negative health effects of conflict or emergency.
Improving quality of care
Pregnancy doesn’t wait. And in humanitarian emergencies, one of the most joyous moments in a woman’s life is often overshadowed by fear. Without basic services provided by a skilled health provider, such as prenatal care, a safe place to deliver, care for complications, and postnatal care, simple and treatable infections and complications become life-threatening for both mother and baby.
According to Sonia Walia, Lead Public Health Advisor for the U.S. Agency for International Development’s (USAID) Office of U.S. Foreign Disaster Assistance, the situation in many countries is dire. Even though the WHO doesn’t recommend them unless indicated for the safety of mother or baby, pregnant women in Syria would rather schedule C-sections than wait until they go into labor because they fear that violence will prevent them from reaching the hospital. In South Sudan, an increasing number of pregnant women are acutely malnourished due to conflict-induced food insecurity.
Rebuilding health systems around a basic package of health services has succeeded in maximizing maternal and newborn care in post-conflict settings. In Afghanistan, after the fall of the Taliban in 2001, MSH worked with the Ministry of Public Health to institute a Basic Package of Health Services, establishing standards of care focused on saving women, children, and infants first. In the seven years following, the number of attended births increased over 4,000 percent and helped drive maternal deaths down from 1,600 to 400 per 100,000 live births, while the infant mortality rate dropped significantly from 165 to 77 deaths per 1,000 live births. Not only have these clinical and administrative standards spurred a firm push to achieve the national maternal and infant mortality targets under the Sustainable Development Goals, but they are a key component of the country’s strengthened, more resilient health system.
Strengthening management and governance
Physicians, midwives, nurses, and other frontline health workers have been recognized frequently for their contributions and are often the heroes of poignant testimonies. However, in order to better equip them to do their jobs well and rapidly respond to emergencies, strong management and governance is needed in the health system.
MSH’s recent response to the deepening crisis in Syria focused on strengthening supply chain management to deliver life-saving medicines to displaced people in Syria, Iraq, Turkey, and Yemen. Through the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, MSH trained health workers, logisticians, and program managers from UNICEF, UNFPA, FAO, WHO, and the International Medical Corps in Amman, Jordan in standard supply chain management procedures such as forecasting need, procuring supplies, negotiating prices, warehousing, distribution, rationing, and waste disposal. In light of increasingly protracted conflicts, SIAPS advisors teach health workers and program managers to pair the band-aid approach of humanitarian aid with building strong, flexible, and resilient health systems in the face of future crises.
Through the USAID-funded Collaborative Support for Health (CSH) program, MSH supports the government of Liberia to rebuild its national health system in the aftermath of a 13-year civil war and the devastating Ebola outbreak of 2014. The CSH program focuses on building leadership, management, and governance capacities in a decentralized system, through improved planning and the better use of health data.
This work centers on a simple truth: When people have the resources, tools, and training they need to do their job, they become accountable for making a difference. Furthermore, the overall health system becomes more resilient to endure future emergencies.
According to Jill Keesbury, Senior Director of Program Development and Strategy at MSH, proven interventions cannot revitalize a post-conflict population without adequate coverage. Simple but crucial principles of health systems strengthening must therefore be applied at scale.
In the Democratic Republic of the Congo, MSH has expanded access to proven, life-saving maternal and child health services after helping to build the capacity of the country’s national health system. Through the USAID-funded Evidence to Action for Strengthened Family Planning and Reproductive Health Services for Women and Girls (E2A) project, MSH has worked with Pathfinder International and others to help 22 million people - over a quarter of country’s population - access quality care. So far, the number of attended births has increased by almost 4,000 percent and the number of patient visits increased from 2 million to 44 million a year. This stronger, more flexible health system has saved the lives of an estimated 150,000 children under 5 and 11,000 newborns across the country within a five-year period.
Strong systems save lives
In today’s reality, where millions of people are impacted by disaster or conflict, it is critical to ensure that tried and true health interventions continue to be available, ensuring that babies are born healthy and mothers survive to care for their children. Even in complex and challenging contexts, solutions exist to provide quality health care and save the lives of those most at risk. Strengthening a country’s health system before, during, and after crisis ensures that it will be resilient and responsive when its people need it most.