Maternal health

	Commonwealth Disaster Relief Co-ordinator Colonel Linton Graham of Jamaica visits a hospital in Maldives after the Indian Ocean tsunami disaster

Reducing maternal mortality is the focus of the Secretariat’s work in maternal health. It is also the MDG that appears least likely to be met by 2015.

The lifetime risk of maternal death is 1 in 2,800 in developed countries, and 1 in 16 in developing countries. Ninety-nine per cent of the estimated 515,000 annual deaths of women from pregnancy-related causes occur in developing countries. Almost all of these maternal deaths can be prevented, treated and managed with relatively inexpensive health care. Regrettably, maternal mortality rates are rising in certain Commonwealth countries, with the HIV/AIDS pandemic adding to an already dire situation.

The Secretariat advocates for maternal health at the highest levels. Maternal health was the theme for Commonwealth Health Ministers Meetings in both 2004 and 2005. The advocacy film on maternal mortality, My Sister Myself: Women of the Commonwealth speak to the women of the world, was launched by the Secretariat in July 2004, in partnership with other organisations in the field of maternal health, such as the World Health Organisation (WHO), British Council, United Nations Population Fund (UNFPA) and others. The Secretariat then mobilised funding and collaborated with WHO to produce a series of seven advocacy films on maternal and newborn health.

Reducing the unacceptably high level of deaths of mothers and newborn infants requires skilled health care personnel. The Secretariat has focused on improving the education of midwives working in rural areas. A workshop organised in collaboration with the East, Central and Southern Africa Health Community in March 2005, for chief nursing officers and registrars of nursing and midwifery councils, identified short-term strategies to improve the skills and knowledge of midwives working in rural areas, and a longer term plan for continuing education of midwives.

Avoiding maternal deaths is possible even in resource-poor countries, but the right information is required. The WHO has developed tools for carrying out maternal death audits. Complementing this work, the Secretariat assists Commonwealth countries in implementing maternal death review programmes to gather information on the specific factors causing mothers to die.

The Secretariat also works to address the broader causes of maternal mortality, including the low social status of girls and women and the discrimination they suffer in many countries, which limits their access to reproductive health services and, therefore, their ability to protect themselves from unwanted pregnancy and HIV/AIDS. A rights-based approach is also used to address issues of access to basic health care delivery and treatment.

Access to health care

Today, globally, there is an unprecedented shortage of human resources for health, leading to a crisis in the health sector and a more generalised development crisis, as countries already hard hit by HIV and AIDS are losing staff both to other countries and to the disease itself. The growing shortage of health workers poses a major threat to health systems, especially in developing countries. The Secretariat has worked with ministries of health to identify ways of reducing the threat.

It is estimated that in Africa an additional one million health workers will be needed over the next decade to deliver basic health interventions and to achieve the minimum level of health workforce density of 2.5 health workers per 1,000 people. Currently, in some countries in Africa the figure is only 0.8.

The Secretariat’s focus is on sharing good practices in the management of human resources for health, developing a framework for country-to-country bilateral agreements, collaborating with other partners, and the implementation of the Commonwealth Code of Practice for the International Recruitment of Health Workers adopted by Commonwealth Health Ministers in May 2003. This seeks to limit the adverse effects of migration upon the most vulnerable countries and to promote fairer practices in the recruitment of health workers.

Regional workshops for key health workers were organised in Ghana, Mauritiu and Singapore to identify good practices in the management of human resources for health, develop national action plans for the retention of health workers and discuss implementation of the Code of Practice.

The Commonwealth is also working on a managed migration programme for health professionals through temporary movement arrangements, so as to benefit health-care systems in both source and destination countries. The Secretariat commissioned a study on the feasibility of such a project in the Caribbean. Health and trade ministries of Commonwealth Caribbean countries, intergovernmental organisations and academic institutions, meeting in Barbados in 2005, agreed on a framework of action for a programme of temporary movement of nurses. They also endorsed a proposal to establish a system for the temporary movement of nurses from the Caribbean as part of a trade and development approach to managing the high social and economic cost of emigration of health-care professionals. A similar project has begun in the countries of the Common Market for Eastern and Southern Africa (COMESA).