1. Reducing Maternal and Neonatal mortality in North West Province
14th SOMSA CONGRESS
RIO Hotel
Ms Grace Tsele

2. LAYOUT Introduction Background Institutional Maternal Mortality
Primary Causes
Interventions
Progress (NCCEMD )
U/5 Mortality
Neonatal mortality
Progress
General Challenges

3. INTRODUCTION
“The quality of life of women and children particularly rural women, poor women and women from ethnic and indigenous minorities is a strong measure for a real change for the world’s most vulnerable people”- Kofi Annan
A midwife – A first hand to touch, to love, guide the way, first helping hand, to calm and feed.
Effective midwives must be clinically competent with required knowledge, skills and attitude to provide quality care.
Their success depends on a supportive supervision, continuous education, enabling policies and access to resources

4. NW fertility rate ↓ from 3.11 (2001-2006) to 2.90 (2011-2016)
BACKGROUND
The North West Province has an estimated population size of 3,790,600. The total female population is estimated at 1,8655,610 of which represent the number of women in reproductive age (15-49). U/5 population is at
NW fertility rate ↓ from 3.11 ( ) to 2.90 ( )

5. SOCIAL DETERMINANTS
North Western part of the country
Boarders – FS,GP,Botswana,NC
4 Districts, 19 Sub-Districts, 383 municipality wards, 328 facilities
Rural (West) – economic activities around agriculture and seasonal jobs
Eastern part –host highly populated districts(Boj, KK)-mining, migrant labour, informal squatter settlements

7. HIV PREVALENCE PREVALENCE YEAR SA NW 2013 29.6 28.2 2014 30.0 28.6
2015
30.6
29.1

8. (Where are we from ?)NCCEMD 2008-2010)

9. Institutional MMR per province 2008-2010
Red line 15% above, green 15% below national average

10. NCCEMD REPORT PRIMARY CAUSES Non preg . related infections
AVOIDABLE FACTORS :
Patient: delay seeking medical help
Administrative: transport
Health Care Professional: Time of emergency >> ANC; PNC (sub-standard care), delayed referal, poor monitoring & no action; Lack of clinical supervision.
PRIMARY CAUSES
Non preg . related infections
Obstetric haemorrhage
HPT
Medical and Surgical disorders and others
Sepsis

11. NWP Specific actions for saving mothers lives
6 INTERVENTIONS ACCOUNT FOR 90% OF MATERNAL LIVES SAVED
HOW MANY MOTHERS DIE (TOTAL) IN THE NWP –
Source DHIS -12 May FY

12. OTHER INTERVENTIONS CARMMA implementation MWH ESMOE and OEST BANC
9 Obstetric ambulances
MMR meetings
Maternity case records audits and Maternal Death assessors support
Provincial MCWH forum

13. OTHER INTERVENTIONS
PPH monograph
C/S monograph
Decentralization of High Risk Clinics

14. NCCEMD )

15. NO. OF U/5 DEATHS REGISTERED BY PROVINCE (STATS SA)

16. EARLY NEONATAL , LATE NEONATAL, AND POST NEONATAL MORTALITY RATES NW 1996-2005

17. INTERIM REPORT ON MORBIDITY AND MORTALITY IN CHILDREN UNDER 5 YEARS COMMIC :2012
INFANT MORTALITY RATE
U/5 MORTALITY
2007
2008
2009 SA
47.4
44.7
38.1
62.1
59.8
50.7
North West
77.6
70.2
48.4
100.3
93.1
63.1

18. LEADING CAUSES OF DEATHS

19. NWP SPECIFIC ACTIONS FOR SAVING CHILD LIVES
HOW MANY CHILDREN DIE (TOTAL) IN THE NWP –
Source DHIS -4 June FY
11 INTERVENTIONS ACCOUNT FOR 70% OF CHILD LIVES SAVED

20. 2ND TRIENNIUM REPORT (COMMIC)

21. SPECIFIC ACTIONS FOR SAVING NEW-BORN LIVES
7 INTERVENTIONS ACCOUNT FOR 90% OF NEONATAL LIVES SAVED
HOW MANY NEONATES DIE (TOTAL) IN THE NWP –
Source DHIS -4 June FY

22. OTHER INTERVENTIONS Training of Traditional leaders BANC PLUS KMC
Human Milk Bank
PMTCT Option B Plus
Birth PCR
HBB
MSSN
Interfacility transport
Decentralised High Risk clinics

23. CHALLENGES CONT…
High staff turn over
Insufficient budget to replace staff
Non compliance to protocols and guidelines – avoidable deaths

24. ACKNOWLEDGEMENTS
Hon. MEC Dr Magome Masike for his leadership and support
Maternal death assessors
Provincial ministerial commitee members
Provincial MCWH Forum
Developmental partners
Doctors and Midwives
Civil society groups

25. I THANK YOU