A sustainable approach to reducing mother and newborn deaths in South Africa

South Africa is just one country where PATH is working to protect mothers and newborns when they are most vulnerable. But our efforts there are notable because they represent such a sustainable approach:

• Introducing simple, lifesaving health technologies and proven techniques into the health system.
• Updating health workers’ training and skills to make use of these new tools.
• Helping decision-makers monitor the results.

This work builds on the substantial infrastructure already in place in South Africa, where most births happen in a health facility.

Existing health facilities equal opportunity for impact

Like other countries in the region and in the developing world, South Africa has high maternal and newborn mortality rates. But the relatively prosperous South Africa has a network of hospitals and clinics where women can and do go to have their babies. That means we can reach a lot of people by strengthening the existing health system. We’re working hand in hand with the government in peripheral, rural health clinics in KwaZulu Natal, one of the country’s most populous provinces.

The neonatal resuscitator

Worldwide, a million newborns a year die at birth, struggling to take that first breath, even though newborn resuscitation devices are both inexpensive and effective—if only birth attendants have them and can use them. In South Africa, fully one-third of newborn deaths are due to breathing problems.

Building on years of experience evaluating neonatal resuscitators, PATH is working to identify the low-cost models that would best fit health systems in South Africa. We’re also training health workers to use resuscitation devices properly and ensure they are available to skilled health workers.

Postpartum bleeding and the radically simple Uniject® device

Postpartum hemorrhage is a leading cause of maternal deaths, but it can often be prevented by a relatively simple technique called “active management of the third stage of labor,” or AMTSL. PATH has developed a complementary clinical training video on AMTSL for on-the-job training (available on request). It contains footage that models quality care in real-life clinical situations to better prepare birth attendants for labor and delivery and graphics that clearly illustrate how to perform this lifesaving procedure.

A key component of AMTSL is a drug—usually oxytocin—that stimulates contractions of the uterus and prevents excessive blood loss after delivery.

The Uniject device—a prefilled, autodisabling injection device developed by PATH—can help health workers quickly and easily give an accurate dose of oxytocin without risk of infection transmission from needle reuse. PATH is conducting a study at several hospitals in KwaZulu Natal to assess the effectiveness of administering oxytocin via the Uniject device compared to using traditional syringes.

• Read more about PATH’s work to prevent postpartum hemorrhage.
• Request a copy of the AMTSL video.
• Learn more about the Uniject device.

Updating the skills of health workers

To update the knowledge and skills of health workers, we have worked with a team of maternal and child health experts to develop an innovative, on-site training for health care providers that do deliveries. The training consists of a competency-based clinical practicum that is supported by ongoing activities to improve clinical practices and quality of care. Trainings cover the following critical areas:

• Newborn resuscitation and use of neonatal resuscitators.
• Active management of the third stage of labor to prevent postpartum hemorrhage.
• Use of partograms—a series of charted measurements that are used to assess the progress of labor—to monitor labor and detect warning signs of potential complications.

Basic tenets of essential newborn care, including cutting the umbilical cord with a clean blade, giving drops for the eyes, keeping the baby warm with skin-to-skin contact, immediate breastfeeding, and closely watching for danger signs.

We are working with government partners to institute this training as well as to make other health system improvements through planning sessions that involve health care providers, managers, supervisors, and other stakeholders at each site. We find that lasting solutions and improvements are best designed by the very people who will carry them out.

Lasting change for moms and babies

Other components of our strategy that ensure lasting success are:

• Instituting an accreditation system for training sites and an ongoing certification system for health care providers.
• Working with health officials to develop ways to capture data from labor wards on specific causes of maternal and neonatal deaths. These statistics will help decision-makers make choices about which interventions are working and how they can continue to improve the quality of care at clinics and hospitals.

Health technologies designed especially for low-resource settings, updated training for health workers, system improvements designed by health workers themselves, and data for decision-making—all of these interventions add up to a stronger health system that provides new mothers and their babies the safe, strong start they deserve.

Uniject is a registered trademark of BD.

Photo: Richard Lord.