Thembo is a recent graduate from a school of public health in West Africa. He was recently recruited to work for an international NGO – Africa Reach-Out (ARO), working in East Africa. ARO had recently received funding for a maternal and child health project for a community called Arewo in East Africa.

On assuming his post, Thembo made a field visit to Arewo. In his field report to his supervisor, Thembo noted that the maternal mortality ratio in Arewo was much higher than those in the neighbouring districts and national averages.
He reported that there were six health facilities in the community to serve some 250.000 people, mostly poor subsistence farmers. Three of the health facilities were providing basic primary healthcare services, two were providing secondary level care, and one was a teaching hospital. On average, a woman had to walk for at least three hours to reach the closest health facility. The poor road infrastructure and extreme poverty made it impossible for local taxi drivers to reach out to the remote communities in Arewo. Only one health facility had an ambulance. Although the Ministry of Health usually allocated money to support Maternal and Child Health services in Arewo. Unfortunately, only a fraction of these funds were received at infrequent intervals. As a result, the health facilities had to charge for the services provided in order to sustain their activities. Most women were unable to pay these user fees. The government had allocated a significant amount of regular funding to the teaching hospital. The teaching hospital had enough drugs, and healthcare personnel who were assigned to the peripheral health facilities often paid bribes to be assigned to the teaching hospital instead. In addition, the quality of healthcare was low as most personnel were not aware of some of the recent evidence-based strategies. Drug shortages were common in the five clinics so that at times patients were given expired drugs. The power supply was also a problem, so fridges were not regularly functioning.

Thembo’s report documented the case of a pregnant woman whose husband refused to accompany her to the hospital because, according to him,’ giving birth was a woman’s problem’ and subsequently would not give her enough money to go to the clinic. The said pregnant woman was HIV positive and reluctant to visit the clinic because people in the community began avoiding her after she went there for ante-natal care. Apparently, a nurse in the hospital had told a neighbour of her (the pregnant woman’s) HIV status.

Question 1

● What is maternal mortality, and how is it usually expressed? (5 points)
● In 150- 200 words, explain why it’s a problem when a woman dies in childbirth in a community? (15 points)
● What do you think would be the most commonly occurring direct and indirect
causes of maternal deaths in Arewo, and why? (Use between 500 and 600 words) 30 points
● Identify the similarities and differences between the issues you have outlined regarding Arewo community and those in your region/country. Give specific examples (150-200 words; 10 points)

The Country Director of AOR was disturbed by Thembo’s findings. He immediately reached out to the Director of Maternal and Child Health (DMCH) at the Ministry of Health at national level. The DMCH called for a meeting and invited Thembo to come over and discuss his report.

Question 2

● If you were Thembo, which two to three evidence-based potential solutions would you suggest addressing both the direct and indirect causes of maternal deaths in Arewo, and which evidence-based interventions would you recommend to achieve progress towards those solutions?
● Remember to breakdown your response into separate headings/subheadings (word count 800-1000; 35 points) ● References account for 5 points.

Answers to Above Questions on Case

Answer 1: Maternal mortality is defined as the death of a woman when she is pregnant, or it can be within 42 days of termination of pregnancy. It is usually calculated by dividing the number of maternal deaths from that of number of live births and expressed as follows:
MMR = Number of maternal deaths/number of live births * 100000

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