WWHI Mission We build sustainable local healthcare systems focused on maternal and child health. wwhi.org
Story of Awa
1.WWHI and GIC 2.Why Women? 3.Global Issue 4.Delivery Issues 5.WWHI model 6.Looking ahead
Global Interdependence Center(GIC) Question:
Can there be a sustainable, healthcare delivery system in developing world?
Case Studies
WHY WOMEN?
“When women thrive, all of society benefits and succeeding generations are given a better start in life.� -Kofi Annan
Why Women? Woman’s income more likely than a man’s to go toward food,
education, medicine, and other family needs1 When a mother is present and healthy improvements are seen: • Education of children (including girls) increases • Nutrition and health improves • Influence multiplied • Family economic output greater • Survival of infants
1. Jowett M. “Safe Motherhood interventions in low income countries: an economic justification and evidence of costeffectiveness.” Health Policy 53(3): 201-28. 2000.
Why Women? – Economic Strategies Women contribute to economic growth; their UNPAID work at home and on the farm equals about 1/3 of global GDP Women operate the majority of small businesses and farms in developing countries
Return on investment in maternal mortality reduction
It is estimated that US$15 billion is lost every year due to maternal mortality1 1.
USAID Congressional Budget Justification FY 2002; Program, Performance, and Prospects – The Global Health Pillar.http://www.usaid.gov/pubs/cbj2002/prog_perf2002.html.
Millennium Development Goals • Goal #4 related to child health
Target 1 Reduce by two thirds, between 1990 and 2015, the under-five mortality rate
•Goal #5 related to maternal health Target 1 Reduce by three quarters the maternal mortality ratio Target 2 Achieve universal access to reproductive health
Current Picture From 1990 to 2005, the maternal mortality ratio
declined 41% in Sub-Saharan Africa (UNFPA) One woman still dies nearly every minute of every day from treatable or preventable complications related to pregnancy and childbirth For every one woman who dies, 20 develop debilitating injuries, infections or disease related to or exacerbated by pregnancy and childbirth Sub-Saharan Africa owns 56% all maternal deaths (15 times higher than developed regions)
Hitting Targets? Reduction in under 5 mortality
Reduction in maternal mortality
Ghana1
30%
40%
Senegal
35%
45%
1 (Ministry of Health (MOH), 2008 and GHS, 2003)
Developing World: Complex Problems • Difficult to access with only unfinished minor road access
• No maintained roads to villages in Saraya District
• High rates of poverty • GDP % Healthcare low
PROBLEM: Health Access • 64.5% births happen in their homes • Only 27.2% of births are assisted by a formallytrained birth attendant
• 20.4% of the women in the region receive no prenatal care while most have 1 visit.
Problem: Healthcare Expenditure Ghana 2000 2006
Senegal 2000 2006
USA 2000
2006
Total Expenditure on healthcare as % of GDP Private Expenditure on health as a % of total expenditure on health External Resource for health as % of total expenditure
7.2
5.1
4.3
5.8
13.2
15.3
58.6
65.8
63.1
43.1
56.3
54.2
9.5
22.6
17.4
12.3
0
0
WHO Report: “Health Expenditure; World Health Statistics, 2009.
Problem: Healthcare Expenditure • Expenditure per capita: • Lowest - US$ 31 per capita • High of US$ 2636 per capita • Shortfall is made up in low-income countries by private spending - 85% of which is out of pocket
• External resources represented 17% of low-income country health expenditure in 2006. • Some low-income countries have two thirds of their total health expenditure funded by external resources. - predictability of aid is an important concern.
Delivery of healthcare in Rural settings • • • •
Very little communication between healthposts Only women who access care are tracked Limited emergency services available Travel at great cost and long distances for emer. care • Majority of women deliver at home, alone due to cost and distance • Access care often too late • Cost of care high
•
CB-MAP Delivery and Reporting Flow
National Senegal Ministry of Health (MOH)
• •
Anemia causes mother and infant death, premature births, and low birth weight Malaria during pregnancy kills 10,000 mothers and 200,000 infants each year 90-100% malaria prevalence in Saraya health district
Tambacounda Regional Hospital
• •
Executive Director WWHI Dana Allison
Full-service, surgical hospital >3 hour drive from Saraya
Medical Director – WWHI Dr. Linda Ellison
Medical Director Youssou Ndiaye
•
•
Central District Hospital – new structure built equipped for inpatient, outpatient laboratory and surgical services Trainings and data reporting and analysis
Primary Care Supervisor
Program Manger – Saraya, Senegel
Program Manager WWHI
Lab Technician
•
Mid Wives
•
•
Small, under-resourced clinics providing triage and malaria treatment, maternity MOH employees
•
Community Health Workers (CHWs)**
•
•
Nurses
40 community-based health workers to deliver village based healthcare
Matrons**
Badienou Gokh**
Multi-modal approach – 1) test and treat malaria 2) test and treat anemia 3) educate mothers on both Community-based outreach ensuring 100% of women have access to lifesaving interventions Improve quality and access by ‘inside out’ approach
** Not MOH supported employees
Dana Allison Executive Director dana.allison@wwhi.org
Questions?