Save the Children Briefs Congress on Maternal and Child Health Needs
Save the Children Director of Health David Oot briefed House of Representatives members March 28th, 2002 on maternal and child health issues in Afghanistan as they prepared to consider appropriations legislation for Afghanistan.
Save the Children has been actively engaged in helping to address the needs of the Afghan people since 1985. Initially, this focused on the Afghan refugee population in Balochistan and Northwest Frontier Provinces of Pakistan, and beginning in 1988 through cross-border assistance, and subsequently in 1994 through programs based in around Kabul, Mazar-i-Sharif, and Andkhoi in the north. Save the Children is continuing to implement programs in these areas and has expanded its program in the north to include the provinces of Jowzjan, and Balkh. Programs in the north include micro-credit for women, drought response, including food, seed, and fertilizer distribution, loans, and cash and food for work. Save the Children is also assisting with school construction and/or rehabilitation, water supply, and primary health care.
Since the magnitude and severity of need related to maternal and child health has been well documented by others, I will instead share some thoughts to consider as the U.S. proceeds with plans to assist with the rebuilding of the health system and programs in Afghanistan.
Do The Things We Know Will Work First
There are health interventions that are technically feasible and affordable that can be implemented at scale quickly. These include, for example, extending access to immunization services and vitamin A supplementation. Only 10 percent of pregnant women and 21 percent of children are immunized against measles and neonatal tetanus - two deadly and highly preventable diseases that kill tens of thousands of Afghan children each year. Few children receive vitamin A supplements -- a low-cost, intervention that is relatively easy to deliver, and could significantly reduce under-5 mortality. Immediate and exclusive breastfeeding is also critical to infant and child survival, and should be promoted while we work on the longer-term task of rebuilding the health system.
Be Prepared To Stay The Course
Establishing or strengthening health systems and bringing about positive changes in some health behaviors will take more time and resources - both human and financial - to implement. Reducing maternal mortality is a case in point. More than 97 percent of women deliver at home, with less than 10 percent of these deliveries attended by a skilled health practitioner. A successful effort to bring about sustained reductions in maternal deaths must improve household practices before and during delivery, increase access to a well-trained, community-based female birth attendant, and improve access to a facility where life-saving emergency obstetrical care is available. Reducing high risk pregnancies, and especially increased birth spacing, is also a critical issue, and should be addressed within the context of maternal and child health services.
Focus On Feasible And Affordable Interventions In Low-Resource Settings
We need to focus on technically feasible and affordable community-based interventions that address the most important causes of illness and death, and on those age groups that are most vulnerable (women, infants, and young children). It is tempting to think, for example, that constructing high-quality, hospital-based care is the most critical need, when, in fact, relatively few will benefit from these facilities, and they are not needed to prevent and treat the most common causes of illness and death such as pneumonia, diarrhea, and immunizable diseases.
Engage Women In Planning And Implementing Programs
Women must play a critical role in designing and implementing programs that address the needs of women and children. We must listen to, and learn from, women and other community members (including men), and engage them in defining solutions to the issues that are identified. We should seek to engage women as community health volunteers, especially to promote improved health practices, timely and appropriate care seeking, and as participants in delivering basic services. The lack of female service providers is a key constraint to access to care at all levels in the health system. We must remember that many of the conditions that led to the poor health of women, especially poor health practices and barriers to care (e.g., low status of women and restricted mobility) - existed before the Taliban, and persist today - and must be addressed in order to bring about sustained improvements in health care.
Take Time To Understand What Is Most Needed To Improve Health Services
We should take the time to obtain a more complete picture of the current health situation and what remains of the health system (e.g., facilities, staffing, equipment, supplies, etc.) before making large investments in system strengthening. Physical infrastructure, for example, is needed but it is only one of several key constraints to improving the quality, availability, and use of key services. Health facilities, even where they may exist, are often grossly under-utilized because they lack staff (and especially female staff), drugs, or because of physical, cultural, and social barriers to care seeking.
Creating Real And Lasting Partnerships
We must remember that the Afghans must lead and own the solutions to improving the health of women and children. International nongovernmental organizations can be key partners - especially in the near to medium term - in helping to rebuild the health system in Afghanistan. Working with and through local government and nongovernmental institutions, we can help both to rebuild the physical and human infrastructure, and in providing services to meet existing health needs in the near term.
In sum, there are programs that can be implemented that can save the lives of Afghan women and children now. Resources are urgently needed to finance recurrent costs (including salaries of government health workers), train and deploy health workers (especially women) at all levels, and rebuild the systems needed to deliver quality health care at the community level. We would urge the Congress to make the significant and sustained investment in the future of Afghanistan that will give women and children a real opportunity to survive and thrive.
