To address under-five mortality in sub-Saharan Africa, there is need to improve the quality of postnatal care (PNC) services by adapting an integrated service delivery model, which will include improving access to lifesaving vaccines including their timely delivery; access to nutrition services including infant young child feeding and growth monitoring; increased uptake and use of early infant diagnosis of HIV; community education; and post-natal checks for mothers. Because resources are finite, this initiative should integrate services and prioritize vulnerable communities
By Florence Gune
Human Resources Intern
United Nations Population Fund – UNFPA
New York, USA
Initiatives for Catalytic Investment for Rural Africa
Sub-saharan Africa, including countries in southern Africa, continues to be the region with highest under-five child mortality rate in the world. In 2018, 1 in 13 children in sub-Saharan Africa died before their 5th birthday. For example, the under-five (U5) mortality rates for Malawi, South Africa, Tanzania, and Zambia were 49.7, 33.8, 53 and 57.8 deaths per 1,000 live births respectively in 2018. These U5 mortality rates were in part due to high prevalence of infectious but preventable diseases, HIV, poor quality of care with an underlying low socioeconomic status. To address these challenges, there is need to improve the quality of postnatal care (PNC) services by adapting an integrated service delivery model, which will include improving access to lifesaving vaccines including their timely delivery; access to nutrition services including infant young child feeding and growth monitoring; increased uptake and use of early infant diagnosis of HIV; community education; and post-natal checks for mothers.
Because resources are finite, this initiative should prioritize vulnerable communities. Immunization is among the most accessed public health interventions in southern Africa; therefore, ensuring that access to lifesaving vaccines is integrated within PNC services provides a platform for delivery of other essential health services such as nutrition screening, prevention and care services; diagnosis and care for HIV infected children; birth registration. These interventions are low cost but have high returns on investment.
Investing in improving quality of PNC services especially by integrating services will reduce morbidity and prevent unnecessary deaths. In addition, improving PNC services helps improve quality of care and is a critical step in building resilient health systems because of addressing human resources constraints; information systems for planning and monitoring; supply systems including access to basic health commodities; community engagement; and highlighting issues of program governance.
While addressing PNC service would be an important pillar in reducing U5 mortality, there is need to identify and leverage strategic entry points, which include piggybacking already high uptake of vaccination at the facility and community level and use of existing HIV awareness, prevention and care structures. The strategy here is to use supports as a catalytic investment to trigger domestic investment from country governments or potential private sector entities to incrementally support and eventually champion this initiative.
The implementation of this initiative will require identifying relevant partners, which should be contingent on defining the program context. Aware that over half of the global population live in urban areas with increasing numbers in slum environments (hard-to-reach populations affected by multiple deprivations) and in hard-to-reach rural remote areas, the partners to help facilitate this approach of integrated PNC services would need to be those who have expertise in these settings. In addition to working with governments, the partners should be resourceful in implementing this initiative and targeting the most vulnerable in urban and rural poor communities.
It is important that best practices and challenges from this initiative are documented and disseminated in the region, therefore academia will need to be engaged to shepherd the evidence and knowledge generation.