Delivering care for mother and
children in developing countries:
the experience of
Doctors with Africa CUAMM
Istituto Superiore di Sanità,
Rome, 5th April 2018
Dr. Fabio Manenti
Project Departement Head,
Doctors with Africa - CUAMM
HEALTH SYSTEM
(WHO definition)
•Governance and Leadership
•Health services delivery
•Health workforce*
•Health Financing
•Health Information System
•Medical products, vaccines & technologies
Health System Strengthening: based on context analyses and
in agreement with national and district plan and with local stakeholders
District Health System:
effective coverage, access to quality,
efficient and equitable health care
*Capacity building (training schools, university ect.)
CUAMM: >60years… approach
Hospital
Community
Peripheral
health
facilities
The «3 delay model» of health
system…“how to reduce the
barrier to access?”
Main gaps for maternal health:
Hospital
Community
Health units
Addressing main gaps for maternal health:
Hospital
Comunità
Health Units
Addressing main gaps for maternal health:
Hospital
Comunità
Strutture
sanitarie
periferiche
Addressing main gaps for maternal health:
Mother and children first: 2012- 2016 A Public Private Partnership to increase access to quality delivery
Wolisso Hospital,
South West Shoa, Etiopia
Chiulo Hospital
Ombadja, Angola
Tosamaganga Hospital
Iringa Rural, Tanzania
Aber Hospital
Oyam, Uganda
Total deliveries
Angola: from 15% to 45% of coverage
18,2% 18,3%
22,0% 22,0% 20,8%
0%
5%
10%
15%
20%
25%
0
500
1.000
1.500
2.000
2.500
3.000
3.500
2012 2013 2014 2015 2016
Deliveries trend and coverage Ombadja, Angola
Cesarean sections
Hospital deliveries HCs deliveries
Etiopia: from 16% to 46% of coverage
20,0% 23,7%
41,9%
53,6% 56,4%
0%
10%
20%
30%
40%
50%
60%
0
1.000
2.000
3.000
4.000
5.000
6.000
7.000
8.000
9.000
2012 2013 2014 2015 2016
Deliveries trend and coverage, Wolisso Etiopia
HCs deliveries Hospital deliveries
Cesarean sections Total deliveries
Tanzania: from 68% to 88% of coverage
90,0%
100,3%
85,8%
90,4% 89,0%
75%
80%
85%
90%
95%
100%
105%
0
1.000
2.000
3.000
4.000
5.000
6.000
7.000
8.000
9.000
2012 2013 2014 2015 2016
Deliveries trend and coverage, Tosamaganga, Tanzania
HCs deliveries Hospital deliveries
Cesarean sections Total deliveries
Uganda: from 32,7% to 53% of coverage
42,2% 46,5%
66,5% 64,7% 66,9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
0
2.000
4.000
6.000
8.000
10.000
12.000
14.000
2012 2013 2014 2015 2016
Deliveries trend and coverage, Aber, Uganda
HCs deliveries Hospital deliveries
Cesarean sections Total deliveries
Total assisted
deliveries
TARGET 125.000 DELIVERIES….. ACHIEVEMENTS
Antenatal care
5.929
590
Ambulance
transports
Health staff
trained
308.102
134.910
Mother and children first: the first 1.000 days
2017- 2021
…safe delivery is the first step, yet not enough if
developement and nutrition of the newborn and
child are impeared….
Pregnancy Skilled delivery Weaning, and care Exclusive
breast feeding
…from 4 districts to 10 districts involved..
Target
• 320.000 skilled deliveries
• 10.000 acute maulnourished treated
• 50.000 children followed during growth
Chiulo H
Angola
Wolisso H
Etiopia Lui H
Yirol H
S. Sudan
Montepuez H
Mozambico
PCMH
Sierra
Leone
Aber H
Matany H
Uganda
Iringa H
Sogambele H
Tanzania
COMMUNITY INTERVENTIONS
Education and
prevention
Monitor of growth
and early
identification of
malnutrition
Diet diversity
Referral of acute
malnutrtion
HEALTH UNITS INTERVENTIONS
Quality antenatal
care (infections and
micronutrients),
skilled delivery and
post natale care
Training and data
monitoring
Supervision and
planning with the
local authority
Treatment
of acute
malnutrition
HOSPITAL INTERVENTIONS
• Quality care
• Drugs and equipment
• Management of emergencies and transport
• Doctors and personell for training of local staff
Thanks!!!!
www.doctorswithafrica.org
