Review of maternal deaths and the connection of essential reproductive, maternal, and kid health services in the context of COVID-19 and the Humanitarian Crisis in the Sahel, Burkina Faso
In the context of the double concern of COVID-19 and Humanitarian Emergencies in the Sahel region, analysis of data from the official weekly telegram-letter (TLOH) of the Ministry of Health’s revealed an abnormally high number of institutional maternal deaths reported in this area during the 4 weeks (Week 16 to Week 19) of the year 2020, compared to information from the exact same duration in2019
The Ministry of Health initiated investigations to determine the genuine causes of this increase in maternal deaths in the region’s health centers to propose appropriate restorative services. With the assistance of WHO, the Department of Family Health organized a joint field objective with the main objective of supporting the region in carrying out a review of all notified maternal deaths, enhancing the capacity of health facilities for the connection of quality Reproductive, Maternal, Baby, Child and Adolescent Health ( RMNCAH) services, and establishing a roadmap for the reduction of preventable maternal death in this context.
Tools for auditing maternal deaths and monitoring RMNCAH services’ connection in the health facilities were used to help with the scenario’s analysis.
The mission was led by the Director of Household Health and made up of technicians from the Directorate for Quality of Care and Services (DQSS), the Directorate of Health Stats of the Ministry of Health, experts in Maternal Health, Reproductive Health, and Health Policies & Systems of WHO, along with managers/regional focal points from WHO, UNICEF and UNFPA.
The working approach consisted of: working session with the members of the mission at the Ministry of Health for the preparation of the activity; contact with the administrative authorities in Dori; interviews with the actors, under the chairmanship of the Regional Director of Health of the Sahel; presentations on the situation of maternal death, followed by plenary conversations; guided trip of the Regional Health Center (CHR); review of maternal deaths that took place in the CHR and the four Health Districts throughout the last six weeks (Week 16 to Week 21); restitution to the health region’s supervisors and meaning of the next steps.
The review of maternal deaths highlighted the direct stimulated reasons for reported maternal deaths: hemorrhage (shipment hemorrhage), severe infections, postoperative issues (pelvic peritonitis), and eclampsia. There was a considerable decrease in using services, shipments in health facilities, the variety of cesarean sections, Family Planning, and a high rate of institutional maternal deaths compared to the variety of shipments.
Interviews with service providers and program managers assisted to gain better focus on the aspects adding to this situation:
a) At the neighborhood level: insufficient monitoring of pregnancies (No Antenatal Care, or very little Antenatal Care contact); a high number of home shipments; the rejection of evacuation by some attendants (due to insecurity, high expense of neighborhood transport); malnutrition.
b) At the level of health facilities: in addition to the health facilities that are closed (72/121) or that operate at minimum (24), there are stock-outs of necessary drugs, a lack of certified workers, no resuscitation or extensive care services, and permanent unavailability of labile blood products.
The mission identified the difficulties to be taken up for the optimal company of care and the fortifying of the health system to guarantee the connection of quality RMNCAH services and enhance capabilities in the seriousness to act to minimize the variety of maternal deaths in this region. These include:
- Prioritizing the avoidance and management in health centers of the main causes of maternal deaths identified throughout this evaluation: Postpartum hemorrhage, maternal infections, and eclampsia.
- Enhancing the capacities of village midwives who take care of pregnant women in areas where health centers are closed or are running at a minimum, by providing training and important devices.
- Strengthening the capacities of neighborhoods, families, and individuals on self-care to guarantee the continuity of services.
- Train Centers for Health and Social Promotion (CSPS), Medical Centers (CM) and Medical Centers with surgical antenna (CMA) officers in Emergency Obstetric and neonatal care and those of the CMA/CHR in Comprehensive Emergency Obstetric and Baby Care, Family Planning, post-abortion care.
- Reinforcing the capacity of Maternal Deaths case evaluation committees on the audit of maternal deaths.
- Urgently improving the schedule of labile blood items in the Sahel region.
- Support the realization of the Dori Regional University Hospital and CMA groups’ formative guidance by multidisciplinary groups from the main level, consisting of professionals from Society of Gynecologists and Obstetricians of Burkina Faso (SOGOB) and Burkinabe Pediatrics Society (SOBUPED).
All in all, this very first experience was considered promising by health authorities. The Ministry of Health prepares to continue the same objectives to evaluate maternal and neonatal deaths and assess the continuity of RMNCAH’s essential services in other health regions dealing with similar issues, notably in the Center, East, Center-North, and the Boucle du Mouhoun.
Following this mission to Dori and thanks to the advocacy of Dr. Diarra Nama, WHO Resident Agent in Burkina Faso, financing was mobilized in a short duration for the photovoltaic installations of a center to house the blood bank in Dori, the purchase of a generator, and the construction/rehabilitation of 11 advanced health posts in the Sahel region.
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