At the end of the Millennium Development Goals, Namibia did not meet the targets for the improvement of maternal, newborn and child health (maternal mortality ratio-385/100, 000, under-five mortality rate of 54 per 1000 live births). Although significant progress was made in improvement of child health, similar progress was not achieved for maternal health and neonatal health.
To develop a strategy to meet the new sustainable development goal targets (Maternal Mortality Ratio of less than 70/100, 000 births and under-five mortality rate of less than 25/1000), the Namibia Ministry of Health and Social Services recommended a national EmONC assessment. The first national EmONC assessment was conducted 10 years earlier (2005). Through the support from World Health Organisation (WHO) and European Union funding through the programme for accelerating the reduction of maternal and child mortality in Namibia (PARMaCM), CMNH was requested to conduct the assessment.
The findings from the assessment will provide evidence for developing relevant policy, to facilitate planning and prioritisation of interventions to strengthen the availability and utilisation of quality EmONC services in Namibia.
A team from CMNH, lead by Dr Charles Ameh, designed and carried out a cross-sectional health facility survey which included the national referral hospital (NRH), all intermediate hospitals (IH) (four), all district hospitals (DH) (30), all health centres (HC) (43) and 15% (45) of randomly selected clinics. Facilities included in the survey were in all 14 regions of the country. Design of the study, piloting of tools (electronic and paper based data collection tools), training of data collectors and data collection were carried out in September and October 2016. A report was produced and approved by the Namibia national EmONC assessment technical working group in December 2016 and disseminated to stakeholders in January 2017.
The report describes in detail the methods used and presents results based on standard WHO methodology. It further provides a comparison of WHO emergency obstetric care indicators between the 2005 and 2016 EmONC assessments, and clearly shows the extent of change achieved. The reasons for suboptimal improvements in these indicators were highlighted. The assessment also provided an opportunity for review of emergency obstetric and newborn care related guideline and policy documents.
There has been some progress in the availability of EmONC since the first national EmONC assessment in 2005 but this falls short of the expected national and international standards. This is despite the efforts of Government; development of relevant policies, designation of all hospitals (NRH, IH and DH), HC and clinics as EmONC facilities, deployment of health workers, provision of drugs and equipment.
Possible reasons identified for sub-optimal availability of quality EmONC services includes low caseload at HC and clinics, lack of essential EmONC medications and equipment, sub-optimal functioning of blood transfusion services, lack of knowledge and skills of maternity care providers, lack of training in EmONC and lack of clarity of some national guidelines.
Therefore, policy related and operational related recommendations were made to accelerate the reduction of maternal and newborn mortality by providing sustainable quality of maternal and newborn care services.
Improving the survival and health of mothers and newborns as well as achieving SDG 3 is of high priority for Namibia and to meet the more ambitious targets the results and recommendations from the 2016 assessment is vital for the development of a renewed road map to improve Maternal and Newborn Health.