Mauritania - Islamic Development Bank

• The current rate of progress of 8.5% during the
past decade will be insufficent for Mauritania
to reach the MDG target for the under-five
mortality rate (from 135 per 1000 live births
in 2000 to around 122 per thousand in 2007,
while the MDG target is 45 set for 2015). There
are also deep inequalities in mortality. The
gaps are 13 points between rural and urban
areas, 84.3 between Dakhlet Nouadhibou and
Guidimagha; 57 between the richest and the
poorest and 49 points depending on the level
of education of the mother.
• Similarly, the maternal mortality rate (MMR)
remains among the highest in the region it
is unlikely that Mauritania will achieve the
related MDG target 4. Currently, at 686 per
100,000 live births in 2007, decreasing from
930 in 1990 and 747 in 2000, Mauritania is still
far from the target of 232 set for 2015 (MICS).
59. The coverage rate of the Expanded Program
on Immunization (EPI) has been falling for the
past three years and now stands at 76% for
children below five years of age, well below the
85% coverage rate considered by the WHO as
necessary to protect the population.
60. The high CMR is largely due to respiratory
infections and delivery conditions, and living
conditions. Precarious living conditions inherent
in poor and rural areas also play a role (housing,
access to potable water, sanitation etc).
Malnutrition is also factor in child mortality, along
with lack of knowledge of proper childcare in new
mothers.
61. Along with the lack of proper health facilities
and equipment, the high MMR is largely due to
the high proportion of premature and frequent
pregnancies, low access of pregnant women to
quality antenatal care and emergency obstetric
services. Cultural aspects contribute to both of
these factors
62. While the proportion of births attended by
skilled personnel increased from 57% in 2001 to
61% in 2007, the remaining 39% were assisted
by an unqualified person, a relative or without
any type of assistance whatsoever.
2.2 Main Constraints
63. The main constraints to improving the
alarming situation of child and maternal
mortality are closely related to malfunctions
that characterize the entire health system in
Mauritania.
Limitations of health services
• Inadequate funding and institutional capacity:
Absence of a clear and coherent policy and a
national health sector plan, coupled with both
underfunding — a paltry US$13 per capita —
and understaffing of the Ministry of Health
(MOH) hinder efficient stewardship role for
the implementation of the Health Sector
Development Plan. Also, program execution
in the sector is slowed down by the rapid
turnover of staff holding key positions and
by weaknesses in financial management and
procurement.
• Poor quality of the health management
information system (HMIS/ and lack of
coordination between MOHSA and SECF,
which shares the mandate for malnutrition
prevention and reduction, has been
problematic over the past years.
• Shortages of qualified and motivated health
and social workers along with imbalances
in the skill-mix and uneven geographical
deployment remain among the key factors
affecting the quality and utilization of services.
According to the MOH, 90% of trained
midwifes currently live in Nouakchoutt.
• Inadequate drug quality and supply: Drug
shortages continue to persist in health facilities
and the capacity of the drug procurement
and distribution system needs further
strengthening.
Weak Social Health Determinants
• Inadequate quality control over all
components of the Health Sector (SOPs, drugs
and health commodities, equipment, training,
HMIS etc) is a prevalent feature.
• Low literacy rates especially among women
in the rural areas compounded with deeply
MCPS for Mauritania, 2011-2015 17