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AHN Newsletter Issue N˚7 August 2011 - Anglican Health Network

AHN Newsletter Issue N˚7 August 2011 - Anglican Health Network

AHN

AHN ProgrammesMaternal and New BornMhealth programmeEach year more than 536,000 womenworldwide die from complicationsof pregnancy and childbirth. Manymore survive but will suffer ill healthand disability as a result of thesecomplications. A recent decline inmaternal mortality figures was notedin the year 2010. This showed a 34%reduction on the absolute numberof maternal deaths. However, 99% ofthese deaths occurred in developingcountries. Of the deaths in developingcountries, 65% were contributedby eleven countries with six of thesecountries (Nigeria, DemocraticRepublic of Congo, Ethiopia, UnitedRepublic of Tanzania, Sudan andKenya) in sub-Saharan Africa.In addition, an estimated 4 millionneonatal deaths occur each year, accountingfor almost 40% of all deathsunder 5 years, while a similar numberof babies are still-born. More than95% of all these newborns deathsoccur in Asia and sub-Saharan Africa.The health of the neonate is closelyrelated to that of the mother. Themajority of deaths in the first monthof life could also be prevented ifinterventions were in place to ensuregood maternal health.AHN and its partnersThe Anglican Health Network and theLiverpool School of Tropical Medicineare drawing together a collaborationto improve maternal and new bornhealth services at district level inSub-Saharan Africa. This initiative isinitially focused on the ongoing partnershipbetween the Anglican Dioceseof Accra, Ghana and Whiston Hospital,Merseyside, UK to provide trainingfor midwives and traditional birthattendants in two health districts ofGreater Accra. The combination ofNHS volunteers and medically qualifiedlocal church members makesfor a sustainable ongoing supportnetwork, closely coordinated withDr. Julie Langton of Whiston Hospital visited Accra in November 2010to help train midwives and TBAs.the district health authorities. ArchbishopJustice Akrofi and his wife, Dr.Maria Akrofi are working closely withAHN to establish a wider programmefor the Province of West Africa andbeyond.This collaboration will also draw fromthe experience of Perspect Consultingto develop Mhealth interventions thatwill enhance learning and establisheffective communications. It willdraw from the women’s leadershipprogramme offered by the Council ofAnglican Provinces of Africa (CAPA)to facilitate participation by seniorwomen in a wide range of dioceses.The respective partners will pooltheir various resources and competenciesto help meet the challengeof improving maternal and newborn health. In effect, it will drawtogether health and technologyprofessionals from across the public,private and faith based sectors, bothin country and from outside. Thewidespread distribution and commitmentof Anglican health resourcesand leadership throughout the worldcan support the local and internationalpartnerships required to operatethis initiative in a range of sitesthroughout the continent.Transition to skilled birthattendanceProviding Skilled Birth Attendants(SBAs), who are able to prevent, detectand manage the major obstetriccomplications, is probably the singlemost important factor in preventingmaternal and newborn deathsand disability. To work effectively,SBAs need an enabling environmentthat includes the equipment, drugsand other supplies essential for theireffective functioning, as well as aback-up referral system, A skilled attendantis defined as ‘an accreditedhealth professional who has beeneducated and trained to proficiencyin the skills needed to managenormal (uncomplicated) pregnancy,childbirth and the immediate postnatalperiod, and in the identification,management and referral of complicationsin women and newborns’(WHO 2006).Training of Traditional Birth Attendants(TBAs) was ‘in vogue’ duringthe 1980s and 1990s. However, thisstrategy did not significantly reducematernal deaths. In a number ofstudies this was linked to the absenceof ongoing skills, competency developmentand regular supervision.Effective referral systems did not2

emerge and there was insufficientintegration of TBAs into the healthcare systems. Since 1999, the core internationalSafe Motherhood strategyhas been to work towards ensuringthat 90% of all births are attended bya skilled health care worker by 2015.Providing a skilled health worker withmidwifery skills at every birth andensuring that women have access toemergency hospital obstetric carewhen needed, are crucial interventions.However, this is not yet a realityfor many poor and marginalisedwomen in Sub Saharan Africa whereuptake of skilled birth attendanceis until now still low and is availablemainly at the health facility level.In reality therefore, there are inmany settings a range of carers atcommunity level who cannot be classifiedas ‘Skilled Birth Attendants’who look after women before, duringand after childbirth. Currently an estimated60 million women give birthat home alone or with the assistanceof relatives, or with another memberof the community who does nothave the agreed accredited skills of aSkilled Birth Attendant. In sub SaharanAfrica the availability and uptakeof SBA care is still very low - 33.7% inEast Africa, 41.2% in West Africa. Inthese settings, utilization of skilledcare was substantially higher amongthe women living in urban areas thantheir rural counterparts.Key interventionsIt is well documented that humanresource constraints, poor infrastructure,distance of many ruralcommunities from health facilities,socio-cultural beliefs, practices andpreferences, poverty and the ways inwhich gender roles and relations areexperienced, interweave to limit orrestrict many women’s ability to accessSBAs. For many women deliveryby a community based carer may bethe only care available during pregnancyand childbirth.The AHN maternal and new bornmhealth programme will improveaccess to SBAs through a range ofinterventions that will meet thesechallenges. At the same time it willtransition the role of TBAs to that of‘community based carers’. They willbe drawn more closely into the districthealth systems and be providedwith continuing education and trainingto accompany and support womenthrough pregnancy and post natalcare. The church will provide ongoingsupport to the district authorities andwill engage its own health facilitieswhere appropriate. AHN leads thepartnership and provides an Anglicanplatform for widespread adoptionthroughout the continent.Programme developmentThe programme is still in the earlyphases of design and is currentlyevaluating the opportunities todevelop pilots in 2 other countriesas well as Ghana. With signs of agrowing commitment to maternal andnew born health in the internationalcommunity, AHN is determined tofacilitate the potential of parish anddiocesan resources in collaborationwith other partners to make realstrides forward in the key MillenniumDevelopment Goals 4 and 5.This is a role many Anglicans arealready engaged in and which thereis much to learn from one another.An example of a similar programmein Mozambique features later in thisnewsletter.Any interested members of AHNwho would like to get involved orshare their learning and experienceshould contact network coordinator,Paul Holley.Anglican HealthMission in the Churchof England: A reviewand conferenceAnglican mission is often expressedthrough the ‘Five Marks’ adopted atthe Anglican Consultative Councilmeeting in 1984. Two of thesemarks imply that the Church shouldcontinue to address the variousdeterminants of health and wellbeing:• To respond to human need byloving service• To seek to transform unjuststructures of societyThe 1988 Lambeth conferenceconsidered the role of the church inpromoting health and healing anddeclared that each congregationshould be involved. It affirmed theholistic nature of healing, whichincorporated professional healthcare services, medical research andhealth promotion along with prayer,sacrament and counselling.Though its role in managing medicalservices has been delegated to thestate in recent years, the Church ofEngland retains clear competenciesin the spiritual and pastoral supportof those who are sick through hospitalchaplaincy. Within the parochialsetting, clergy and lay people offerprayer, accompaniment, counseland sacrament. On top of this, thechurch’s continued commitmentto improving the opportunities andconditions of those at the marginsof society gives it an understandingof what can be effective in developinghealth promotion initiatives.Its urban and rural congregationsare caught up in and address thosesettings that spur unequal healthoutcomes in poor communities.The motivation for the Church tooffer care, compassion and healingto those in pain and fear naturallyarises from Christian faith, and hasstrong precedence historically. Inmany senses it is unnatural for theChurch to leave significant elementsof health mission to a secularprofession and State control. Thisputs the Church at a distance fromits core calling. As if to highlightthe inappropriate distance betweenthe twin vocations, there is growingevidence of re-engagementbetween faith and health. Parishesare providing safe spaces for supportgroups for those with disabilities,mental health problems andaddictions. Some have establishedhealthy living centres or host primarycare programmes run by primarycare trusts. Some general practitionerpractices have employedspiritual care advisors to add depthto their work. Nevertheless, thereremains significant tension betweenthe secular values of the professionand their religious counterparts.Innovations in public policy through2011/13 look set to create significantchanges to the structuresthat currently manage and providehealth care in England’s NationalHealth Service. This provides atimely space in which the churchcan review and articulate afreshits health mission interests. AHNhas convened a planning group inconsultation with the Church ofEngland to establish a review processthat will culminate at a conferencein Birmingham in the secondquarter of 2013. The group includeskey leaders from the following:Burrswood Christian Hospital, AcornChristian Healing Foundation, ParishNursing UK, the Guild of Health andthe Guild of St. Raphael.3

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