BY RUTH ABRAHA | SHABAIT
Right at the outset of independence, the Eritrean Government recognized health as one of the key human rights without which achieving sustainable development cannot materialize.
As such, it prioritized the provision of equitable health care along with other social services, and continuously invested in the field’s growth and improvement and sought out solid partnerships that would complement the country’s needs and work with the Ministry of Health to meet its strategic plans and priorities.
To name just a few notable achievements, Eritrea made remarkable progress in the implementation of the Abuja Declaration on HIV/AIDS, Tuberculosis and Malaria, the Continental Policy Framework on Sexual and Reproductive Health and Rights and the Maputo Plan of Action for its implementation, the African Health Strategy and the Campaign on Accelerated Reduction of Maternal Mortality in Africa resulting in a reduction in maternal and child mortality and new HIV infections. Indeed, the Government of Eritrea recognizes that women’s health is key to attaining a healthy and fully productive society.
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According to the 2019 Eritrean International Conference on Population and Development (ICPD) report, there was a strong link between the Eritrean government’s commitment and the decline of maternal and child mortality and numerous other accomplishments in the health sector. For the purpose of this article, we focus on the country’s efforts to reduce maternal and child mortality.
The health services in the country are organized on a three-tier basis. The primary level constitutes community health services, (health stations, which will progressively be phased out as the system develops further) and health centers and community hospitals. The secondary level includes second contact hospitals and Regional Referral Hospitals. The tertiary level comprises national referral hospitals.
The general access level at independence in 1991 was a dismal 8%. Since then, the health infrastructure, both in terms of skilled human capacity as well as facilities and equipment, has increased exponentially with emphasis on equitable national distribution. As a result of the government’s efforts and commitment, access to health care within a 10 Km radius increased from 46 percent in 1991 to 80 percent in 2019. Currently, over 60 percent of the population lives within a 5 KM radius from a health facility. This is a key intervention that contributed to the decline in maternal and child mortality.
The Sexual and Reproductive Health (SRH) department in the Ministry of Health handles all work-related maternal and child mortality as well as other co-related health issues such as obstetric fistula and deaths due to unsafe abortions.
The promotion, prevention and curative responses to maternal and child health services are part of the Eritrean government’s primary basic health care package that is mostly given free of charge or at an affordable nominal fee. Indeed, the Ministry of Health has prioritized maternal and child health (MCH), placing it at the center of its Primary Health Care policy. To ensure safe delivery for the mother and the child, the country’s health centers provide the three crucial stages of motherhood care: antenatal, delivery and postnatal care.
The Ministry of Health has made significant efforts to provide prenatal care to all women, and in 2017, 96% of pregnant women received antenatal care as compared to only 48.9% of women in 1995. The number of births performed by skilled health professionals has also increased significantly and this has contributed to the reduction in maternal mortality rates.
In 1990, the maternal mortality rate was 1700 per 100,000 live births. By 2013 it declined to 380 per 100,000 live births. The annual decline rate during 1990-2013 was 6.5%, further declining to 352 by 2015.
There is little variation in the number of women attending at least one antenatal coverage between the different categories of age, residence, educational status, and wealth index. The Antenatal care coverage was above 95% in all regions except in the Southern Red Sea region, which was 86%. Almost 100 Percent of women with higher education, women in the highest wealth quintile, and women in the Central Region have at least one antenatal visit during the last trimester of pregnancy.
Free healthcare for pregnant women and children under 5 years old has also contributed to the lowering of maternal and child mortality. This is a remarkable achievement because antenatal care presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. As a result of the awareness-raising campaigns of women about the safe delivery mechanisms, the numbers of pregnant women who deliver in respective health centers with the help of professionals have increased reducing the risk of maternal and child mortality. According to the ICPD report and MDG report in 2015, among mothers of children 0-11 months, 62% gave birth in a Health Facility (HF).
Postnatal care (PNC) and the goal to eliminate postnatal mother or infant mortality is another area that receives significant investment from the government. At this time, 96% of mothers of children 0-11 months receive postnatal care by qualified personnel. Out of those who received PNC, 88% were within 7 days and 83% within two days.
For women who have suffered from unsafe delivery and face health complications due to circumcision, namely fistula, a fully equipped, special care center was established in Mendefera Regional Referral Hospital, Southern Region.
Eritrean women have greatly benefited from investments in the health sector. It is worth repeating here that as a result of the Eritrean government’s commitment, Eritrea was able to achieve three health-related MDGs (MDG 4 on reducing child mortality, MDG 5 on improving maternal health, and MDG 6 on combating HIV/AIDS, malaria and other diseases).
Indeed, equitable health care structures, as well as a committed corps of health professionals, have allowed the country to register remarkable achievements thus far.