In Ghana, measurements of the Maternal Mortality Ratio are unreliable. The latest official figures are based on the 1993 Demographic Health Survey (DHS) when it was estimated to be 214 per 100,000 live births. A draft review of health sector performance for 2006 suggests a downward trend and an estimated maternal mortality rate of 187 per 100,000 live births. These figures need to be interpreted with care. At country level, discussions with the United Nations Population Fund (UNFPA) are taking place over the measurements of maternal mortality in the 2008 Demographic Health Survey and/or the 2010 Census.
Development partners including DFID together with the World Health Organisation (WHO), UNFPA and United Nations Children's Fund (UNICEF), are discussing within the framework of annual plans of the health Sector Wide Approach (SWAp) and the new five-year health sector plan (2007-11), the implementation of package health interventions. This is aimed at accelerating progress towards Millennium Development Goals 4 and 5 around safe motherhood strategies, improving access to and quality of emergency obstetric care and the promotion of child spacing.
Malawi's 2004 DHS shows a slight decline in the Maternal Mortality Ratio from the 2000 DHS figure of 1,120 per 100,000 live births, to 984 per 100,000 live births. This is unacceptably high.
DFID has committed £100 million over six years to the Government of Malawi-led health SWAp (2004-05-2010-11). Of this, £55 million will address the human resource crisis through salary top-ups to recruit and retain staff, improved training and, as a stop-gap measure, providing expatriate volunteers to fill training and specialists positions. £45 million will finance the Essential Health Package including improved facilities, drugs and other supplies.
On 30 March Malawi's Minister of Health, Marjorie Ngaunje, launched Malawi's 'Road Map' to reduce maternal and neonatal deaths in Malawi under the SWAp. This strategy aims to strengthen service delivery at all levels of the health system and the capacity of individuals and communities to improve maternal and neonatal health. Districts have also been able to 'kick start' action on maternal health using flexible funds from the SWAp. This includes the signing of 47 service level agreements with the Christian Health Association of Malawi to remove user fees for maternal services and using locum payments to midwives to go to health centres to cover staff shortages.
The UN (UNFPA, WHO and UNICEF) supported the development of Malawi's Road Map. The UN and DFID sit together on the sectoral level Sexual and Reproductive Health Technical Working Group which coordinates stakeholder support to the implementation of this government-led strategy.
In Zimbabwe, maternal mortality has worsened significantly in the last 15 years, due mainly to the HIV and AIDS epidemic, deteriorating health services and increasing barriers to access including user fees. Recent figures estimate that the lifetime risk of a woman dying of pregnancy or childbirth related clauses is one in 16 or 6,250 per 100,000.
DFID is working with the UN (UNFPA and UNICEF) and civil society organisations to develop a joint programme to reduce maternal and infant mortality. DFID will contribute £25 million over five years. This programme aims to protect the lives of mothers and newborns, especially those affected by HIV and AIDS and to maintain access to family planning services, including contraceptives and to lifesaving obstetric services and newborn care. The programme will build the evidence base about obstacles to sexual and reproductive care, infant feeding for HIV exposed babies after six months, and will support a national maternal and prenatal mortality study in Zimbabwe in order to inform policy options.