Maternal and child mortality rates are declining on a global level, although progress remains insufficient to achieve Millennium Development Goals 4 and 5 by 2015. Although South Africa (SA) continues to experience unacceptably high maternal, newborn and child mortality rates for a middle-income country, the under-five mortality rate has declined significantly in recent years whilst recent data suggest that the maternal mortality ratio (MMR) has also begun to decline.
The past few years have been characterised by a number of international and national commitments and interventions that focus on improving maternal, newborn and child health. At an international level ensuring provision of evidence-informed packages of care to all women and children continues to be regarded as the key to improving maternal and child health, while the importance of addressing equity, increasing accountability and strengthening the health system are increasingly recognised. In SA, the Negotiated Service Delivery Agreement highlights reductions in maternal and child mortality rates as one of the four strategic outcomes for which the health sector must account, while the first National Maternal, Newborn, Child and Women's Health and Nutrition (MNCWH&N) Strategic Plan provides a road-map for achieving improved survival and health for women and children. Restructuring of primary health care (PHC) also provides an opportunity to improve coverage and quality of maternal and child health services through reaching learners in schools, reaching households through visits by community health workers and improving clinical governance at district level through deployment of clinical specialist teams.
Weaknesses and inefficiencies in the health system will need to be addressed if current gains in maternal and child survival are to be maintained and accelerated, and the potential benefits of PHC restructuring and other efforts to improve maternal and child health are to be realised. Human resource capacity to deliver quality maternal and child health services will need to be strengthened, while monitoring systems must be improved to facilitate both improved planning and greater accountability.
Programmatic priorities include improving care at district hospital level, especially with regard to management of obstetric emergencies, newborn care and better care for acutely ill children. As child survival improves, more emphasis must also be paid to ensuring that all children reach their full potential - this will require improvements in the nutritional status of all children, ensuring that all children receive the full package of preventive health services and implementation of other early childhood interventions at scale.
This chapter provides an overview of maternal, newborn and child survival, global and national commitments and strategies that aim to improve maternal and child health, as well as progress in implementing priority interventions outlined in the MNCWH&N Strategic Plan. In the final section, priority actions are identified.