Developing a tool for setting priorities in the maternal health planning process at district level in Cameroon

Abstract

In 2000, United Nations member states committed in the fifth Millennium Development Goal (MDG 5) to improve maternal health in order to combat poverty. Despite this strong commitment, the number of maternal deaths is still high in Sub-Saharan Africa. Monitoring indicators shows that Cameroon will not reach the 2015 s target for MDG 5. The Demography Health Surveys conducted in Cameroon show an increasing maternal mortality since 1998 while several studies show that most of the maternal deaths are preventable and occur at peripheral level. In view of the age-old problem of limited clinical capacities at the peripheral level, the optimal and effective use of public health evidence to develop strong and efficient local reproductive/maternal health strategic plans, appears as a supplementary option to address maternal health issues. The overall goal of this research was to develop a tool that will enable district managers to strengthen maternal health planning and practices in their district. We examined the barriers limiting the planning process at district level and we explored the opportunities to improve it. Methodology: A cross sectional, descriptive and process based research analysis was conducted through a literature review followed by interviews of stakeholders. A tool was then developed based on analysing the results from the interviews. The tool was reviewed during a national workshop by the relevant stakeholders involved in the policy and planning process in Cameroon, and tested by two district teams before its finalization. Findings The research revealed that the subject of maternal health is covered as a component of the reproductive health policy, which was developed with contributions from all the key stakeholders identified by the Ministry of Health. However, some limitations in the process tend to narrow the scope of the policy; the peripheral level had little involvement in the process and there was no national strategic and implementation plan; which explains the failure of the implementation of the policy by the peripheral level. Prioritization at the peripheral level is likely to be mostly influenced by the availability of funds. The planning at peripheral level is done by a district team, with very little support from the higher level or the local partners. Outcome The tool was developed in the form of an integrated matrix of priority activities, introducing the concept of Package of Priority Activities (PPA), and designed as a dynamic cross-table. The whole idea was to identify priority activities for each national health programme in a cross table, and see which under-resourced priority activity can be covered by similar or overlapping resourced programme s priority activity. The tool was tested by districts before its finalization. Conclusion The tool is designed to enable implementation of priority maternal health interventions. The tool should also contribute to improving the effectiveness of the integrated primary healthcare system, which is the ideal way to go in order to reduce the burden of maternal mortality in Sub-Saharan Africa.