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.
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.
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.
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.
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.