South Africa's National Strategic Plan For A Campaign On Accelerated .
SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)SOUTH AFRICA’S NATIONAL STRATEGICPLAN FOR A CAMPAIGN ON ACCELERATEDREDUCTION OF MATERNAL AND CHILDMORTALITY IN AFRICA (CARMMA)“South Africa cares: Nowoman should die whilegiving life”1
SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)CONTENTSAcronyms4Introduction6The South African situation on maternal, perinataland under-five mortality7Campaign On Accelerated Reductionof Maternal And Child Mortality (CARMMA)8The goal of the campaign in South Africa8General objectives9Specific objectives9Targets and Indicators9Current progress of CARMMA at the Africa Union level10Key components of CARMMA in South Africa11Activities for actual launch of CARMMA in South Africa133
4SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)ACRONYMSAIDSAcquired Immunodeficiency SyndromeAUAfrican UnionAUCAfrican Union CommissionARTAntiretroviral TherapyCARMMAin AfricaCampaign on Accelerated Reduction of Maternal and Child MortalityCBOCommunity Based OrganizationCHCCommunity Health CentreCTOPChoice on Termination of PregnancyCSOCivil Society OrganizationEOSTEmergency Obstetric Simulation TrainingESMOEEssential Steps in Management of Obstetric EmergencyHIVHuman Immunodeficiency VirusIECInformation, Education and CommunicationIUCDIntrauterine Contraceptive DeviceKMCKangaroo Mother CareMCHMaternal and Child HealthMCWHMaternal Child and Women’s HealthMDGMillennium Development GoalNGONon Governmental OrganizationOPDOut Patient DepartmentPMTCTPrevention of Mother to Child TransmissionPHCPrimary Health CareSAINCSouth African Initiative on Neonatal CareSTISexually Transmitted InfectionSRHSexual Reproductive HealthSRHRSexual and Reproductive Health and Rights
SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)TBTuberculosisTLTubaligationWHOWorld Health Organization5
6SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)INTRODUCTION1.High maternal, perinatal and under-five morbidity and mortality are someof the formidable development challenges in Africa. The disturbing partis that the large number of deaths is due to preventable causes. TheWorld Health Organization (WHO) estimates that worldwide, as many as1500 women die every day due to complications related to pregnancy orchildbirth. Similarly, 10 000 babies die per day within the first month of lifeand an equal number of babies are born dead. More than 90% of thesedeaths occur in developing countries, most of them in Africa. AlthoughAfrica is home to 10% of the global population, it contributes to almost halfof all child deaths worldwide.2.The maternal mortality ratio in Africa will have to be reduced from between500 and 1 500 to 228 per 100 000 live births for the continent to meetthe target of reducing by three quarters, between 1990 and 2015 thematernal mortality ratio. The second target of Millennium DevelopmentGoal (MDG) 5 calls for the achievement, by 2015, of universal access toreproductive health. The MDG 4 requires Member States “to reduce bytwo thirds, between 1990 and 2015 the under-five mortality rate”. It shouldbe noted that MDG 4 and 5 are used as a standard to measure the humandevelopment level of any country, region or continent.3.It is against this background that the Fourth Session of the African Union(AU) Conference of Ministers of Health held in Addis Ababa, Ethiopia inMay 2009, under the theme:- “Universal Access to Quality Health Services:Improve Maternal, Neonatal and Child Health”, launched the Campaign onAccelerated Reduction of Maternal and Child Mortality in Africa (CARMMA).The campaign was launched under the slogan “Africa Cares: No WomanShould Die While Giving Life!”4.The Fifteenth Ordinary Session of the African Union Assembly held inKampala, Uganda in July 2010, under the theme ”Maternal, Infant and ChildHealth and Development in Africa” endorsed CARMMA. The decisionsof the Assembly included amongst others a list of Actions on Maternal,Newborn and Child Health and Development in Africa by 2015, whichHeads of State and Government committed to undertake. The first actionreads as “ We Commit to Launch CARMMA in our countries and broaden itas an advocacy strategy for the promotion of Maternal, Newborn and ChildHealth and involve all key stakeholders such as the women, children andyoung people, persons with disabilities, parliamentarians, community andreligious leaders, civil society organizations, the media, and the privatesector and institutionalize an annual CARMMA week in solidarity with thewomen and children of Africa for the next four years”.
SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)THE SOUTH AFRICAN SITUATION ON MATERNAL, PERINATAL ANDUNDER-FIVE MORTALITY5.Maternal, perinatal and under-5 mortality in South Africa remainunacceptably high. According to November 2011 National Department ofHealth’s Report of the Health Data Advisory and Coordination Committee,the figures for Maternal Mortality Ratio, Under-five, Infant and NeonatalMortality Rate are 310/100 000, 56/1000, 40/1000 and 14/1000 live birthsrespectively. The 2015 MDG target for Maternal Mortality Ratio and Underfive mortality rate is 38/ 100 000 and 20/1000 live births based on 1998Demographic and Health Survey base line of 150/100 000 and 59/ 1 000live birth respectively.6.Since its inception, the Saving Mothers Report identified five major causesof maternal deaths as: Non-pregnancy related infections mainly AIDS (50%) Obstetric haemorrhage (14%) Complications of hypertension (14%) Pregnancy related infections (5%) Complications of pre-existing medical conditions such as cardiacconditions, diabetes etc (9%)7.Forty (40%) percent of all maternal deaths are avoidable. These are relatedto community, administrative and clinical factors. The consequences ofmaternal mortality are well documented e.g. the effect on children’s lives,the family, the community, the economic status of the country. Much painand suffering is caused when mothers die in childbirth.8.Studies on disease burden for under-five children conducted in the countryrevealed the following as the commonest causes of under-five deaths: AIDS related deaths including TB (40%) Diarrhoeal diseases (11%) Pneumonia (6%) Severe malnutrition (5%) Deaths during neonatal period (18%) Low Birth Weight (12%) Infections (3%) and Birth Asphyxia (3%)7
8SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILDMORTALITY (CARMMA)9.CARMMA is an initiative of the African Union Commission (AUC) to promoteand advocate for renewed and intensified implementation of the MaputoPlan of Action for Reduction of Maternal Mortality in Africa and for theattainment of MDG 5. Although the principal focus of CARMMA is maternalmortality, it also includes reduction of child mortality. The 15th Session ofthe Ordinary Session of the AU Assembly recommended that issues ofnewborn and children be covered in CARMMA and for the development ofthe practical strategies.10.CARMMA derives its significance from previous commitments made byAfrican Heads of States on Maternal Health such as the 2005 ContinentalPolicy Framework on the Promotion of Sexual and Reproductive Healthand Rights (SRHR) in Africa, the Maputo Plan of Action (2006- 2010),extended to 2015, the Abuja Call for Accelerated Action towards UniversalAccess to HIV/AIDS, Tuberculosis, and Malaria services in Africa (2006 2010) also extended to 2015, the Africa Health Strategy (April 2007- 2015);the international consensus on MDG 5 and others.11.The campaign currently focuses on four key areas:12. Building on-going efforts particularly best practices; Generating and providing data on maternal and newborn deaths; Mobilizing political commitment and support of key stakeholders includingnational authorities and communities to mobilize additional domesticresources in support of maternal and newborn health and mobilizingcommunities to let them know that everyone has role in improvingmaternal and child health and reduction of maternal and child deaths;and Accelerating actions aimed at the reduction of maternal, infant and childmortality in Africa.CARMMA is designed to be nationally driven and owned, and to enjoystrong support and partnership from several United Nations bodies,bilateral interests, foundations and nongovernmental organizations andother stakeholders and partners.
SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)THE GOAL OF THE CAMPAIGN IN SOUTH AFRICA13.The goal of the campaign in South Africa is to accelerate the reductionof maternal and child morbidity and mortality through acceleratedimplementation of evidence-based interventions essential to improvematernal health and child survival.GENERAL OBJECTIVE14.To accelerate implementation of key recommendations and strategiesto reduce maternal and child morbidity and mortality through effectiveadvocacy for quality maternal and child health care, health systemstrengthening, community empowerment and involvement and effectivecollaboration with partners and relevant stakeholders.SPECIFIC OBJECTIVES15.The objectives of CARMMA as outlined by the African Union Commissionare:15.1.To enhance political leadership and commitment at national andcontinental levels.15.2.To identify and work with national champions to mobilize support andparticipation at national level.15.3.To raise and maintain awareness as well as appropriate responses atglobal, continental, regional and national levels.15.4.To build linkages with global campaigns, which seek to ensure (a) theestablishment of new innovative mechanisms and (b) the appointmentby the UN Secretary General of someone to advocate for the reductionof maternal and child mortality.15.5.To promote the recognition of maternal mortality as a key indicator of awell-functioning health system.15.6.To promote exchange of experiences and practices and to adopt andreplicate best practices of countries, which have significantly reducedmaternal and child mortality.TARGETS AND INDICATORS16.The targets and indicators for CARMMA in South Africa are in line withthe MDG4 (Reduce child mortality) and MDG 5 (Improve maternal health),9
10 SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)as harmonized with the Maputo Plan of Action for the Operationalizationof the Continental Policy Framework for Sexual and Reproductive Healthand Rights (2007 – 2015).Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-fivemortality rateIndicators:yy Under-five mortality rateyy Infant mortality rateyy Immunisation coverage at one year of age.yy Proportion of 1 year-old children immunized against measlesyy Life expectancy at birth for males and femalesyy Access to quality child survival servicesTarget 5.A: Reduce by three quarters, between 1990 and 2015, the maternalmortality ratioIndicators:yy Maternal mortality ratioyy Incidence of unsafe abortion reducedyy Proportion of births attended by skilled health personnelyy Access to quality safer motherhood servicesyy Contraceptive prevalence rate (Couple year protection rate)yy Adolescent birth rateyy Antenatal care coverage ( At least one visit and at least four visits)Target 5.B: Achieve, by 2015, universal access to reproductive healthyy HIV, STI, Malaria and SRH services integrated into primary health careyy Strengthened community-based STI/HIV/AIDS/STI & SRHR servicesyy Family planning repositioned as key strategy for attainment of MDGsyy Youth-friendly SRHR services positioned as key strategy for youthempowerment, development and wellbeingyy Resources for SRHR increased
11SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)yy SRH commodity strategies for all SRH components achievedCURRENT PROGRESS OF CARMMA AT THE AFRICAN UNION LEVEL17.About 36 African Union Member States have launched CARMMA fromMay 2009 to May 2012, when CARMMA was launched in South Africa.Countries that have already launched CARMMA have submited annualReports to the African Union Commission. A special meeting on CARMMAwas held at the Fifth Session of the African Union Conference of Ministersof Health held in Windhoek, Namibia in April 2011. The meeting agreed onthe following:a.To continue to cover issues of newborn and children in CARMMA asrecommended by the 15th Session of the Ordinary session of the AUAssembly.b.The Ministries of Health to provide leadership for CARMMA, despite themulti-sectoral approach to ensure sustainability.c.Advocacy for increased resources for maternal and child health shouldbe strengthened with due emphasis on domestic resources.d.All countries to devote a week in November called the “CARMMA week”to further focus attention on the health of women and children.e.Task shifting within the health team and between levels of care should beencouraged in response to some of the challenges of the health system.f.Women’s rights and SRHR should be promoted as a means of contributingto improving maternal health.g.Maternal, newborn and child mortality audits should be prioritized by allMember States in order to strengthen operational research and provideinput into program planning.h.Increased utilization of ICTs for health should be undertaken.i.Recognize the key role of nutrition (services and programmes) inpregnancy, and PMTCT (prevention of mother to child transmission ofHIV).j.Promotion of breastfeeding as recommended by the World HealthAssembly decision should be prioritized to improve child survival.k.Waiving user fees for maternal and child health should be promotedacross Member States.l.National Health Insurance Schemes should be developed, especiallyproviding coverage for the vulnerable and marginalized population.m.Improve logistics support to community health extension workersparticularly with mobility and communication to facilitate service provision
12 SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)in hard to reach locations.n.Improve transportation infrastructure while exploring practical transportsystems/mechanisms to increase access to services.o.Promptly finalize modalities for the proposals for the establishment ofCARMMA adopted model clinics.KEY COMPONENTS OF CARMMA IN SOUTH AFRICA18.The following are the key components of CARMMA in South Africa:a)Strengthen and promote access to comprehensive SRHR services, withspecific focus on family planning services.b)Advocacy and health promotion for early antenatal care and attendance/booking.c)Improve access to Skilled Birth Attendants by:yy Allocating dedicated obstetric ambulances to every sub-district to ensureprompt transfer of women in labour and women and children with obstericand neonatal emergencies to the appropriate level of care.yy Establishment of maternity waiting homes.d)Strengthening Human Resources for Maternal and Child Health by:yy Providing training on Essential Steps in Management of ObstetricEmergencies (ESMOE) to doctors and midwives.yy Intensifying midwifery education and training.e) Improve child survival by:yy Promoting and supporting exclusive breastfeeding for at least 6 months.yy Providing facilities for lactating mothers (boarder mothers) in healthfacilities where children are admitted.yy Promotion of Kangaroo Mother Care (KMC) for stable low birth weightbabies at all levels of care.yy Advocacy for appropriate care and support for pregnant women andlactating mothers in the workplace.yy Improving immunization and vitamin A coverage.yy Intensifying management of severe malnutrition in health facilities.yy Intensifying case management of sick children through: Improving implementation of key family practices including diarrhoea
13SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)management at home Strengthening implementation of IMCI in all primary health care facilities Strengthening clinical skills for the management of severe diseasesincluding pneumonia and diarrhoea in referal facilitiesf) Intensifying management of HIV positive mothers and children by:yy Improving access to treatment for both mothers and childrenyy Improving management of co-infections andyy Eliminating Mother to Child Transmission of HIVIMPLEMENTATION PLAN OF THE KEY COMPONENTS OF CARMMA INSOUTH AFRICAKEY COMPONENTS1). Strengthening access to comprehensive SRHR services,with specific focus to familyplanning ACTIVITESPromote provision of family planning services toevery woman who comes intocontact with health care provider e.g OPD, Medical ward,ART, TB, etc.Fast track capacity buildingof health care providers onintegrated SRHR servicesincluding family planning,sexual assault, cervical cancer, screening.Revive in-service trainingfor the family planning programme.Build capacity of communityhealth workers to support family planning services.Promote male and femalecondoms as part of dualprotection against unplannedpregnancy and STIs,T/L must be accessible postdelivery for all women whorequest it before dischargeEnsure availability of contraceptive commodities in allhealth care settings, includingemergency contraception.Empower Civil SocietyOrganisations and communities to demand family planning servicesAdvertise family planningwidely (local radio, news papers, TV)Develop relevant IEC materials on family planning in alllanguages, including BrailleEXPECTED OUTCOMEIncreased access andquality to family planningservices.Increased demand for family planning services
14 SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)KEY COMPONENTS2) Advocacy and promotion ofearly antenatal care attendance/ booking 3) Improve access to SkilledBirth Attendance through: i) Allocation of obstetric ambulances to every facility where deliveries are conducted ACTIVITESEmpower CSO and communities at large on importanceof early antenatal attendance/booking and regular followupsAdvertise antenatal careservices widely (local radio,news papers, TV)Develop relevant IEC materials on the importance of early and regular antenatal careattendance in all languages,including brailleEnsure that all sub-districthave an obstetric ambulance.Ensure that the planned patient transport is fully functional at all timesEffective coordination ofemergency obstetric ambulancesEnsure all district hospitalsdelivering women have MWHEXPECTED OUTCOMEIncreased rate of bookingfor Antenatal care on confirmation of pregnancy andregular follow-upsAll Drs and Midwives providing maternity care areskilled to provide emergency obstetric careii) Establishment of maternitywaiting homes, where necessary 4) Strengthening HumanResources for Maternal andChild Health through: ESMOE and EOST trainingfor all doctors and Midwivesin facilities providing maternitycare services. Maintenance of a register forESMOE trained health professionals Establishment of a task teamto look into staffing, bed andequipment norms.a.Training on Essential Stepsin Management of ObstetricEmergencies (ESMOE) for doctors and midwivesb. Strengthening midwifery education and training Facilitate and support the increase in number of midwivesrendering MCWH servicesConduct an audit of midwivesDevelop plans to stregthenmidwifery in the public healthsectorReduced transfer time.Statistics on healthcare workers trained onESMOE and EOST maintainedStaffing and equipmentnorms established and implementedData on avaliable andpractising midwives
15SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)KEY COMPONENTS5) Improve child survival through: a) Promotion of breast-feeding, b) Provision of facilities for lactating mothers (boarder mother)in health facilities where childrenare admittedc) Promotion of Kangaroo MotherCare (KMC) for low birth weightbabiesd) Advocating for appropriatecare and support of pregnantwomen and lactating mothers inthe workplace6) Intensifying management ofHIV positive pregnant women andmothers and HIV infected and affected children through:I.Improved access to HIV treatment for both mothers and childrenII.Improved management of coinfectionsIII.Elimination of Mother to Childtransmission of HIV by 2015 ACTIVITESPromotion of Breast Feedingas recommended by theWorld Health Organisation(WHO)Adopt the South AfricanInitiative on Neonatal Care(SAINC)EXPECTED OUTCOMEReduction in Malnutritionand improvement in Childsurvival.Orient of managers and trainhealth care providers in implementation of SAINCImplemention of KMC forlow birth weight babies in allfacilitiesAssess status of facilities formother and baby friendliness.Ensure support for pregnant women and lactating mothers in theworkplaceImplement the ActionFramework on eliminating mother to child transmission titled, ‘Nochild born with HIV by 2015 andimproving the health and wellbeing of mothers, and babies inSouth AfricaIncrease the number of NimARTtrained nurses to initiate ART andprovide support.Ensure efficacious regimens forHIV positive pregnant women andwomen of child bearing age andchildrenMother and baby friendlyworkplaces establishedand maintainedAll eligible HIV positivewomen initiated on ARTReduced morbidity andmortality from HIV andAIDS related conditionsReduced new HIV infections with less than 2% HIVtransmission at 6 weeksand less than 5% transmission at 18 months of age
17SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR A CAMPAIGN ON ACCELERATED REDUCTION OF MATERNAL AND CHILD MORTALITY IN AFRICA (CARMMA)
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The South African situation on maternal, perinatal and under-five mortality 7 . Current progress of CARMMA at the Africa Union level 10 Key components of CARMMA in South Africa 11 Activities for actual launch of CARMMA in South Africa 13. . maternal mortality are well documented e.g. the effect on children's lives, the family, the .
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Stats SA Library Cataloguing-in-Publication (CIP) Data CHILD POVERTY IN SOUTH AFRICA: A Multiple Overlapping Deprivation Analysis / Statistics South Africa. Pretoria: Statistics South Africa, 2020
management in Africa 3. Community involvement in natural resources management in Africa – regional overviews 3.1 Introduction: Different understandings of, and approaches to, CBNRM in different regions 3.2 Central Africa 3.3 East Africa 3.4 Southern Africa 3.5 West Africa 3.6 Summary 4. What has CBNRM achieved in Africa? The ‘3Es .
(National Geography Standard 13, p. 169, C, E) U1.3.1 Use maps to locate the major regions of Africa (northern Africa, western Africa, central Africa, eastern Africa, southern Africa). (National Geography Standard 1, p. 144) U1.3.2 Describe the life and cultural development of people living in western Africa before the 16th century with respect
South Africa is located on the southern tip of Africa. Its two main physiographic categories include the interior plateau and the land between the plateau and the coast (Statistics South Africa, 2019). The most populated city in South Africa is Johannesburg with almost 13 million people. For comparison, New York has about 9 million residents.
Education Series Volume V: Higher Education and Skills in South Africa, 2017 / Statistics South Africa. Pretoria: Statistics South Africa, 2019 Report no. 92-01-05 90 pp ISBN 978-0-621-46254-8 A complete set of Stats SA publications is available at Stats SA Library and the following libraries: National Library of South Africa, Pretoria Division
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Alfredo Chavero (1981) concluye que los anteojos no son otra cosa que ex-presiones de las nubes y en cuanto a los colmillos, . lo señala Alfredo López Austin (1990): .como creador, Tláloc lo fue de la luna, del agua y de la lluvia y fue también uno de los cuatro soles cosmogónicos que precedieron al actual. Además de esto, reinaba en su propio paraí-so, el Tlalocan, que se .
