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SENEGAL: Funding Could Weaken Campaign Against Maternal Mortality

Souleymane Faye

DAKAR, Dec 8 2010 (IPS) - Senegal’s efforts to improve maternal health and reduce child mortality are hampered by a lack of health centres and poor care in those that do exist. But the government faces a major financial hurdle in financing the Bajenu Gox initiative – a community health programme intended to address this.

Nearly 1,500 women have been trained across the country under the programme. They will become links between local communities and health centres, under the supervision of doctors, nurses and midwives, according to Dr Bocar Daff , the health ministry official in charge of the initiative.

Their tasks will include raising awareness of the importance of pre and post-natal visits, as well as attending to the health of newborns and children under five. The health workers will be actively involved in promoting good hygiene, promoting exclusive breastfeeding and family planning.

According to Daff, the government wants to have between 15,000 and 20,000 such health advocates in the field by the end of 2011.

In the Kédougou region, in the east of the country, where the rate of maternal mortality is 703 deaths for every 100,000 live births. Midwife Astou Diop says 50 women have already been trained in child and maternal health, and in basic procedures for handling childbirth in the region, but she fears the training is not enough.

“They do not have the resources to pass on information, other than mobile phones distributed by the government to ease their contact with the community.”

Diop is flagging a potential weakness in the government’s plan to field thousands of trained community health workers: particularly in rural Senegal, distance magnified by poor road infrastructure could rob the expanded health network of any real impact.

For example, the leading cause of maternal death in childbirth is haemorrhage. But – assuming they can get to her in time to help with her labour – the new health workers will have limited options to assist a woman with internal bleeding,

“It often happens that patients are unable to get to health centres, for lack of transport and money. The government has to give us the necessary resources,” said Oulimata Ndao, a local health official working with the project in Keur Alpha, a village in the central Kaolack region.

Mbaye Diouf, the head of the Tambacounda health district, in the east of the country, agrees. “With a good implementation of the project… the number of cases of malaria in pregnant women will be considerably reduced. More pregnant women will be screened for HIV,” he said.

“However, the lack of financing for the project, the state of the ambulance fleet in certain regions such as Tambacounda, and the shortage of gynecologists could prevent Senegal from achieving MDGs 4 and 5.”

Eugene Kaly covers health for the government daily Le Soleil. “I think the health ministry has to provide the means to work and move around, especially the women chosen as agents of Bajenu Gox,” he told IPS.

“A project this ambitious… needs funding in the same measure to avoid failing. This project must get financing from the government and its partners, on the same level as the programmes against malaria, tuberculosis and HIV/AIDS.”

The Bajenu Gox programme, which is supported by several international agencies including the United Nations Population Fund (UNFPA), has ambitious intentions to solve this too, but funding will be a problem. The government allocated around $200,000 to the initiative, but to achieve its millennium development goals on infant mortality and maternal health it will need around 96 million dollars.

Daff says 70 percent of this total would go towards buying equipment, particularly ambulances.

“We don’t have the budget for the project, but 100 million francs CFA ($200,000) has been directed to the training of women who will carry out the project,” he told IPS. “Over the next two years, our financial partners will tell us how much they can give to the project.”

The government also plans to raise the allocation of the health ministry from 11 percent of the total budget in 2010 to 15 percent in 2011, according to the Senegalese prime minister, Souleymane Ndéné Ndiaye.