Acknowledgement
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Incidence of Unsafe AbortionIn 24 countries (55.8%) legislative/policy frameworks on abortion have existed for many years. These are being developed in 7 countries (16.3%), but 12 (27.9%) have not yet begun to address this matter (indicator 13). Moreover, 28 (65.1%) countries have in place programmes, strategies and action plans to reduce unwanted pregnancies and unsafe abortion. While the process is under way in another eight (18.6%) countries, no action has been taken in seven (16.3%) (indicator 14). Eleven (42.3%) countries report that 8–50% of their service delivery points provide post-abortion care (PAC) services, while 15 (57.7%) countries have more than 50% of their service delivery points providing PAC services (indicator 15). Many countries have strategies in place or are developing them, although laws and legal frameworks need review. Because abortion is generally criminalized, back-street abortion prevails and PAC is still unsatisfactory. A strategy for advocacy and education to raise awareness among youth and to improve the attitude of health workers, teachers and the community at large to abortion should be adopted. The media can play an important role here.
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Indicators |
Done |
In progress |
Not done |
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Road map for the reduction of maternal and newborn morbidity and mortality |
38 (88.4%) |
4 (9.3%) |
1 (2.3%) |
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National action plan to roll out the road maps |
34 (79%) |
6 (13%) |
3 (7%) |
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Preservice curricula incorporating EmONC for all appropriate cadres |
30 (69.8%) |
9 (20.9%) |
4 (9.3%) |
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Functional referral system from community to health facility |
15 (34.9%) |
20 (46.5%) |
8 (16.6%) |
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Availability of IMCI protocols |
34 (79.1%) |
1 (2.3%) |
8 (18.6%) |
Nine (30%) countries say that 100% of their EmONC sites have access to an adequate supply of safe blood and 11 (36.6%) countries reported 50–80%. Another 10 (33.4%) countries indicate less than 50% for this service (indicator 21).
Programmes and strategies to scale up PMTCT are in place in 36 (83.7%) countries. Four (9.3%) countries are developing them, and three (7%) have nothing in place (indicator 22).
Two (7.4%) countries reported that 100% of their HIV-positive mothers who have delivered are receiving ARVs. Another 14 (51.8%) had 50–91% coverage, while 11 (40.7%) manage to cover less than half (indicator 23).
Resources for SRHR
The available resources are mainly within the general health budget, which is limited in some countries. A few countries do assign limited but specific budget lines for SRHR including family planning. Many programmes are donor dependent, which means that their sustainability is not assured. Local resources should be mobilized including from the private sector, and supplemented by external funds (Table 4).
Table 4: Resources allocated to health and to SRHR
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Indicators |
Done |
In progress |
Not done |
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National budget allocated to health |
5 (11.6%) |
12 (27.9%) |
26 (60.5%) |
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SRHR integrated in national PRSPs & other development plans |
32 (76.2%) |
5 (11.9%) |
5 (11.9%) |
Five (41.7%) of the 12 countries that responded to this indicator allocated 10–15% of the health budget to SRHR, three (25%) allocate 1–2%, and two (6.5%) allocate 6–7%. Two (16.7%) countries have no specific budget allocation for SRHR (indicator 25). Inadequate supervision was noted as an added challenge.
Botswana has attained and surpassed the 15% allocation of the national budget to the health sector.
Some countries found it difficult to report on this indicator, as they have only estimates or have not yet tried to measure the capacity of this important human resource. Staffing shortages are compounded by high turnover, low salaries and other challenges to do with motivation. The shortage of midwives is generally more acute in rural areas. One country recorded 41 midwives per 10,000 population and another recorded 30 midwives per 10,000 population. Three countries said they have 11 midwives per 10,000 people, while another three recorded 5 per 10,000. In six countries there are 2–4 midwives per 10,000 people and in seven there are only 1–2 midwives serving that population. One country reported having <1 midwife per 10,000 people (indicator 27).