Caring for Her

Written by Manam Iqbal • May 2011

Over the last thirty years, two approaches have been developed for the promotion of healthcare in developing countries. One was forwarded at the Alma Ata Declaration of the World Health Organization which recommended a comprehensive approach to primary healthcare including “Education to inform prevailing health problems and measures to control them, food security and improved nutrition, supply of clean water and sanitary services, maternal and childcare services including family planning, immunization against communicable diseases, the control of locally endemic disease, and the supply of essential drugs for critical health problems.”

The Rockefeller Foundation, to the contrary, maintained that comprehensive primary healthcare would be excruciatingly costly to implement for most developing nations. Therefore, the smarter option was to recognize those widespread health issues affecting the major portion of the population and develop ways to cure them.

Recognizing the core issues as being Maternal and Child Health, Sri Lanka being a low-income country, has made use of the Rockefeller model of healthcare to have become the South Asian country with the lowest mortality rates in newborns and mothers.

As religious beliefs and cultural affinity play a huge role in the daily lives of people in most South Asian countries, the Sri Lankan government has taken a parochial approach to addressing the issues of maternal and child health, halving not just mortality ratios every decade since 1960 but also creating community consciousness among its citizens.

Trained midwives, or the Public Health Midwife, are the frontline cadre of professionals who are making this progress possible by bridging the gap between health facilities and communities in Sri Lanka. Because of them, women in rural settings and geographically non-contiguous areas also have access to a skilled attendant at birth.
These midwives go through an 18-month training period for the complete technical know-how of prenatal, postpartum and antenatal care after which they are assigned particular vicinities. Each midwife is responsible for approximately 3000 to 5000 people in her particular area with most women being identified before 12 weeks of pregnancy.
Because of this system, maternal and child health has improved tremendously in the last six decades. This can be gauged from the fact that mortality rates of 450 out of 100,000 live births went down to merely 43 in 2005. And the interesting part is that all this was achieved without any financial constraints.
It is unfortunate that almost 99% of all pregnancy related complications and deaths occur in the developing world particularly because of low economic outreach of people. This is why Sri Lanka’s system is free of cost and easily accessible to all.

A Public Health Midwife (PHM) is not just trained for childbirth or complications related to it. She also provides regular check-ups pertaining to the general health of people. Complicated cases are always referred to the nearest health facility. Today, few families are more then 1.4 km away from the nearest health facility.
Only recently, Lalitha Padimini has been recognized as one of the twelve most outstanding health workers by Global Health Workforce Alliance for her efforts in the Sri Lankan village of Medagama.

Alongside the health system put in place by the government, the generally high status of women along with the emphasis on educating girls also has a role to play in achieving low levels of mortality rates in this South Asian nation.

Sri Lanka has often been cited as a perfect model of healthcare services rivaling the standards of countries with much higher per capita incomes. Other developing nations can also take measures to ensure safer childbirth which is the right of every woman. A genuine effort on the part of leaders may actually help realize the Millennium Development Goal of reducing infant mortality across the world by three quarters till 2015.