Sexual and Reproductive Health Keys to achieving the Millennium Development Goals:

1. Sexual and Reproductive Health Keys to achieving the Millennium Development Goals: Nurses and Health Care Workers at the fore front Dr Inonge Kamungoma-Dada BSc. HB; MBcHB; (UNZA). MA Pop. Research (Exon). United Nations Population Fund (UNFPA) SANNAM Conference, October 2007

2. Presentation outline • Sexual and Reproductive Health (SRH) Defined • What are the Millennium Development Goals (MDGs) • Rationale for focusing Nurses and Health Care Workers (HCWs) • SRH and the MDGs • Conclusion • Key messages

3. What is Sexual and Reproductive Health (SRH) • “Reproductive Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and process.” (ICPD-PoA para. 7.2)

4. Implications of SRH definition • Medical complications of pregnancy and childbirth • Right of men and women to enjoy quality RH as a basis for having healthy children, intimate relationships and happy families. • Encompasses all stages of the life cycle, starting from conception to birth, until death • Includes the SRH needs of Nurses and Health Care Workers

5. SRH: social and cultural dimensions

6. The Millennium Development Goals (MDGs)

7. The Millennium Development Goals (MDGs) • There is no specific goal which addresses SRH • SRH issues have been distributed into various components in particular 3,4,5,6 • World Federation of United Nations Associations in the 38th plenary Assembly, November 2006 made the following resolutions: • Recognized that health related development goals are complementary and synergistic and cannot be achieved in isolation as HEALTH (SRH) is central to achievements of non health goals.

8. Rationale for focusing on Nurses and HCWs

9. Nurses & HCWs on the attainment of MDGs: Goal 1:Eradicate Extreme Poverty & Hunger Population trends affect the course of and prospects of poverty reduction Sub Saharan Africa demographic factors: • High fertility • High infant and child mortality • High adult mortality (incl. MMR, AIDS, Malaria, TB)

10. Uptake of Maternal health care by poverty quintiles, MOZAMBIQUE DHS 1997 (IMMPACT)

11. Nurses & HCWs on the attainment of MDGs: Goal 1:Eradicate Extreme Poverty & Hunger…. • Programmes to improve nutritional status of families • Supplementary feeding programmes for pregnant women and children • Health education programmes on nutrition • Family planning programmes (spacing of children) • Collaboration with other departments such as Water and Sanitation services

12. Nurses and HCWs on attainment of MDGS Goal 2: Achieve universal primary education SRH impacts various level of Education and vice versa • Girls may be pulled out of school to care for siblings • Teenage pregnancy, • Early marriage • Gender disparities for education of girls

13. Nurses and HCWs on attainment of MDGS Goal 2: Achieve universal primary education • Identification of children not attending school from the clinic and community setting • Family planning services: poor school enrolment especially of girls in poor large families • Youth friendly services to address school dropouts as a result of Teen Pregnancy • Advocate for girls education from the parent population amongst their patients and community • Advocate for greater social welfare investment for children’s needs including school health programmes

14. SRH on attainment of MDGs.Goal 3: Gender equality and empower women Universal access to SRH is essential for achieving gender equality • Male involvement in SRH is crucial for promoting gender equality and to increasing men’s RH • Gender based violence including sexual violence has a profound effect on women’s health • Addressing cultural and traditional practices harmful to women’s health: FGC, Early marriage • Opportunities for education and paid employment and thus access to services including SRH

15. SRH on attainment of MDGs.Goal 3: Gender equality and empower women… The ability of women to control their own fertility is absolutely fundamental to women’s empowerment and equality. When a woman can plan her family, she can plan the rest of her life. When she is healthy, she can be more productive. And when her reproductive rights … are promoted and protected, she has freedom to participate more fully and equally in society. Reproductive rights are essential to women’s advancement. Thoraya Ahmed Obaid, UNFPA

16. SRH on attainment of MDGs.Goal 3: Gender equality and empower women… • Recognize gender inequities suffered by female nurses, midwives and health care workers • HCWs forefront to identify and manage GBV and sexual abuse • Need to scale up male involvement in SRH including services addressing male SRH: recognize male decision making power • Advocacy role

17. Nurses & HCWs on attainment of MDGs:Goal 4: Reduce child mortality SRH services are crucial • Birth spacing is life saving for both mother and baby • Children born to teenagers at increased risk of morbidity and mortality • Antenatal Care • Post natal care • Child health clinics including immunizations • Referral system for sick children

18. Nurses & HCWs on attainment of MDGs:Goal 4: Reduce child mortality Effect of modern Contraceptive rates on Infant mortality CPR % Average Infant Mortality/ 1000 live births

19. Nurses & HCWs on attainment of MDGs:Goal 5: Improve maternal mortality • Over 300 million women in developing countries suffer from complications of pregnancy, childbirth, abortion • 529,000 die each year – one woman every minute • 4 million babies die, 4 million are stillborn • For every woman who dies, 30 survive but suffer from chronic problems or disabilities

20. Nurses & HCWs on attainment of MDGs:Goal 5: Improve maternal mortality “NO WOMAN SHOULD EVER DIE GIVING LIFE,” Thoraya Obaid Statement at the 60th World Health Assembly, 15 May 2007 • UNFPA: ‘midwives and others with midwifery skills (MOMS)’, to mean ‘skilled birth attendant • 700,000 more midwives are needed to provide universal access to skilled care at birth. • Address shortage through education, training and deployment to underserved areas in order to achieve the MDGs goals 5 in particular

21. Maternal Mortality Ratio and Skilled Attendance at Delivery % of births with skilled attendant Maternal deaths per 100,000 live births

22. The Average proportion of births by attendant by region based on WHO estimates on Available DHS data 2000

23. Nurses & HCWs on attainment of MDGs: Goal 5: Improve maternal mortality • Unmet need for modern contraception, including dual protection, emergency contraception • Comprehensive and emergency obstetric care • Antenatal care • Postnatal care • Newborn Care • Unsafe abortions • Male involvement in SRH

24. Nurses & HCWs on attainment of MDGs: Goal 6: Combat HIV and AIDS, Malaria and other disease Addressing SRH needs and HIV and AIDS and other diseases requires essential medicines and services as well as health care workers to be available • VCT, PMTCT, PICT, ART • Prevention and treatment of STIs • Prevention of malaria in pregnancy • Addressing contraceptive needs of HIV positive • Addressing the health needs HIV positive nurses and Health care workers. • Nurses/ midwives are crucial to attaining all above

25. Nurses & HCWs on attainment of MDGs: Goal 7: Ensure environmental sustainability • Population growth is an indirect driver of environmental degradation • Complex dynamic including poverty, gender inequality, policy and market failures • Still large populations in countries with fewer resources to invest in health, education and family planning • Urbanization: SRH needs for urban poor in slums, shanty towns and shacks

26. Nurses & HCWs on attainment of MDGs: Goal 7: Ensure environmental sustainability • Backbone of health services for rural and urban poor. • Critical services for urban poor include: • Basic health services • prevention and treatment of STIs,HIV and Aids • Youth friendly services • Accessibility of the services • Community health services including environmental protection and management

27. Poverty is multi-dimensional and poverty reduction is threatened by climate change Dimensions of Poverty Examples of Determinants Income and Consumption Opportunity Health Capability Education Security Vulnerability Participation in Empowerment Decision-making Environmental Links Natural resources, e.g., agriculture, forests Access to markets Water quantity, quality and sanitation Air quality, Vector-borne and water-borne diseases Environmental awareness Ecological fragility Natural shocks, e.g., severe weather Environmental governance

28. Nurses & HCWs on attainment of MDGs: Goal 8: Global partnerships • International recognition of chronic shortage of well- trained nurses and HCWs to address SRH issues • Shortage is a major obstacle for reaching MDGs particularly MDG 4,5 and 6 • Important to strengthen health systems by focusing on the skills, health and well being and remuneration of health care workers • Reproductive Health Commodity Security

29. Nurses & HCWs on attainment of MDGs: Goal 8: Global partnerships • WHO report 2006: “Working together for Health” • “Treat, train, retrain”: WHO,ILO, IOM and other stakeholders to strengthen HR for health and promote comprehensive national strategies for human resource development across different disease programmes • UNFPA and International Confederation of Midwives (ICM) working together to strengthen midwifery capacities world wide • Local partnerships: SADC, in country etc

30. Treat, train, retain Treat: though HCWs are at frontline of HIV/AIDS and other disease programmes, they often do not have adequate access to these services themselves Train: expand the numbers of new health care workers and maximize the efficiency of the existing workforce Retain: interventions to ensure that countries are able to keep existing HCWs and stem the brain drain

31. In conclusion “A hand cannot wash itself”, African proverb We cannot provide health services to attain the MDGs without HCWs and vice versa

32. Key messages… • Achieving universal coverage of Sexual and reproductive health services is a pre-requisite for all attaining all MDGs • Nurses and HCWs are front line to attaining particular health MDGs 4,5,6 • Adequate access to services to look into health needs of HCWs including VCT, ART and other services • 'Train' and retrain to maximize the efficiency of the workforce • Interventions to help ensure that countries are able to keep existing workers employed in the health system stem the brain drain:

33. Key Messages from UNFPA… • Midwives make a tremendous contribution to the health of mothers and babies worldwide. • UNFPA calls for greater investment in the training, recruitment, pay and working conditions of midwives. • Recognizes “MOMs” ‘midwives and others with midwifery skills • Call to governments and their partners to strengthen health systems and health workforces to protect the health of mothers, children and families • Road maps to accelerate reduction of maternal and newborn mortality: skilled attendance, capacity of communities, families and individuals

34. Key Challenges • How do we reach poor rural and urban communities with no basic health services and other facilities? • How do we increase the number of HCWs including addressing their conditions of service to make sure that these communities are served?

35. Thank you! Nitumezi! Siyabonga! Mucho obrigado! UNFPA – Because everyone counts