Ministry of Health & Environment

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The Ministry of Health and Environment has begun to implement the 2007 to 2011 Strategic Plan for Safe Motherhood in the four Regional Health Authorities as well as in health facilities across the island.

Director of Family Health Services and the focal point for Reproductive Health and Safe Motherhood, Dr. Karen Lewis-Bell said that regional workshops would accompany the roll out, so as to ensure that the island's health teams are familiar with the Ministry's aim to improve safe motherhood.

She told JIS News that the Ministry embarked on the plan following a National Safe Motherhood Conference held in 2006, which included presentations from local health officials as well as international organizations including: the World Health Organisation/Pan-American Health Organisation (WHO/PAHO); the United Nations Children's Fund (UNICEF) and the United Nations Population Fund (UNFPA).

The plan includes all the components of safe motherhood and is divided into four specific areas: an enabling policy environment, quality of care, surveillance, and health promotion.

Dr. Lewis-Bell explained that the enabling policy environment involved the development of policy guidelines and standards for service delivery and investigations of maternal deaths.

"As such, the Ministry has actually drafted policy guidelines for the management of common obstetrics emergencies as well as started the process of revising the surveillance guidelines for maternal deaths," she pointed out.

This component also includes the provision for revising policies that guide the operations of the schools of midwifery. In addition, it alludes to the manpower development plan in the Ministry to address issues of training and employment and retention of midwives and public health nurses. "These are nurses who operate our antenatal clinics and assist in labour and delivery primarily in our hospital," she pointed out.

The plan also speaks to the establishment of a National Maternal Mortality Committee, which was convened in 2006, whose major task is to monitor maternal health and guide policy development in that area. The committee also looks at the causes of maternal deaths and the factors that impact on maternal deaths.

In terms of the quality of care, the Ministry promotes that women should have early regular antenatal care. "We want them to have adequate information to make informed choices about their care and as such we revised the take home maternal record which is now a booklet," she said.

In addition, hospitals have been upgraded to improve obstetrics care as 18 of the nation's 23 hospitals provide maternity services. The Director explained that hospitals are classified as Type A, B or C, with the latter being the parish hospital that provides basic medical care and some surgical care.

However, some of the Type C hospitals, based on their location and ease of transportation to other referrals sites, have been upgraded from Type C to Type B hospitals, which provide inpatient and outpatient services in five specialties

- General Surgery, General Medicine, Obstetrics and Gynaecology, Paediatrics, and Anaesthetics.

"May Pen and Annotto Bay hospitals have been upgraded and what that means is that they now have obstetricians, gynaecologists and paediatricians employed to those facilities to improve the care that is given to pregnant women," Dr. Lewis-Bell informed. There are also some 340 health centres that provide maternal and child health services.

As part of improving the quality of care, there is ongoing "in service" education of doctors and nurses in various aspects of safe motherhood. In fact, the Director said that every year the Ministry has training sessions to ensure that the quality of care improves.

Additionally, the Ministry has formed a coalition for support from United Nations agencies. The group includes, PAHO/ UNICEF and UNFPA in keeping with the Common Country Assessment/United Nations Development Assistance Framework (UNDAF) documents relating to support to the health sector.

"We have a group that meets quarterly to discuss proposals and support that can be given to the Ministry's various programme activities for safe motherhood," she noted.

On the matter of surveillance for maternal death, Dr. Lewis-Bell explained that it is a class one notifiable event, which means that the death should be reported within 24 hours of occurrence and must be investigated within a six-week period. To facilitate this process, each parish has to monitor hospitals as well as funeral homes and police departments in order to ascertain deaths which occur in women of reproductive age. "This is to see if the woman was pregnant at the time of death," the Director said.

Several forms used when conducting community, health centre and hospital investigations into the cause of death, have been revised. This has been done to facilitate addressing issues from a policy level and also at the social level, in order to prevent such deaths in the future.

Health promotion is another big component of the strategic plan and this is being carried out through a public education campaign. "What we want to do is to inform women and men about the issues of safe motherhood," Dr. Lewis-Bell pointed out.

Jamaica's current maternal mortality rate is 95 deaths in every 100,000 live births.

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