Opinion: Strengthening Health Systems to Combat Maternal Deaths – A Call for Innovative and Sustainable Solutions

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Maternal mortality is a global health crisis that continues to claim the lives of over 800 women daily, one death occurring every two minutes, according to 2020 statistics. In his recent presentation at the DIMA Health Webinar Series, Professor Lawrence Chauke from the Gauteng Department of Health and the University of the Witwatersrand provided a comprehensive overview of the current state of maternal mortality and the multifaceted solutions necessary to combat this tragic reality.

Prof. Chauke’s presentation, titled Health Systems to Combat Maternal Deaths: Lessons Learnt and Innovative Solutions, explored why maternal death remains a pressing human rights issue, an indicator of the quality and functioning of health systems, and a marker of social and gender inequality. Maternal mortality reflects not just the failure of health systems but also the socio-economic and cultural factors that limit women’s access to timely and adequate healthcare. Chauke emphasized the grim reality that the vast majority of these deaths —75%—are caused by  pregnancy related complications  like haemorrhage , hypertensive disorders, and infections, all of which are largely preventable with affordable, evidence-based solutions.

One of the most poignant points of the presentation was the exploration of the barriers to care, illustrated through the Three Delay Model. The first delay—deciding to seek care—is often due to socio-economic and cultural factors. The second delay—reaching healthcare facilities—is hindered by inadequate transportation and facility access, while the third delay—receiving timely, appropriate care at healthcare facilities—underscores systemic inadequacies in the healthcare system. These delays collectively contribute to the staggering maternal mortality rates in low- and middle-income countries, particularly sub-Saharan Africa (SSA), where the maternal mortality ratio (MMR) remains at 317 per 100,000 live births, compared to much lower rates in high-income countries.

While the Sustainable Development Goal (SDG) 3.1 calls for reducing the global MMR to less than 70 per 100,000 live births by 2030, Prof Chauke presented a sobering projection: at the current rate, this goal seems almost unattainable. From 2015 to 2023, the MMR decreased only marginally from 227 to 223  , a rate far below the 11.6% annual reduction needed to meet SDG 3.1. The best-case scenario for SSA still forecasts an MMR of 198, demonstrating that without immediate and significant intervention, the region will fall short of the global target.

Prof. Chauke then turned to possible solutions, offering hope through microlevel interventions and structural reforms within health systems. His advocacy for increased access to family planning, improved antenatal care, and the use of skilled birth attendants at facility deliveries echoes global best practices that have been shown to dramatically reduce maternal and neonatal deaths. His support for task shifting—where less-specialized healthcare workers take on tasks traditionally reserved for more highly trained personnel—has proven to address workforce shortages in countries like Mozambique, Malawi, and Rwanda, with demonstrable success. Such strategies, when coupled with political commitment and policy support, can be transformative.

Technology, according to Chauke, is one of the most powerful tools at our disposal for addressing maternal mortality. The rise of e-health and digital solutions, such as geospatially enabled GPS maps for improving healthcare access, mobile messaging services for patient education and reminders (such as South Africa’s MomConnect), and drones for the transportation of medical supplies, represent innovative ways to overcome the traditional barriers faced in healthcare delivery. The role of telemedicine, electronic health records (EHR), and decision support software (DSS) has further demonstrated potential in reducing maternal mortality by improving access to healthcare services, supporting clinical decision-making, and coordinating care across vast and often underserved regions.

You can watch the full video here: Link to Video.

DIMA Health’s Role in Addressing Prof. Chauke’s Recommendations

DIMA Health is uniquely positioned to address the Three Delays Model as outlined by Prof. Chauke, through a comprehensive suite of programs and digital tools. DIMA Health’s Ma’ambassadors Program could play a key role in addressing the first delay—the delay in deciding to seek care. Trained maternal health champions are embedded within communities to raise awareness about the importance of timely antenatal care, recognizing danger signs during pregnancy, and encouraging women to make informed health decisions. Their close ties with local communities are essential for promoting early care-seeking behaviours, which are crucial in reducing maternal mortality.

The second delay—the delay in reaching healthcare facilities—could be directly tackled by the DIMA SafePassage Program. This program provides reliable, safe transportation for pregnant women in areas with poor infrastructure, ensuring that they can reach medical care when needed. By overcoming geographical barriers, the SafePassage Programme helps reduce the time it takes for women to access lifesaving services, mitigating the risks associated with delayed care.

DIMA Academy could address the third delay, which involves delays in receiving adequate care at healthcare facilities. Through its accredited training programs, the DIMA Academy enhances the skills of healthcare workers, ensuring that a sufficient number of trained professionals, such as midwives and community health workers, are available to provide high-quality care. This training equips healthcare workers with the knowledge and skills to handle maternal emergencies efficiently, reducing the risk of delays in treatment due to staff shortages or inadequate training. By building a stronger healthcare workforce, DIMA Academy directly improves the quality-of-care women receive, particularly in underserved areas.

A critical, integrative element across all three delays is DIMA Health’s DIMA Link platform, which acts as an enabling tool to streamline maternal health services. DIMA Link bridges the gap between healthcare providers and patients by offering digital tools for appointment scheduling, health education, and care coordination. For the first delay, DIMA Link provides women with timely reminders for antenatal visits and health information, empowering them to seek care early. For the second delay, the platform allows easy booking of transportation through SafePassage, ensuring that logistical issues do not prevent women from reaching healthcare facilities. For the third delay, DIMA Link facilitates care coordination, ensuring that healthcare workers have access to patient information, can manage appointments efficiently, and perform timely follow-ups, thus reducing bottlenecks in service delivery.

In conclusion, DIMA Health’s Ma’ambassadors Program, SafePassage, and DIMA Academy could work in tandem to address the three delays, while DIMA Link serves as a powerful enabler that integrates these solutions. Together, these initiatives create a comprehensive framework to reduce maternal mortality and improve health outcomes, making DIMA Health a key player in transforming maternal healthcare across Africa.


Disclaimer:
The recommendations and insights presented in this document reflect the perspectives and initiatives of DIMA Health and do not represent the direct views or statements of Prof. Lawrence Chauke. While Prof. Chauke’s work on maternal health and the Three Delays Model has informed aspects of our approach, the content herein has been developed independently by DIMA Health to align with our programs and solutions aimed at reducing maternal mortality in Africa.
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