Celebrate Solutions: Accelerating the Reduction of Maternal Mortality in Morocco

By: Rati Bishnoi, Special Projects Intern at Women Deliver

The Moroccan Ministry of Health last week hosted a scientific meeting to share lessons on its success in reducing maternal mortality by 60 percent since 1990—a success that has won it the distinction of being “one of a small group of countries ‘on track’ to achieve MDG 5 by 2015,” according to UNFPA.

The meeting was held in Rabat from June 29 to July 1 and convened national and regional researchers, policymakers, and administrators, including representatives from Tunisia, Djibouti, Palestine, Egypt, Sudan, Morocco, and Yemen.

At the meeting, leaders in the maternal health field where able to explore the Moroccan government’s multisectoral and “whole-of health-systems” approach that has helped make the right of safe motherhood a reality for increasing numbers of Moroccan women. Currently, the maternal mortality ratio in Morocco is estimated at 112 deaths per 100,000 live births.

Although there have been some efforts to improve maternal and child health since the 1970s, maternal mortality became a top priority in political discourse in 2008. In the same year, the Minister of Health appointed a commission charged with accelerating the reduction of maternal mortality and undertook several key measures to improve the functioning of the health care system for obstetric and neonatal emergencies. The commission brought together the academic community, professional associations, and public health officials and was backed by 1.4 billion dirham (U.S.$1 = 8 dirham) across five years.

The commission’s national strategy focused on three intervention areas:

•    Reducing physical and financial barriers to emergency obstetric care;
•    Improving the quality of care; and
•    Improving governance.

To reduce barriers to access and improve the availability of qualified personnel, policymakers removed fees for all emergency obstetric care, including caesarean sections, and newborn care, providing obstetric ambulances for women in rural areas, increasing the training of doctors and midwives, offering ongoing training for existing providers, and using mobile medic units to identify and manage high-risk pregnancies in rural areas.

The commission also used nearly 30 percent of its budget on upgrading the physical equipment of maternity hospitals. An audit of all maternal care facilities across Morocco had shown that only 28 percent of 90 maternal hospitals and 518 health centers with maternity units provided the basic functions of emergency obstetric and neonatal care. Now, these facilities offer “privacy, respect, and comfort” and allow mothers to receive 48 hours of mandatory post-partum care and families members can stay in reception and waiting areas.

More midwives, obstetrician-gynecologists, and anesthetists have also been trained under the commission’s plan. For example, midwifery students have increased from 168 in 2007 to 530 in 2010. In addition, continuing education for health care providers has included an annual one-week course on managing labor and delivery complications for midwives and general practitioners, twice yearly visits by obstetricians to coach midwives in health centers, and refresher courses on new World Health Organization clinical guidelines.

In addition, a national maternal mortality surveillance system for maternal deaths has been established to monitor progress. The system uses a confidential inquiry to track all maternal deaths irrespective of where they occur and requires the reporting of deaths of women ranging from 15 years old to 49 years old. In just the course of one year, the system has already provided valuable information. For example, in 2009, the system captured data on 3,814 deaths of women aged 15 to 49 years old, 436 of which were maternal deaths. A total of 313 maternal deaths were analyzed and showed the main causes of death to be post-partum hemorrhage (33 percent), pre-clampsia and eclampsia (18 percent), infection (8 percent), and uterine rupture (7 percent). The analysis also showed that 77 percent of these deaths could have been prevented with timely access to care (42 percent) and appropriate treatment (44 percent).

More than 800 community liaison volunteers currently work with communities to raise awareness of the benefits of delivering in health care facilities and connect community members to midwives at birthing homes, ambulances, and hospitals. These advocacy efforts and better services have helped the proportion of births attended by skilled personnel rise from 61 percent in 2004 to 83 percent in 2009.

According to UNFPA, Morocco’s success shows that dramatic reduction in maternal mortality can be achieved within a decade. In particular, lessons learned from Morocco’s experience show that strong political engagement, mobilizing funding, and collaboration can help improve an entire health system.

Photo via saracino