Andrew Mews
IN September this year, two-year-old Mpho was supposed to become a big brother. Instead, because his parents could not afford to pay for his mother, Lerato, to give birth at the nearest district hospital, he became an orphan.
Lerato went into labour one afternoon. The women trying to help her give birth at home recognised too late that her baby was in distress. Finally, in the early morning hours, the lifeless body of a baby boy was born. Immediately afterwards, Lerato began to bleed profusely. It took two hours for her husband to find transport to take her to the hospital, but by then it was too late: when they finally arrived at the hospital, she was already dead.
Lerato is just one of thousands of Basotho women who, every year, have to pay with their lives to deliver their babies – just because they cannot afford hospital fees.
Official figures from the Lesotho Ministry of Health show that Lesotho is the second worst-performing country in the world in terms of maternal mortality, just behind impoverished, war-torn South Sudan.
However, Doctors Without Borders (MSF) and St Joseph’s Hospital in Roma have proven that a simple and relatively affordable measure could help to change this grim statistic. When, in early 2014, we began to strengthen the quality of hospital delivery care and to cover the out-of-pocket costs for women to deliver at St Joseph’s, the number of births in the hospital increased by 45% in just a year, while the proportion of mothers-to-be who died was drastically reduced. This success story could easily be extended to the entire country, and for a very affordable proportion of the existing health budget, if Lesotho were to adopt as national policy carefully planned Free Maternity Care both at health centre and hospital level, in line with recommendations from the United Nations and the World Health Assembly.
In the third quarter of 2014 we began negotiations with the Lesotho Ministry of Health, proposing to build on our Roma success story by supporting health authorities in the district of Mohale’s Hoek. We wished to magnify our Roma experience by strengthening capacity in the last of Lesotho’s three main hospitals that does not yet benefit from strong support from an international partner.
In addition to improving the quality of maternity services in the district’s rural clinics, we also offered to upgrade the capacity of the district hospital to become a regional quality referral facility, cover all costs associated with antenatal care and deliveries, and help it to become a quality training centre for midwives in the region. Despite early enthusiasm for our proposed project, however, the Ministry of Health ended up rejecting it because they guaranteed that another organisation, Partners in Health, was already covering the reproductive health needs of the district by working in the community.
Our experience in Roma tells us that an integrated approach is necessary to make a dent in Lesotho’s unacceptably high maternal mortality rate. In short, community, health centre and hospital must work very closely together. As partners working at different levels of the health pyramid should collaborate at each level of service delivery to the greater benefit of populations.
With the planned handover of our Roma project proceeding on schedule, by the end of this year we will regretfully no longer be helping to reduce maternal mortality in Lesotho. For the sake of Basotho women, we sincerely hope that the government and its partners will make every effort to meet all maternal health care needs in Mohale’s Hoek.
To all our patients, staff and partners in Lesotho, we would like to say thank you for a fruitful and inspiring five years’ effort to improving health care for all, and we hope to return to Lesotho in the near future.
*Andrew Mews is Head of Mission for Doctors Without Borders (MSF) South Africa & Lesotho
