The Role of Professional Associations in Promoting Skilled Attendance

After the launching of the SMI 1987, maternal mortality has gained attention and since then the awareness of this neglected tragedy has heightened which has led to mobilization of resources. However,     despite these efforts the maternal mortality is not declining as expected in most developing countries, particularly in countries in conflict, economic crisis, high prevalence of HIV/AIDS and malaria as well as countries with limited resource and poor reproductive health services. Generally, the root cause for the high MMR is presumed to be poverty but some countries have reduced MM in the face of adverse socio-economic status. This has been demonstrated by the findings that countries with GNP less than USD 1000 their MMR varies between 22 and 1600 per 100,000 live births which implies MMR have to do with making available and accessible quality health  services.

Ten years later in 1997, i.e. after the launching of SMI in 1987, experts gathered to review the adapted strategies. Historical and epidemiological evidences with few exceptions revealed that countries as the proportion of skilled attendant at birth increases the MM start to decline. Since then the focus has shifted from predicting obstetric complications to managing them appropriately and agreed that ensuring skilled birth attendant during and immediately after delivery backed up by efficient referral system as  essential and effective intervention in reducing MM. Due to this fact, in September 2000, the UN general assembly included  improving SBA to 80% in the MDG as    indicator of reduction of MM by 75% by the year 2015.

The Inter-Agency Group for Safe Motherhood (SMIAG) defined skilled attendant as “people with midwifery skills (example, doctors, midwives, nurses etc) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer complications”. This definition excludes TBAs as SBA. Further more, the SMIAG has defined skilled attendance explicitly, “skilled attendance as the process by which a woman is provided with adequate care during  labour, delivery and the postpartum period. This    includes the skilled attendant and the enabling environment, which in turn includes adequate supplies, equipment, infrastructure as well as efficient and effective systems of communication and referral”. However, it must be admitted that there is no universally applicable definition of SBA.

Although, the historical and epidemiological evidences indicate the inverse proportionality of SBA and MMR; there are many factors that influence this relationship that includes availability and uneven distribution of SBA to the needy population, level of knowledge and skill of the SBA, the partnership ratio between high level (doctors) and midlevel (midwives and nurses) health care providers in a given setting.

The professional societies like ESOG have to play an active role in improving SBA by:

Training (pre-service, in-service distance education), Developing national strategies and curricula for     improving SBA, Setting standards and system accountability: Setting standards in Gyn-Obs practices and designing a system of accountability in the country should be primarily the responsibility of the professional associations. Currently training institutions are mushrooming in the country. This is a welcomed phenomenon but extra-caution should be taken not to compromise the quality. Developing standards and protocols are critical to guide and support

quality ethically acceptable  practices.

Delegation of responsibilities: Provision of EOC by doctors will not be feasible in the near, so, there must be delegation of these responsibilities to lower level health cadres. Experience in Africa (Mozambique) and elsewhere have shown that Assistant Medical Officers (AMO) trained in surgical emergencies for 2-3 years have performed well with minimal complications. However, delegation of responsibilities without strict supervision could have deleterious consequences.

Policy, Laws and Regulations: Rules and legislation should be reviewed and amended to promote the role of midwives, nurses and GPs, especially in providing life-saving    interventions and prescribing medications. The professional societies can advocate and strive for supportive policies, laws and legislation for skilled attendants to perform certain life saving procedures.

Collaboration and partnership: The associations can create platform for collaboration and partnership with agencies working in the area of RH. This is advantageous in    synchronizing activities and economizes   resources. This section covers some of the important meetings that have been attended or  organized by the Society. Annual conferences of several professional associations as well meetings called by out partners were attended.

Obituary

Dr. Yohannes Werkineh, age 78, a gynecologist and obstetrician, died in Addis Ababa on April 3, 2004, following a courageous battle with cancer.

He was born October 29, 1925, in Addis Ababa, to the late Dr (Hakim) Werkineh Eshete and W/o Ketselawerk Tulu. In 1935, Yohannes and his parents moved to England where he has passed his childhood and developed his interests of being a physician. He attended his first years of school at Victoria College, Cairo and university of Beirut. Dr Yohannes graduated as doctor & master of surgery from Magil University, Canada in 1955.

Back home with enthusiasm he has served his fellow citizens and saved uncountable number of lives working effort fully for 35 solid years. He is known for bringing and introducing the first vacuum extractor, which he was given as a gift while visiting Sweden with the former emperor Haileslase 1^st.  He is also known for establishing the countries first fistula operation setup at Gandhi memorial hospital, where he has been the medical director (1962-1991) and worked the majority of his time.

Dr. Yohannes was a member and the first president of the Ethiopian Society Of Obstetrician and Gynecologists. He was a member of the Ethiopian medical association, serving as a president in 1965-1967. He has been with the Ethiopian peace keeping forces in Congo in 1960 where he has worked both as a physician and a soldier  with a rank of major. Apart from being a good physician he is also known to be a best short distance runner, his 800 meters record at Beirut University was unbeaten for years.

Dr. Yohannes dedicated his life to the Ethiopian girls & women and had a passion for the profession. He will always have a special place in history of our profession.” He is survived by his children and grand children. We are saddened and extend our heartfelt condolences to the whole of his family.