20101207
IPS

Dakar — The Gaspard Kamara maternity centre in Dakar was not especially full on Nov. 25, but the medical staff seemed overhwhelmed. Midwives, nurses and gynecologists rushed in all directions dealing with women in difficult labour.

There were 15 or so patients were inside, anxious relatives waiting by the door talking amongst themselves. One of them, Khady Wade, from the Pikine neighbourhood of the Senegalese capital, said that her daughter had experienced complications late in her pregnancy, and only then finally agreed to come to the health centre.

"This facility gets lots of referrals of complications from other health centres because we have an operating theatre," said midwife Ndiaya Kassé Thiam. "They send us the sick, but they don't send the linens, much less beds for them..."

That the staff at Gaspard Kamara have their hands full is a sign of a shortage of facilities for maternal care in Senegal. According to a document from the Community Programme for Maternal, Newborn and Child Health, just one in ten of the country's health posts offer emergency obstetric and neonatal care.

There is a major gap between conditions in the major cities and the countryside. Dakar has far away the most faciliteis and qualified personnel. In the rural areas - like Kolda in the south, or Tambacounda in the east - only 26 of the 76 health centres are equipped with an operating theatre to deal with such emergencies. "In Senegal, the rate of maternal mortality is estimated to be 510 deaths for every 100,000 live births. We are far from achieving the Millennium Development Goal of 120 deaths per 100,000 births by 2015," said Dr Cheikh Tidiane Niang, head of the office for planning in the reproductive health division of the Ministry of Health.

Women make use of alternatives. In front of an unassuming house in Pikine, women are seated waiting for their turn to see Aminata Sanogo, who enjoys a certain celebrity in the neighbouhood. Oumou Fall, seven months pregnant, says, "Here the price is affordable - 200 or 300 francs CFA (40-60 cents). I feel like i'm safe here, and she is very attentive to our needs. That's why i prefer to have my check-ups and lying-in here."

Fatim Ndiaye, another patient, says, "During my first childbirth at the hospital, I nearly died there. The hospital staff treated me with disdain, without caring for my needs or suffering: we were two in the same bed, it was horrible."

The health ministry's Niang concedes the point. "It's a problem linked to the health system itself and the quality of service that's offered. We're told repeatedly that women are better treated at home than in health facilities," he says. "A strong element of care must surround childbirth. That's what's missing in health facilities, and women prefer to give birth at home in conditions that are very dangerous."

The Senegalese Association for Family Health (known by its French acronym, ASBEF) carries out information campaigns encouraging pregnant women to have medical check-ups, the reduction in costs for obstetric services as well as the importance of family planning.

"There is a lack of information and awareness of the importance of these visits," says ASBEF programme director Dr Hassane Yadarou.

But the twin failures to provide enough healthcare centres and sufficient quality of care are the factors that translate into high rates of maternal and neonatal mortality, says the doctor