The Challenges and Strategies for Improving Postnatal Care in South Sudan
Madam Flora Gabriel Modi, Juba City's First Female Mayor
By Dr Thomas Akuith Ngong, Kwajok, Warrap State
Wednesday, 18 October 2023 (PW) — The standard healthcare required by a mother and her newborn for a certain period after delivery is crucial in South Sudan, but it is being overlooked by both beneficiaries and providers. There seems to be a dilemma between unawareness of the negative consequences of its unavailability and insufficient knowledge of its benefits. The absence of this care continually results in the loss of lives of postnatal mothers and newborn infants. However, this care provides significant benefits to the health of the mother and child, their family, community, and the nation as a whole.
Postnatal care refers to the special healthcare provided to a mother and her newborn by skilled birth attendants during the first 24 hours up to 6 weeks after childbirth. However, due to the neglected healthcare workforce in South Sudan, the country’s healthcare system is fragile, resulting in the absolute lack or inadequacy of postnatal care. This has led to maternal and neonatal deaths, especially in rural areas of the country. Despite no proper government response, there are concerns by humanitarian sympathizers about the postnatal catastrophe in our beautiful country.
The first few weeks and days after childbirth are critical for both the mother and her baby. In fact, half of all maternal and neonatal deaths occur within the first 24 hours, and two-thirds occur during the first week after delivery. In sub-Saharan Africa, only 48% of mothers receive assistance from skilled birth personnel, while the remaining 52% give birth at home under the care of traditional birth attendants (according to WHO, 2016). Unfortunately, in South Sudan, there is a complete lack of postnatal healthcare data. This is due to a weak health management information system or fear of public criticism. If proper documentation was available, the numbers would likely be alarmingly high.
Postnatal healthcare services are essential and life-saving for new mothers. When a mother delivers at a healthcare center or is brought there after delivering at home, the healthcare staff conducts a thorough assessment of her condition to identify and address any postnatal health issues. This is in contrast to home deliveries, which are often associated with serious concerns and even maternal deaths. Therefore, delivering at a healthcare facility is the best option for mothers to ensure good health outcomes.
As for postnatal care, there are several services that are provided for both mothers and newborns. Let’s start with the mother. Firstly, she will receive education on how to breastfeed her baby, including when and how often to do so each day. This is particularly helpful for first-time mothers who may be unfamiliar with the process. Proper breastfeeding technique can help prevent bleeding after delivery and promote the involution of the uterus, allowing it to return to its pre-pregnancy state.
The woman will receive counseling on nutrition during her postpartum period and will be given a folic acid supplement to boost her hemoglobin levels for three consecutive months. If she delivered vaginally or with high-degree perineal tears, she will receive antibiotics to prevent wound complications. Additionally, she will receive counseling for postnatal depression and appropriate services for women experiencing miscarriages, stillbirths, and newborn deaths will be provided.
Providing in-hospital or health centre postnatal care is crucial for the health of newborns. Experienced healthcare providers remain vigilant and responsive to any newborn issues that may arise. This care includes assessing the newborn for danger signs, promoting early and exclusive breastfeeding, ensuring clean and dry cord care, using chlorhexidine antiseptic to prevent infection, practicing Kangaroo mother care to keep the baby warm, delaying bathing for 24 hours after birth, drying babies with clean cloths, administering preventative care such as vaccines, tetracycline eye ointment, and vitamin K at birth, scheduling timed postnatal check-up visits, and providing special care for sick, low birth weight, and preterm babies.
After examining the various types of postnatal care services available for mothers and their newborns, it is important to discuss the benefits of this exceptional healthcare. This type of care offers many advantages to different groups such as mothers and their babies, families, society, and the nation as a whole. Firstly, it helps mothers and their families adjust to a new member of the family, the newborn, with ease. Additionally, it ensures that any potential dangers to the mother and baby after birth are prevented, promptly diagnosed, and effectively managed by skilled healthcare professionals.
In addition, the purpose of this initiative is to enable healthcare providers to provide fundamental health education and counseling to mothers regarding the importance of taking rest, getting sufficient sleep, maintaining healthy lifestyles, consuming nutritious food, and identifying maternal and neonatal warning signs. It also serves as an interactive opportunity for mothers to familiarize themselves with their healthcare providers, their roles, and how they can assist them at any stage, whether it’s during pregnancy, childbirth, or after delivery. The main objective here is to ensure that both the mother and her newborn are healthy and up-to-date.
After giving birth, mothers can experience a range of complications, including severe bleeding, depression, hypertension, infections, and breast problems. Similarly, newborns may suffer from postnatal difficulties such as infections, asphyxia, birth injuries, or congenital problems. If a mother chooses to give birth at home, any of these complications can be life-threatening. Therefore, it is essential to seek postnatal care to ensure the safety of both mother and baby. I would like to emphasize that there is help available, and it is up to the individual to decide whether to seek it.
It is worth noting that traditional practices that are deemed unsafe are also a threat to postnatal care in South Sudan. There are harmful customary practices and cultural beliefs that negatively affect postnatal healthcare in our country. For instance, some communities and cultures forbid mothers from eating certain nutritious foods after giving birth. This practice compromises the dietary and nutritional supply to their bodies. In addition, the application of substances such as cow dung, milk, honey, ash, and similar items to newborns’ umbilical stumps is detrimental to their health and can lead to infections.
Inadequate or poor postnatal care can result in maternal and newborn mortalities due to complications that are not diagnosed by healthcare providers. Such incidents destroy the trust of bereaved families in the healthcare system and the government. It also creates a hostile environment where health service providers are blamed and hated, especially when mothers arrive late with severe complications that are difficult to manage in settings with a shortage of supplies.
Improving postnatal care services in South Sudan requires the involvement of the government at various healthcare levels, as well as the participation of communities and healthcare implementing partners. In this piece, we will discuss some strategies that, if implemented effectively, can significantly reduce the maternal and neonatal death toll caused by lack of postnatal care. The following key strategies can play a crucial role in improving postnatal care in South Sudan.
Improving Access to Postnatal Care for Mothers: It is highly recommended that women give birth in healthcare facilities to ensure that health professionals can quickly detect and manage any postnatal complications. For those who have already given birth in rural areas, it is important that they visit healthcare centers as soon as possible, even if they do not have any clear postnatal complaints. This will allow them to consult with healthcare providers for evidence-based health counseling, enabling them to have a more successful postnatal recovery period.
It is crucial to ensure that our healthcare system, in partnership with health organizations, employs and motivates skilled healthcare providers. These professionals should be deployed to health facilities to offer a diverse range of healthcare services, including postnatal care. Fortunately, our country has an abundance of locally trained healthcare professionals, such as registered medical officers, public health practitioners, anaesthetists, associate clinicians, clinical officers, registered midwives, registered nurses, laboratory technicians, pharmacy technicians, and theatre attendants. These professionals are capable of delivering quality healthcare services to patients.
Our Central and State Ministries of Health often use budgetary constraints as an excuse for not improving the healthcare system in South Sudan. It is unclear when they will be able to allocate sufficient funds to address this issue. Without a proper system in place to support its employees technically, administratively, and developmentally, even abundant funding may not necessarily lead to improved healthcare outcomes. Therefore, it is crucial to have a robust political will and a patriotic mindset to drive the necessary changes in the healthcare system of South Sudan. These changes will not only reduce referrals, deaths, and treatment costs but also bring about a transformative impact in a short period of time.
Effective postnatal care service delivery requires both generalised community mobilisation and evidence-based health education. The active participation of community-level healthcare teams, including Boma and community health workers, is essential to achieving this. By working together, these teams can enhance the community’s trust in the efficacy and uptake of postnatal care services.
In addition, it is crucial to ensure that there is a sufficient supply of medicines, vaccines, medical supplies, and equipment available to healthcare workers. When postnatal mothers arrive at health facilities and find that these basic medical commodities are unavailable, they may become disappointed and share negative messages about postnatal care and its providers. This can discourage other postnatal women from accessing postnatal healthcare services.
Postnatal healthcare is crucial for reducing maternal and infant fatalities in South Sudan. Hospitals and healthcare units offer a unique range of postnatal healthcare services for both mothers and their newborns. Compared to home deliveries, postnatal healthcare provides proven advantages for mothers and their newborns. However, there are challenges that hinder the delivery of basic postnatal healthcare services.
This article calls on the national and State Ministries of Health, along with their partners, to support the health workforce already at the frontline. This will help to boost healthcare service delivery, including postnatal healthcare, in South Sudan. Ultimately, this will lead to a reduction in maternal and neonatal death toll, as well as associated post-traumatic stress disorder (PTSD).
Please note that the opinions expressed in this article belong solely to the author, Dr Thomas Akuith Ngong, and do not necessarily represent the views of any medical organizations or government healthcare agencies. Dr. Ngong is an independent opinion writer who holds a Bachelor of Medicine and Bachelor of Surgery degree from the University of Juba, South Sudan. He currently resides in Kuajok Town, Warrap State and can be reached by phone at +211 921 809 762 or by email at thomasakuiz88@gmail.com.
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