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TERMS OF REFERENCE FOR A LOCAL CONSULTANT TO DEVELOP POSTNATAL (PNC) CARE FOR MOTHER AND NEWBORN GUIDELINES

The global case of postnatal care
The death of women from pregnancy, childbirth and post-delivery complications is a global problem, and this is particularly the case in the developing world. According to the World Health Organization (WHO), United Nations Children Emergency Fund (UNICEF), United Nations Population Fund (UNFPA),World Bank (WB), and the United Population Division (UNPD) (2014:21), about 289 000 women died during childbirth in 2013. The majority (99% or 286 000) of these deaths occurred in developing countries (WHO, UNICEF, UNFPA, WB & UNPD 2014:22). The women died of known and preventable causes, such as postpartum bleeding and hypertension. Postpartum deaths accounted for 60% of all maternal deaths, compared to 15.5% and 23.9% for intrapartum and antepartum respectively. Although women may sometimes seek help from health facilities on time, the quality of the services offered in these facilities in the developing world are substandard. This is reflected in the high (99%) maternal mortality ratio (MMR) in developing countries.

Postnatal care in sub-Saharan Africa

Home births are common in the sub-Saharan Africa region because of women’s belief or trust in traditional practitioners to offer quality postnatal care. Although this is the case, hospital-based delivery rates are reported to be on the increase though at a slow pace. Irrespective of its pace, the increase in hospital-based delivery rate is considered a positive and significant step towards the reduction of maternal and infant mortality rates. The slow pace of utilisation of healthcare professional services, which in this case relates to hospital-based delivery, is a function of reported or livedexperience of poor quality care. Thus, the maternal and neonatal mortality ratios in this region could be dramatically reduced if health care workers could provide quality and immediate PNC.

The case of postnatal care in Eswatini

Eswatini has a high MMR of about 452 per 100 000 live births, and a high neonatal mortality rate of about 20 per 1 000 live births. It is also noted by the Eswatini Ministry of Health that the country had 88% hospital deliveries in 2014, and over 57% of these were attended to or facilitated by midwives. It is worth noting that about 60% of maternal and new-born deaths often occur during the first 48 hours of puerperium in health facilities. While this is the case, it is important to mention that most of the causes of maternal and neonatal deaths are preventable. Examples of these causes include haemorrhage, sepsis, pre-eclampsia or eclampsia and other indirect causes, such as anaemia, HIV, and acquired immune deficiency syndrome.