Bulletin of the World Health Organization

Fighting the ‘silent epidemic’

Dr. Joy Phumaphi
Joy Phumaphi

Joy Phumaphi (48), is a former health minister and former member of parliament of Botswana. She has a B.Com and a Masters in finance accounting and decision sciences. She also serves as a commissioner on the UN Secretary-General’s Commission on HIV/AIDS and Governance in Africa. Before that, she served as a member of the UN Reference Group on Economics and a member of the United Nations Development Programme (UNDP) Advisory Board for Africa. Phumaphi was appointed as WHO’s Assistant Director-General for Family and Community Health in August 2003.

An estimated 11 million children under five years and more than half a million mothers globally are likely to die this year due largely to preventable causes. As Assistant Director-General of the Family and Community Health cluster at WHO, Joy Phumaphi’s task is to raise the profile of perhaps one of most neglected areas of public health. Phumaphi told the Bulletin she hopes the World health report 2005: Make every mother and child count, to be published on 7 April, and the recent appointment of Ethiopian fashion model Liya Kebede as WHO’s Goodwill Ambassador will spur efforts to do more for maternal and child health.

Q: What simple, cost-effective treatments if introduced in the world’s poorest countries could substantially improve the survival chances of mothers when they give birth?

A: Access to professional care in the pregnancy, childbirth and postpartum periods is key to addressing the major causes of maternal mortality. If comprehensive services were made available, you could save most of the lives of the mothers who die. Often, women who haemorrhage badly need a blood transfusion and often don’t have access to a hospital. Obstructed labour is also a problem and facilities that can provide caesarian section are often not accessible. Many women deliver in unsafe conditions with traditional birth attendants who do not have the skills needed to help when something goes wrong. In addition, sepsis or infection can occur, so making antibiotics available to health services would also save lives. Women need skilled antenatal care to identify whether there is a need for delivery in a health facility. Antenatal care providers can show women how to look after themselves during pregnancy and deal with any serious health problems that may arise.

Q: What other factors can contribute to the ill-health of mothers and neonates?

A: There are aggravating conditions where there is a high prevalence of HIV/AIDS, or malaria. That’s why it’s so important for services for the prevention of mother-to-child transmission of HIV to be made available and for women to be given a prophylaxis for malaria during pregnancy and assisted to have a balanced diet to be as healthy as possible during pregnancy.

Q: What simple interventions could save newborn infants’ lives?

A: If comprehensive health services with skilled professionals are accessible during pregnancy, birth and afterwards, then a very large proportion of newborn lives can also be saved. As newborn mortality is a substantial part of overall child mortality, it needs to be tackled.

Q: Have you given your cluster a new direction since you arrived at WHO in August 2003?

A: The cluster deals with primary health-care programmes in the most basic developing country health systems. The tools, guidelines, norms and standards that have been developed over the years are very good. But now we need to increase support to help countries translate this into policies, strategies and practices. We have created a new department: Making Pregnancy Safer and strengthened an existing one, Gender, Women and Health. This shift in focus should put us in a better position to attain the Millennium Development Goals on maternal and child health.

Q: What concrete progress in improving maternal and infant survival do you expect from World Health Day on 7 April, when the world health report devoted to the subject will be launched?

A: Every year we lose about 11 million under-fives, mainly to preventable causes. Four million of these under-fives die in the first week of life. An additional 3.3 million die during or before birth. Every year about 529 000 women die during pregnancy, childbirth or shortly afterwards. These are alarming statistics, it’s a huge loss of life. But the scale of the problem and the scale of neglect in this area are not yet apparent to the global community. It is a silent epidemic. We hope to give a voice to the 11 million children and half a million women we are losing every year. These women and children are not dying in a natural disaster, like a tsunami. It is a disaster which the adult world can prevent because we have the solutions.

"The scale of the problem and the scale of neglect in this area are not yet apparent to the global community. It is a silent epidemic."