2023-08-09 22:21:22
Togolese authorities must urgently improve access to maternal health care in the country and reduce infant and neonatal mortality, Amnesty International said on July 31 on African Women’s Day.
In Togo, the infant mortality rate is 43 deaths per 1,000 live births, and the neonatal mortality rate, which concerns infants who die before reaching the age of 28 days, is 24 deaths per 1,000. children born alive, according to UNICEF. The maternal mortality rate is also high in Togo, with 399 maternal deaths per 100,000 live births.
“The Togolese authorities have taken initiatives to make maternal health care more affordable, but it is essential that they put in place new measures so that pregnant women can give birth in a dignified manner in establishments where they will receive support and appropriate care,” said Aimé Adi, director of Amnesty International Togo.
The Amnesty International delegation conducted interviews with 21 people, including 13 patients, four midwives and four doctors, at five health facilities in Lomé, the capital, and Aného, a city in southeastern Togo. , in February and March 2023.
In most health facilities, the Amnesty International delegation observed understaffing, dilapidated equipment and poor quality of care.
The right to health is guaranteed by article 12 of the International Covenant on Economic, Social and Cultural Rights, article 16 of the African Charter on Human and Peoples’ Rights, article 14 of its additional protocol relating to women’s rights, and article 16 of the Togolese Constitution. Article 97 of Togo’s Health Code provides that “every pregnant woman has the right to benefit from good monitoring of her pregnancy, safe delivery and postnatal care for herself and her child. “.
Lack of staff and inadequate medical equipment
The maternity wards that were visited lacked staff, adequate equipment and sanitary infrastructure. As a result, the few midwives employed by these services found it very difficult to cope with an excessive workload. Three midwives told Amnesty International that they are sometimes on call for more than 15 hours. According to the United Nations Population Fund, Togo has only two midwives for every 10,000 inhabitants.
One of the leaders of an organization of health practitioners in Togo told Amnesty International that the lack of midwives results from the absence of recruitment competitions Moreover, there is a very limited number of gynecologists in public hospitals .
A gynecologist told Amnesty International: “Gynecologists are often exhausted. We are both in consultation, in the operating room, on complicated deliveries… For this reason, gynecologists are rare in the public. They go into the private sector to earn up to the energy invested. For example, there are only two at the Bè public hospital. In some centers there are blocks but no gynecologists. »
On social networks, the secretary general of the National Union of Hospital Practitioners of Togo indicated that out of 127 gynecologists registered with the National Order of Doctors of Togo, only 25 worked in public hospitals.
All maternity wards visited also lacked the basic equipment needed to receive patients and provide care. In one of the medico-social centers (CMS) in Lomé, the Amnesty International delegation noted that the examination tables were in poor condition in the antenatal consultation room, and due to the lack of operating lights, the midwives women had to use the flashlight of their mobile phone during the consultations.
A CMS midwife said that the center had only one delivery table, and that several devices and instruments were malfunctioning or faulty or in short supply, including resuscitation bags, mucus aspirators and episiotomy scissors.
At the Center Hospitalier Universitaire Sylvanus Olympio, where Amnesty International also visited, a midwife said: “We see women giving birth on the floor, on a mattress, and sometimes even on a simple sheet when there is no no mattress. There are new delivery tables, but there are also old ones that are in poor condition and moldy. »
Strained relationships between staff and patients
The lack of equipment and staff also affects the quality of care provided to patients during antenatal consultations and childbirth.
A patient told Amnesty International: “In paediatrics, there is not always room when a mother wants to bring her child there. We had to buy a chair. Sometimes women are forced to stand with their children. »
Poor working conditions also have a negative impact on patient-staff relations. Several patients told Amnesty International that they had been verbally abused or humiliated by staff.
A midwife told Amnesty International: “We are overwhelmed, we cannot perform at our best, this affects patients, we do not welcome them properly and we can make mistakes in our work. Some tasks are delegated to students who make mistakes. »
Midwives have also told Amnesty International that they frequently suffer verbal and sometimes even physical abuse from patients or their relatives.
Access to affordable medical care
In August 2021, the Togolese authorities improved women’s access to maternal health services with the creation of a national support program for pregnant women and newborns called “Wezou” (life), which aims to “reduce maternal and neonatal mortality rates” by enabling women to have access to maternal health services at lower cost.
Amnesty International found that the program had high visibility in the maternity wards it visited, and several patients said they had benefited from it.
However, prior to the launch of Wezou, official websites had announced that this program would “make health care free for pregnant women”. In practice, only certain services are free, and only for women over the age of 18. Antibiotics that are often prescribed after childbirth are not covered by the Wezou program.
While the Wezou program represents significant progress, improvements are still needed. Amnesty International calls on the Togolese authorities to respect, protect and fulfill the right to health, ensuring that sufficient qualified medical personnel are available for patients. They must also ensure that programs aimed at making health care affordable are aimed at all people, without discrimination, and that 15% of the State budget is devoted to the health sector, in accordance with the provisions of the Abuja Declaration adopted by the African Union in 2001.
“The Togolese authorities must strive to improve access to health care, particularly with regard to the quality of equipment and care in maternal health centers,” said Fabien Offner, researcher at the office of Amnesty International for West and Central Africa.
For more information or to schedule an interview, please contact Ousmane Drabo: [email protected]/ Tel: +221 776234040
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