Mwalali Philip, Ngui Emmanuel
Africa Economic Foundation Inc. in Durham, North Carolina, USA.
J Health Care Poor Underserved. 2009;20(4 Suppl):149-69. doi: 10.1353/hpu.0.0224.
Trends in maternal and child mortality (MCM) in sub-Saharan Africa do not follow the patterns seen in developed nations or match the funds and effort invested so far. This paper critically explores trends in MCM, global efforts to reduce MCM, and some of the underlying policies and programmatic issues that have shaped the slow progress or failure in reducing MCM in sub-Saharan Africa. We describe a "yo-yo" effect in policies and funding of Maternal and Child Health, Family Planning, and HIV/AIDS/STI programs in the region, and how this yo-yo effect may limit sustained community level reductions in MCM. We conclude by highlighting how renewed interest in the Alma-Ata declaration, particularly its primary health care concepts with their strong emphasis on horizontally integrated linkage of programs and resources, greater community involvement in program design and implementation, and economic development can contribute to sustainable reductions in MCM in the region.
撒哈拉以南非洲地区的孕产妇和儿童死亡率（MCM）趋势既不符合发达国家的模式，也与迄今为止投入的资金和努力不相匹配。本文批判性地探讨了MCM的趋势、全球为降低MCM所做的努力，以及一些影响撒哈拉以南非洲地区在降低MCM方面进展缓慢或失败的潜在政策和项目问题。我们描述了该地区孕产妇和儿童健康、计划生育以及艾滋病毒/艾滋病/性传播感染项目在政策和资金方面的“溜溜球”效应，以及这种效应如何可能限制在社区层面持续降低MCM。我们在结论中强调，对《阿拉木图宣言》重新产生的兴趣，特别是其初级卫生保健概念，以及对项目与资源横向整合联系的高度重视、社区更多地参与项目设计和实施，以及经济发展，如何能够促进该地区持续降低MCM。
