Child and Maternal Mortality
in Islamic Countries
2
utilization by socio-economic status, educational level and urban-rural residence. Just by
reducing inequity, it is possible to increase antenatal care (ANC), skilled birth attendance (SBA),
and postnatal care (PNC) to 20% to 50% higher than the current prevailing rates in many
settings. The countries and development partners need to implement proven effective
strategies and develop culturally acceptable innovative, cost-effective programs for accelerating
the progress through reducing inequity, improving program performance and assuring high
quality MNCH care.
Key informants from the stakeholders – selected from government officials, UN organizations,
donor agencies, non-government organizations, and public health scientists – in all countries
have identified that leadership and governance is a challenge in the health system functioning.
At a national leadership level, all these countries have developed MNCH policies and strategies
to improve maternal and child health. However, governance to monitor and enforce the policies
seems to be lacking and the lack of effective governance overlapped with other barriers to
accessing healthcare services as well. Adequate governance and monitoring of health centers
and hospitals are needed to keep providers accountable. Many experts mentioned
“moonlighting” or having a private practice after hours or, in some cases, even during office
hours, as a pervasive issue among doctors.
Quality of care was the most prominent barrier to accessing healthcare services that was
discussed by the most key informants in all countries. While utilization of ANC services has
increased over the years in these countries, the WHO recommended ANC 4+ visits is still low
and the quality of those services is lacking. Achieving the newly WHO recommended eight ANC
visits and initiating the ANC visit by the first trimester will be more challenging. There was a
similar concern for delivery care. Experts called for the needs for a quality of care framework by
which to train and measure quality at all levels.
Acceptability of services was another barrier to accessing healthcare services cited by the Key
Informants. Many Key Informants mentioned that trust between the community and the
healthcare providers was lacking, thereby limiting service acceptability. Most Key Informants
mentioned cultural or religious beliefs as potential barriers for accessing healthcare, MNCH care,
and delivery care. For example, multiple Key Informants mentioned that certain parts of the
population have a fear of going to a facility for delivery because they do not want to have a
cesarean section delivery.
Except Indonesia, physical accessibility did not appear to be an issue for maternal, neonatal, and
child health (MNCH) care but the availability of health providers, especially doctors. The Key
Informants related this to an overall concern with human resource management and unequal
distribution. In Iraq, the budget for medicines and medical supplies are considered insufficient
even to cover the essential medicines.
Low and middle-income countries are heavily dependent on sample surveys for estimating
maternal and child mortality and assessing MNCH care utilization. However, these surveys are
often not suitable for tracking mortality or identifying subnational health system deficiencies.
Timely, accurate collection of routine data through a reliable, functional heath information
system (HIS) is critical for monitoring progress towards the target. The Key informants opined
that health information systems are somewhat developed but needs major improvements for
full coverage. HIS data utilization is also low.
We provide a set of actionable recommendations to accelerate child and maternal mortality
reduction in OIC countries that may help them to achieve the MDG-3.1 and 3.2 goals.