Maternal mortality is a shadow that stretches across every corner of South Sudan, claiming more victims in remote areas. With the support of the Health Pooled Fund (HPF), HealthNet TPO is responding to this medical emergency in several hard-to-reach parts of the country, including in Terekeka and Raja County.

The country has extremely poor health indicators particularly for women and children and maternal and child mortality rates remain one of the highest in the world. In 2021, 789 women died for every 100,000 live births (WHO). Destroyed health infrastructure, few roads connecting the largely rural population to hospitals and health clinics, low numbers of qualified health workers and poor quality of health services restrict people from accessing care.

In South Sudan, and specifically in Terekeka County, cultural norms and gender stereotypes deny women the ability to make decisions regarding their own sexual health. Women have little say in determining when to get pregnant and how many children they will have. They are also unable to seek maternal healthcare without their husbands or other family members being involved.

High rates of gender-based violence also contribute to increased complications during pregnancy. Studies show that violence within the home, including verbal and physical abuse, lack of care, neglect, abandonment, and poverty, are among the main factors behind maternal mortality in Terekeka.

Other risk factors include traditional beliefs against blood donations, causing a mass shortage in blood necessary for blood transfusions during emergencies. To counter this, HealthNet TPO is creating massive awareness of the importance of donating blood.

To improve the alarming mortality rates in Terekeka County, HealthNet TPO with support from the Health Pooled Fund renovated the operating theatre at Terekeka primary health care centre, equipping and staffing the centre to handle obstetric emergencies.

Dr. Jacob Alier, Maternal, Neonatal and Child Health Supervisor, leads surgeries, complicated deliveries and extreme cases including eclampsia and pre-eclampsia.

"Most of our residents do not get to the medical centre on time so that they can be attended to promptly, and this affects and contributes to many health complexities," he said, describing that many women were reluctant to seek routine antenatal care. Creating awareness on the importance of antenatal visits is a priority for HealthNet TPO, who’s services are available 24 hours a day.

Dr. Alier visits patients within the community to encourage women to visit facilities. He described, "I once went to Regon Payam and identified a pregnant mother with varicose veins and advised her to give birth at the facility. When her time came, they called us and picked her up and [I] thank God she gave birth without any problems at the facility."

When Cecilia, a mother of 11, was diagnosed with pre-eclampsia during a routine check-up, she received life-saving care by Dr. Alier and his team, who managed her condition for two days before she could have a caesarean.

"I didn't know if I would have made it without support from the medical team here; my daughter and I are alive because of the medical service we got," said Cecilia.

Since starting, Dr. Alier has conducted 13 caesareans at the new centre, and all women and babies are doing well.

Terekeka is not the only county improving its Antenatal Care services to combat maternal mortality. In Raja County, the number of skilled birth attendants was low and only concentrated to the county’s main hospital. Health workers in the three primary health care centres were not skilled in handling deliveries. HealthNet TPO, with the support of HPF and Impact Health Organization, supported 11 health facilities in the region and increased the number of skilled birth attendants by 18% in one quarter of 2022. 

Dr. Ija Jimmy Peter, Maternal, Neonatal and Child Health Coordinator expressed that it is only possible to improve mortality rates through safer birth deliveries by ensuring experienced midwives handle deliveries, a goal that professionals on the field share with the purpose of HNTPO in the region.

It is through support of HPF that HealthNet TPO can provide specialist care for mothers and babies and to end preventable maternal deaths in the region. The organisation provides primary and secondary health care services in 20 health facilities across the county, however due to funding difficulties this number is diminishing.

There is still a long way to go to ensure that mothers and babies living in hard-to-reach parts of the country can access the care they need particularly during times of emergency. HealthNet TPO will continue to support health facilities and improve the number of qualified doctors, midwives and healthcare personnel in these regions. 

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