Progress and challenges in improving maternal health in the Tibet Autonomous Region, China

Abstract

BackgroundThe maternal mortality ratio (MMR) of the Tibet Autonomous Region (hereinafter “Tibet”) is still five times higher than the national average. This study aims to identify the successes and pitfalls of the health system that might be related to the high mortality rate based on the WHO health system building blocks, focusing on human resources for health and health infrastructure and the impact on maternal health and outcomes.MethodsSources of information include China’s central government and Tibet’s local government policies and regulations, health statistical yearbooks, maternal and child health routine reporting system, and English and Chinese online research articles. Joinpoint analysis was applied for MMR and maternal health service trends, and correlation test was used to test the relationship between maternal health services and outcomes.ResultsBetween 2000 and 2015, public health spending in Tibet increased 67-fold, the hospital delivery rate increased 70.1%, and the MMR dropped from 466.9 to 100.1 per 100,000 live births. However, the total number of health workers, qualified medical doctors, and registered nurses per 1,000 people were 4.4, 1.4, and 1.0, respectively, much lower than the national average (5.8, 1.8, and 2.4). In Tibet, there were 80 basic and 16 comprehensive emergency obstetric care (EOC) centers. On average, there were 12 basic and 2.5 comprehensive EOC centers per 500,000 of the population. Though it met the WHO’s recommendation, it might remain inadequate in the low population density of the area like Tibet.ConclusionThe shortage of health professionals and EOC centers and health information in predominantly remote rural areas with a scattered population still needs to be rectified.

Burden of maternal disorders in China from 1990 to 2019: Analysis of the Global Burden of Disease Study 2019

“…Because of its unique geography, cultural history, and other factors, the development of maternal and child health in the Tibet Autonomous Region still lags far behind the mainland and national average levels. The MMR in the Tibet Autonomous Region remains five times higher than the national average [24] . Notably, the total numbers of health workers, qualified medical doctors, and registered nurses per 1000 people are much lower than the national average [24] .…”

“…The MMR in the Tibet Autonomous Region remains five times higher than the national average [24] . Notably, the total numbers of health workers, qualified medical doctors, and registered nurses per 1000 people are much lower than the national average [24] . Because improving the coverage of maternal health services is the main strategy to reduce MMR [25] , a robust health system with access to medical facilities is needed, together with universal coverage of maternal and neonatal intensive care in rural and remote areas [26] .…”

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990–2017

“…Tibet is in remote areas of China, where the land is vast and the people are sparse, making it more difficult to provide maternal health services as part of basic public health services, but the coverage rate has been increasing, so the health of maternal and child is improving. In some remote rural areas of Tibet, there is still a shortage of human resources for health and health infrastructure [33], and the quality of existing maternal health service provision needs to be improved [34], which can lead to poor maternal and child health outcomes. We should adhere to The Pregnancy and Village Outreach Tibet program [35] and continue to provide families with maternal-newborn health education, skills training, and resources.…”

Coverage of maternal health services to maternal mortality ratio moderated by public health center accreditation status and causes of maternal death

“…Mothers who started antenatal care in the first and second trimesters of pregnancy were shown to have a lower maternal mortality rate than mothers who started antenatal care in the third trimester (Sundari, 2020). Delivery in health care facilities has a high negative correlation to the maternal mortality ratio (Labasangzhu et al, 2018). The coverage of delivery assistance by health workers is also significantly negatively correlated with the maternal mortality ratio (Nurjannah et al, 2018).…”