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a g e of fi v e we r e s e v e r e l y m a ln o u r i s h e d , a n d t h e r e h a s b e e n n o in d i c a t i o n t h a t t h e nut r i t i o n s t a t u s h a s ch a n g e d sig n i fi - c a nt l y o v e r t h e la s t d e c a d e . 4 6 A lt h o u g h p r o g r e s s h a s b e e n m a d e in t h e p r o v i s i o n of b a s i c w a t e r a n d s a n i t a t i o n , in 2 0 0 9 POMZPGDIJMESFOIBEBDDFTTUPQJQFEXBUFS BDDFTTUP p r o p e r s a n i t a t i o n a n d s a f e dr i n k i n g w a t e r gr e a t l y infl u e n c e s t r a n s m i s s i o n of co m m u n i c a b l e di s e a s e s . 4 7
MDG 4 and 5: Success stories from other countries C o unt r i e s su c h a s Ho n dur a s , Nepa l , Rw a n d a a n d Sr i L a nk a ar e jus t a fe w e x a m p l e s t h at p oint t h e way fo r ot h e r co unt r i e s wo r k in g to a d dr e s s mat e r n a l mo r t a li t y. Whil e su c c e s s s t o r i e s a r e s t ill a wo r k in pr o g r e s s , t h e y de m o n s t r a t e t h at MD G 5 is in d e e d w i t hin re a c h , p a r t i c ul a r l y fo r a co unt r y t h at re c o g ni z e s t h e in c a l c ul a b l e v a lu e of wo m e n . 4 8 Con c e r t e d FGGPSUTCZUIF)POEVSBTHPWFSONFOUQSPEVDFEB de c r e a s e in Ho n dur a s ’s mat e r n a l mo r t a li t y in le s s t h a n a de c a d e a s a re sult of fo cu s in g on er a di c a t in g t h e ke y c a u s e s of mat e r n a l de at h , whi c h we r e p o s t p a r t um ha e m o r r h a ge , pr e - e c l a m p s i a a n d ob s t r u c t e d la b o ur. T h e go v e r n m e nt wo r ke d in coll a b o r a t i o n wit h t h e Unite d St at e s A ge n c y fo r Int e r n a t i o n a l De v e l o p m e nt (USA ID) a n d t h e Pa n A m e r i c a n He a lt h O r g a ni z a t i o n (PA H O ) in imp r o v in g ef fo r t s to re du c e
mat e r n a l mo r t a li t y. D o n o r inv e s t m e nt f un d e d t h e in c r e a s e of sup p li e s of bl o o d a n d e quip m e nt in clini c s a n d ho sp i t a l s to t r e a t ha e m o r r h a ge , whil e p a r a m e di c s pr o v i d e d pr e - n a t a l ch e c k - up s to mo nit o r pr e - e c l a m p s i a . 4 9
P o v e r t y in Rw a n d a is wid e s p r e a d a n d t h e co unt r y ha s a la r ge r ur a l p o p ul a t i o n , ma k in g acc e s s to he a lt h s e r v i c e s ch a ll e n g - in g , p a r t i c ul a r l y fo r wo m e n . Yet t h e Rw a n d a n go v e r n m e nt ha s ma d e imp r o v in g f a mil y pla nnin g s e r v i c e s a nat i o n a l pr i o r i t y by wo r k in g wit h t h e WH O in hir in g a n d t r a inin g co mm uni t y he a lt h wo r ke r s to pr o v i d e f a mil y pla nnin g e du c a t i o n a n d co un s e llin g to me n a n d wo m e n t hr o ug h o u t t h e co unt r y. A s a re sult , R w a n d a ’s mat e r n a l mo r t a li t y r at e fe ll by mo r e t h a n XJUIJOmWFZFBST5 0
M o r e t h a n a t hir d of Sr i L a nk a ’s p o p ul a t i o n li v e b e l o w t h e p o v - e r t y lin e . How e v e r, p o lit i c a l co mmi t m e nt to pr o v i din g he a lt h c a r e to wo m e n in clini c s a n d ho sp i t a l s , a n d in t h e ir ho m e s , ha s re sult e d in t h e re du c t i o n of t h e co unt r y ’s mat e r n a l NPSUBMJUZSBUFCZJOUIFQBTUZFBST5 1 A de di c a t e d gr o up of mid w i v e s a s sig n e d to e v e r y dis t r i c t in Sr i L a nk a to pr o v i d e b a si c ho m e c a r e fo r e x p e c t a nt a n d ne w mot h e r s fo r m s t h e fr o nt lin e of t h e mat e r n a l he a lt h s y s t e m . In a d dit i o n , t h e e x p a n s i o n of he a lt h f a c ili t i e s a n d en c o ur a ge m e nt of wo m e n
THE FUTURE O F PH A R M A C Y