Assembly/AU/ 6 (X)I Page 6 The main challenges related to the high maternal and newborn mortality include the health systems inability to deliver quality care; insufficient and inadequate allocation of funds; poor coordination and partnership; and poor community participation. Maternal and newborn health services should be seen as the best entry point for strengthening health systems because most of the health priorities can be addressed through this essential service. • Maternal mortality ratio: Indicator 16 Out of the estimated total of 536,000 maternal deaths worldwide, slightly more than half (270,000) occur in the sub-Saharan Africa region and out of the 14 countries that have MMRs of at least 1000, 13 are in the sub-Saharan African region. The new maternal mortality estimates for 2005 2 indicate that the decline between 1990 and 2005 in sub Saharan Africa was only 0.1 per cent per year and that to achieve the MDG5 there is need for a decrease of at least 5.5% per year. These estimates provide us with general information about trends in the Region, but are not appropriate for trend analysis using data from individual countries, because of the difference between the methodologies used in the previous estimates. It is very difficult to have a more reliable and accurate data on maternal mortality because of the weak capacity in birth and death registration associated to the low performance of the health information systems in most of the countries. Even if the available data cannot be compared for trend analysis of individual countries, the two maps presented here provide us with a non encouraging picture of the situation of maternal health in the region. Twenty five years after the launching of the safe motherhood initiative, it seems like there were no significant changes in the risk of dying in childbirth in Africa. Only one country has maternal mortality less than 100 deaths per 100.000 live births in the region. Three countries have moderate MMR (100-299) and, nine have levels between 300 and 549 deaths per 100.000 life births, considered as high maternal mortality level. Thirty one countries have maternal mortality rates that are considered very high, equal or more that 500 death per 100.00 live births. Among these, thirteen countries have ratios that are equal or more than 1000 (Table 5 in the Annex presents the MMR WHO, UNICEF, UNFPA and World Bank estimations from 1990 to 2005) • Proportion of births attended by skilled health personnel: Indicator 17 The percentage of birth attended by skilled personnel is still very low in the African region; the average is 46.5% (varying from 6 to 99%), with 21 countries with coverage below 50% and 37 below 80% 3 . Sub-Saharan Africa has the lowest coverage of skilled birth attendant and there has only been minimal change in the proportion of births attended by health personnel in the region since 1990s. High fertility, combined with high maternal mortality risk, makes a woman in sub-Saharan Africa face a 1-in-16 chance of dying in childbirth, compared with 1-in-7300 in developed countries. 2 “Maternal Mortality in 2005 - Estimates developed by WHO, UNICEF, UNFPA and The World Bank”, World Health Organization 2007 3 World Health Statistics, 2007