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Introduction
The World Health Organization plays a significant role in the governance of global health. It oversees the implementation of Millennium Development Goals (MDGs) dealing with health matters. The MDGs are a combination of eight visions created at the beginning of the new millennium by world leaders at the United Nations Summit with the aim of eradicating global poverty (United Nations, 2015). They include goals 4 and 5 of reducing child mortality and improving maternal care respectively. The WHO supports nations’ efforts to achieve health-related Millennium Development Goals. It sets prevention and treatment guidelines and assists national authorities to develop health policies (Ruger & Yach, 2009). Current paper consists of two sections. The first part focuses on the global health state and analyzes the Republic of Bangladesh in its progress towards implementation of MDG number 5 on improving maternal care. The second part discusses Medicare and Medicaid coverage options and how they benefit or hinder patients’ access to care. It also explores how Diagnosis Related Groups and Charity Care impact the vulnerable and insured population.
MDG 5: Improving Maternal Health
MDG aims at improving the health of women during pregnancy and labor using two targets. The first aim 5A focuses on reducing maternal mortality by a three quarter fraction between 1990 and 2015. The second one, aim 6B, aims at achieving worldwide access to reproductive health by 2015. The first aim uses two indicators to check the development towards the achievement of MDG and is called the maternal mortality ratio meter. It measures pregnancy-related deaths. The second one is the proportion of deliveries made by skilled health personnel indicator that rates the importance of professional birth attendants’ participation in the birth process (Koblinsky, 2008). The second target on worldwide access to reproductive health by 2015 uses three indices. They are the contraceptive pervasiveness pace, adolescent birth rate, and the antenatal care coverage indicators. The MDG vision is essential to the overall global health system. Improving maternal care is linked to the goal four regarding the reduction of child mortality. Improvement in maternal care leads to the birth of healthy children (United Nations, 2015). It is crucial in saving both mother and child’s life. One of measures employed in the fulfillment of current goal is the use of contraceptives in family planning. Consequently, children born in a spaced family are usually healthy just like their mothers (Rahman, 2008).
The People’s Republic of Bangladesh, a nation in South Asia, is considered a fast-track country because, by 2012, it had been working on achieving MDG5. The paper assesses the state of things in the country using the maternal mortality ratio indicator. The maternity mortality ratio has reduced from 514 in 1986 to 400 in 2003 (Koblinsky et. al., 2008, p.281). The government has set a target of minimizing the ratio by 143 by the end of 2015. The country’s national mortality survey index approximates that 82% of deaths are due to direct obstetric causes, such as hemorrhage, and pregnancy-induced hypertension (Koblinsky et. al., 2008, p.281). The mortality rates from induced abortion reduce due to successful family planning projects and legal menstruation policies that the government establishes. The maternal mortality ratio indicates that deaths are high during labor, on the delivery day, and within 48 hours after delivery (Koblinsky et. al., 2008, p.282). As most women choose to deliver babies at home, most deaths occur there. Besides, 45 percent of deaths occur in husband’s homes and 28 percent in a woman’s natal homes (Koblinsky et. al., 2008, p.282).
Trying to reduce the maternal mortality, Bangladesh government uses measures such as reducing women’s fertility. In this respect, the country is considered a model nation. The total fertility rate of women in the country was reduced from 6.6 percent per woman aged 15-49 years in the mid-1970s to 3.0 percent per woman in 2004 (Koblinsky et. al., 2008, p.282). Another measure the nation uses is advocating for an increase in the age of pregnancy bearing women. Data from Matlab, a research center in the country, proves effectiveness of such strategy. The information gathered from 1985 to 2005 showed a decline in maternal mortality from 659 to 237 (Koblinsky et. al., 2008, p.282).
The country developed the National Maternal Health Strategy in 2001 aimed at upgrading existing facilities and the training of hospital staff. By mid-2005, 70 sub-district and 25 district hospitals had its medical officers trained in obstetrics (Koblinsky et. al., 2008, p283). The government also developed an Emergency Obstetric Care Center focusing on the promotion of good practices and the early detection of maternal health complications. The way forward for the nation in achieving MDG5 requires the support of political stakeholders, improvement of facilities, and educating the citizens on maternal health care (Koblinsky et. al., 2008).
Role of Nursing in Achieving MDG5
One function of nurses in the fulfillment of MDG5 in Bangladesh is certified midwifery. They provide primary health care services to women of child-bearing age. The services include prenatal and labor care, delivery care, newborn care, among others (O’Grady, 2008). Through initiatives like NGOs in the country, the nurses can offer the vulnerable and uninsured populations midwife services at a low cost or free of charge. Nurses can also educate the community members on reproductive health care. The education will center on family planning, ante- and post natal care, and the importance of using skilled professionals during delivery. The government of Bangladesh has used birth attendant nurses at the community level as the primary source of maternal health information. They provide counseling on birth-preparedness, for example, danger signs and financing possibilities for the vulnerable and uninsured population in the country (Koblinsky et. al., 2008).
National Health Coverage Plans
Medicaid is a program that pays for health care for low-income individuals funded by both the federal and national governments. Its coverage options, such as prenatal care, benefit pregnant women of low-income and help them access maternal health services. It also provides them with family planning services and supplies. However, its outpatient and surgery coverage options have been considered to hinder access to patient care. On outpatient services, citizens under Medicaid are more likely compared to those covered by private insurance discharged on sub-par medication routines (Dayaratna, 2012). For children, it is difficult to access surgeons. In California, the doctors are less likely to accept patients enrolled in Medicaid programs. They name paperwork, administrative burdens, and poor reimbursement rates as the reasons for such situation. Another hindrance under Medicaid is that mortality rates for patients are high due to late diagnoses (Dayaratna, 2012).
Medicare is a federal health insurance program that pays for hospital and medical care for the elderly and physically challenged citizens. The scheme offers Part A Inpatient coverage option. Here, once a person is enrolled, he/she does not have to pay premiums for the services again (Blumenthal, Davis & Guterman, 2015). However, some services at Medicare hinder patients’ access to care. An example is the outpatient care under Part B of medical insurance. In a given case, the medication coverage option is expensive. Consequently, beneficiaries with low and modest incomes who pay for such services incur substantial financial losses (Blumenthal, Davis & Guterman, 2015, p.672).
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Diagnosis-Related Groups and Charity Care
Diagnosis-related groups are a patient classification scheme. They provide a means of relating patients’ treatments to the costs a hospital incurs. They include hospital payments for Medicare beneficiaries. Charity care, on the other hand, is a concept used by centers that offer quality health care for the vulnerable and uninsured people in the country. Charity care programs help meet health care needs of such people through low costs or free of charge. They have helped the uninsured people access health care services. With the passing of the Affordable Care Act, the centers started providing care for undocumented immigrants not covered by the Act (Chazin et. al., 2010).
Conclusion
It is difficult to say whether Bangladesh and other nations will be able to achieve the set goals, with the time allocated for their completion till the end of 2015. The World Health Organization has an intention to make it real and has comprehensively assisted countries with measures, such as the development of national health policies. Nurses, involved into midwifery and education, help Bangladesh achieve MDG5 on improving of maternal health. In national health coverage plans, Medicare and Medicaid have benefited citizens through coverage options, such as Inpatient and Prenatal services respectively. However, sub-par and expensive medication services under the two insurance schemes have hindered patients’ access to care. On their part, Diagnosis Related Groups ease the payment of Medicaid and Medicare patients in hospitals. Charity care facilities have effectively catered for the uninsured and vulnerable people in the country. However, the enactment of the Affordable Care Act has shifted the most functions of such centers to the two government health insurance schemes. It has created a dilemma for the centers on whether to close shop or cater for the only remaining group of undocumented immigrants.
