There is need for government leaders to strengthen health systems to ensure mothers have greater access to skilled birth attendants in order to achieve the Millennium Development Goal of reducing child mortality by two thirds.This is according to Save the Children’s annual State of the World’s Mothers report.In particular, leaders are asked to fight the causes of newborn deaths, gender inequality and malnutrition said to be key in guarding against maternal and child mortality.The 14th annual report was released early this week ahead of the Mother’s Day, which widely celebrated on Sunday, May 12.The report ranks Rwanda top compared to all the five EAC countries in health and wellbeing for women.Babies born in Rwanda, said the report, have less chance of dying before they reach their fifth birthday than  the other four East African Report (EAC) partner countries.It puts Rwanda’s first-day mortality rate (per 1,000 live births) at 7, and Tanzania, Kenya, Burundi and Uganda at 9, 9, 15 and 10, respectively.After a month, the Birth Day Risk Index indicates that Rwanda’s newborn mortality rate (per 1,000 live births) is at 21, Tanzania 25, Kenya 27, Burundi 43, and Uganda 28.In the first five years, Rwanda’s under-5 mortality rate (per 1,000 live births) is at 54, Tanzania 68, Kenya 73, Burundi 139, and Uganda 90.Rwanda’s maternity care successImproving women and children’s health-care has been a long time commitment of the Rwandan government, according to Health minister Dr. Agnes Binagwaho.Government set up determined plans to scale up access to health services. The Vision 2020 strategy for equitable social and economic development, produced in 2000, emphasised health as a pillar of the national cross-sector approach to poverty reduction.Also, the Ministry of Health opted for identifying and then addressing root causes of mortality rate and morbidity, while expanding access to basic health services to the poor and strengthening the health system. The evidence-based policy making tool has also worked well, according to observers."This is an outcome of the commitment of the government, supported by the development partners as well as the participation of the population, which makes better use of the services available,” Minister Binagwaho told Saturday Times.Effective use of resources also helped, by building a robust system of primary care, she added.In addition to development of health infrastructure – hospitals and clinics – Rwanda put emphasis on human resource development.Efforts are underway to address the shortage by training physicians and nurses.  Government has also trained over 45,000 community health workers who provide in-home care and psychosocial support as well as basic primary care in communities.Rwanda also provides universal health insurance under the community-based health insurance programme, Mutuelle de Santé, with focus on health care for the most vulnerable populations.Mutuelle de Santé has more than halved average annual out-of-pocket health spending and significantly increased access to health care.Rwanda is now on track to meet the maternal health MDG, thanks to the increased number of women giving birth in a health-care facility.According to the Ministry of Health, 69 per cent of mothers were cared for by a skilled health-care worker during birth in 2010, compared to 31% in 2000.In the last 10 years, maternal mortality dropped by 60 per cent and life expectancy doubled, all reportedly at an average health care cost of US$55 per person, annually.In March, Rwanda became the first country to introduce the Measles and Rubella combined vaccine. The country has been vaccinating all infants with one dose of measles vaccine for many years, and experts have estimated that measles deaths in Rwanda declined from 670 in 2000 to three in 2010.However, the report indicates that Africa has highest rates of First-Day Deaths. More than one million babies die the day they are born and the countries with the highest rates of these deaths are in Africa, according to the report.The launch of the report at the United Nations underlined a growing global focus on newborn babies."It was here at the U.N. that all countries agreed to the Millennium Development Goal to reduce child mortality by two thirds,” Carolyn Miles, President & CEO of Save the Children said at the launch."We’ve come a long way, but we won’t get there without new focus on saving the youngest lives. This report presents the growing evidence that the world today has the low-cost tools to prevent millions of newborn deaths once considered inevitable.”It features a new Birth Day Risk Index that ranks 186 countries by the chances a baby will die on the first day of life.The US is a riskier place to be born than 68 other countries, it says.The report also features Save the Children’s Mothers’ Index. This year, it ranks Finland as the best place in the world to be a mother, and Democratic Republic of the Congo as the toughest.The US ranks as the 30th best place to be a mother. The report shows that Britain lags behind many European nations in health and wellbeing for women. It says babies born in the UK have a greater chance of dying before they reach their fifth birthday than in 21 other European countries.According to the report, one million babies die each year on the day they are born, which translates to two babies dying every minute.The Democratic Republic of Congo (DRC) is ranked as the worst country for mothers to reside as Finland was declared the best and the United States of America as having the highest first day death rates "than all other industrialised countries combined.’’The report relates poor health of mothers in Africa to the death of new born babies. Other factors are low use of contraception, poor access to decent health care during pregnancy and a severe shortage of health workers.Niger, Mali, Somalia, Sierra Leone and DRC are ranked as the worst countries for a mother to be, while Nordic countries Finland, Sweden, Norway, Iceland and the Netherlands are at the top.