Maternal and Child Health

Melinda Gates: A New Vision for the Health of Women and Children

Jun 7th, 2010 8:18 PM UTC
By Melinda French Gates

I’m speaking at the Women Deliver conference in Washington, D.C., today to highlight maternal, child, and reproductive health as a global priority.

Three months ago, I traveled to a village in the Indian state of Uttar Pradesh, where I met a young mother named Rukmini. Six days before, she’d given birth to a daughter she named Durga, after the Hindu goddess of power.

According to custom, Rukmini and Durga remained in the same room after the birth. Seven days later, Rukmini carried Durga into the light of day for a ceremony that celebrated the special bond between mother and child, called Chhathi. As their neighbors drummed and sang songs, Rukmini held Durga up to thank the sun god for a healthy birth and ask for his blessing.

I kept thinking about the overwhelming joy, hope, and optimism I felt when each of my three children was born. No matter who you are, no matter where you live, it is incredibly moving to hold a healthy baby in your arms.

But tens of millions of women never get to experience that moment of beauty. For these women, childbirth is filled not with joy, but with dread, pain, and sorrow. They know they might die during delivery. If they survive, they are terrified their baby might die.

The world is now coming together to save the 350,000 mothers and 3 million newborns who die every year. At Women Deliver, we are nurturing a vision that is changing the world.

1. Donors will spend more on women and children, and those donations will be tracked.
2. Developing countries will pass rigorous policies for women’s and children’s health, and fully fund their implementation, and health workers will have the tools and training they need.
3. Communities will work together to gather solid evidence about the interventions that work best, and combine them into a comprehensive plan to save lives.
4. Women everywhere will have the knowledge and power to save their lives and the lives of their babies.

We can make a new world for mothers like Rukmini. When she hugs her daughter Durga, she holds the future in her hands.

In the comments below, please share what you are going to do to bring about this vision of the world.

For more information, go to the foundation’s Women Deliver page or the Women Deliver website. In this recent blog post, I share more of what I’ve seen around the world, the success stories in Malawi and India, and the foundation’s approach to saving women’s and children’s lives.
-Melinda French Gates

$1 billion for mothers and children?

Jun 2nd, 2010 3:51 PM UTC
By Nora Coghlan

The Canadian Press reported over the weekend that Canada is planning to pledge $1 billion towards an initiative on maternal, newborn and child health (MNCH) at this month’s G8 summit.

Heather Scoffield of CP writes: “The federal government is telling other G8 countries that Canada is willing to put about $1-billion toward maternal and child health – as long as other countries ante up too. The Canadian cash will likely target poor countries with the worst records of maternal and child mortality and malnutrition.”

Although the initiative has been in discussion since Canadian Prime Minister Stephen Harper announced in January that he would champion maternal and child health at the summit, with less than a month until the G8 summit few details have been outlined. To ensure that the initiative delivers results for women and children around the world, Canada and the rest of the G8 should take this opportunity to outline an action plan for maternal, newborn and child health with clear objectives and how the G8 will ensure that promises made at the summit are kept in the months and years ahead.

Last month, ONE released its own set of recommendations for the G8, including a call for a robust, results-based initiative to improve maternal, newborn and child health in the world poorest countries.

For maximum impact, new resources for maternal and child health should be channeled through effective bilateral and multilateral mechanisms (especially the Global Fund and the Global Alliance for Vaccines Initiative) and delivered in an integrated, coordinated manner that supports national health plans and works towards ambitious targets such as the recruitment of 3.5 million health care workers, universal access to basic immunization (including new vaccines for rotavirus and pneumococcal disease), and the elimination of mother-to-child transmission of HIV by 2015.

In addition, any new initiatives by the G8 and G20 must incorporate accountability safeguards to ensure that new commitments are kept. As a champion of accountability within the G8, Canada has the opportunity to demonstrate how an MNCH initiative will pilot a new era of accountability by the G8 and the G20. The TRACK principles, a guide developed by ONE and its partners call for commitments to development to be Transparent, Results-oriented, clear about the degree of Additionality and Conditionality, and monitored by an independent mechanism to ensure the promises are being Kept.

If the $1 billion figure is accurate, in the coming days Canada should clarify how it meets the TRACK principles – including where the money will be spent, the timeframe it will be delivered, interim targets and the outputs it intends to achieve – and encourage other donors to do the same to ensure that any new initiative includes both ambition and accountability.

The G8 agrees: Maternal and Child health a ‘top priority’

Apr 30th, 2010 4:36 PM UTC
By Brie O'Keefe

ONE members Jana Henderson (middle) and Nicole Yeadon (right) handed over ONE’s petition to Canadian Minister for International Cooperation Bev Oda © ACDI-CIDA/Mike Dembeck

Earlier this week G8 development ministers met for a crucial round of planning and negotiations on a maternal and child health initiative they will announce this summer at the G8 summit in Muskoka, Canada.  At the top of the agenda: how to best address the global problem of 8 million plus children around the world still dying before their fifth birthday.

ONE ran a petition ahead of the meeting encouraging Canada, as host of the G8, to create a plan that was as ambitious and effective as possible.  Any initiative to tackle maternal and child mortality must be specific, results-based and ambitious, with new funding for key global health initiatives.

The goal of the petition was demonstrate public support for the initiative and to encourage the G8 to be as visionary as possible. Find out more about the specifics of what ONE thinks a good G8 maternal and child health initiative would look like.

On 28 April ONE member Jana Henderson met with Canadian Minister for International Cooperation, Bev Oda, to hand over the 9,000+ signature-strong petition.  Jana said:

“Today could not have gone any more smoothly.  While we waited to meet Minister Oda I saw all the ministers for the G8 countries milling around me.  We then had a quick handover with Bev Oda herself.  It was the opportunity of a lifetime and I couldn’t have asked for any better treatment from those at the G8.”

At the close out of the meeting, the G8 released a joint statement recognising maternal and under-five health as a ‘top priority’ along with a statement of principles which should guide the final product.  ONE will continue working with decision makers across the G8 in the lead up to the summit to ensure that the specifics of the initiative reflect our priorities.

G8 set to develop women and children’s health initiative

Apr 20th, 2010 2:55 PM UTC
By Brie O'Keefe

On 26 April, G8 development ministers will be meeting in Halifax, Canada, to develop an action plan on maternal, newborn and child health.  This builds on Canadian Prime Minister Stephen Harper’s pledge in January that as president of the G8 in 2010, Canada will use this year’s summit to “champion a major initiative to improve the health of women and children in the world’s poorest regions.”

For those of us working to fight global poverty, this announcement came as welcome news.  Despite improvements in global health in recent years, progress on maternal and child health is still far from where it should be.  More than 300,000 mothers still die a year during pregnancy and childbirth and nearly 9 million children die before their 5th birthday.

Yet most of these deaths are the result of preventable and treatable causes.  New support for cost-effective, proven interventions could make a dramatic impact on maternal, newborn and child health.

In the past, the G8 has acknowledged the urgent need in maternal and child health along with some of the solutions, but has made few concrete commitments on how it will help African countries make improvements.  With Canada’s leadership and public commitment to this issue, 2010 can be the year when the G8 finally takes action.

It’s also an important time for these issues to be highlighted.  When African Heads of State meet at the African Union Summit in July they will focus on maternal and child health.  In September all global leaders will meet in New York to review progress on the Millennium Development Goals (MDGs) and with MDGs on maternal and child health being some of the most off-track, a robust plan from the G8 on this issue could galvanise the international community.

Ahead of the meeting of G8 development ministers in Halifax, ONE is outlining its recommendations to the G8.  In order to be effective and to make a real difference in the lives of families in the world’s poorest regions, the G8‘s action strategy should:

• Be results-oriented -  Canada and other G8 countries should commit to an action plan that combines high-impact interventions and long-term investments in local capacity with the ultimate goal of training 1 million health care workers in countries with a high burden of maternal and child deaths.  They should work towards universal access to skilled birth attendants, universal access to bed nets, vaccination packages (including pneumococcal and rotavirus vaccines) and anti-malarial drugs, and support comprehensive education campaigns about pregnancy to women of child bearing age.  Finally, any initiative should have the goal of eliminating mother-to-children transmission of HIV by 2015.
• Mobilize new resources -  Canada and other G8 countries should double bilateral Overseas Development Assistance to maternal, newborn and child health from approximately USD $4 billion in 2010 to USD $8 billion by 2013.  This funding should be channelled through existing bilateral initiatives or new multilateral approaches in the future, such as an expanded Global Fund. In addition, the G8 should commit to full replenishment of multilateral organizations  already working to improve maternal and child health such as GAVI (Global Alliance of Vaccines and Immunizations), the Global Fund, the United Nations Population Fund and the World Bank.
• Emphasise integration, coordination and country ownership – In addition to new resources, Canada and other G8 countries should also commit to improving the quality and effectiveness of maternal and child health efforts through a commitment to the principles of country ownership, integration and coordination.  The G8 and other donors should commit to working with developing countries to devise technically sound national health plans through their internal processes and mechanisms like the International Health Partnership and the private sector to coordinate support and mobilise resources.  The G8 should also support and encourage efforts by developing country governments to transparently mobilise domestic resources for improving maternal, newborn and child health and the expansion of affordable access to quality care.
• Ensure accountability based on the TRACK principles – Canada and other G8 countries should use this initiative to pilot a robust G8 focus on accountability in line with the accountability matrix and the TRACK principles, which calls for new promises to be Transparent, Results-orients and Accountable, while also articulating any Conditionalities and mapping out a strategy to ensure that will be Kept.

Good News for Maternal Health

Apr 16th, 2010 8:18 PM UTC
By Rena Pacheco-Theard

A study published in The Lancet this week reports that maternal mortality has declined significantly for the first time in decades. The study, supported by the Bill & Melinda Gates Foundation and conducted by researchers at the University of Washington in Seattle and the University of Queensland in Brisbane, found that the number of women who died during pregnancy annually fell to an estimated 342,900 (uncertainty interval 302,100—394,300) in 2008 from 526,300 (446,400—629,600) in 1980, representing a 1.3 (1.0—1.5) percent drop in maternal deaths each year since 1990. These findings come after years of no perceived progress.

The divide between these estimates and those reported earlier by the UN (which still estimates around half a million maternal deaths annually, but is expected to release new data later this year), underscores the need for better development statistics and consistent measurement methodologies. When we have accurate statistics, we can effectively target interventions and tailor our approach to priority areas.

Despite the wide uncertainty intervals surrounding the numbers, the message of progress is clear. The study credits a number of factors for the drop in maternal mortality, including lower birth rates, increased educational attainment for women, higher incomes, and better care during delivery.

Six countries were found to account for over half of all maternal deaths: India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of Congo. Additional, targeted efforts are needed in these priority areas.

This study also emphasizes the link between HIV/AIDS and maternal and child health, finding that one in every five maternal deaths in 2008 was related to HIV. In the absence of HIV, annual maternal mortality would have dropped to 281,500 in 2008, supporting arguments for the increased integration of maternal and child survival programs into mechanisms like the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Some countries showed an unexpected increase in maternal mortality, partially attributed to better reporting, such as the U.S., Canada and Norway.

These new data should drive accelerated efforts to use proven interventions to save the lives of mothers around the world. The study should also call attention to the importance of better development statistics to target interventions, and the need for those interventions to reflect the integrated nature of health issues on the ground.

Reducing child mortality: cash transfers can help

Jun 17th, 2009 2:14 PM UTC
By Lisa.Fleisher

A new report by Save the Children UK released today argues that reductions in child mortality can be accelerated if regular, predictable transfers of cash, or cash transfers, are provided to households or individuals by the government. Unlike traditional welfare programs, cash transfers in this case are conditional upon parents seeking and receiving certain services for their children. If children do not regularly attend school or get regular check-ups at health clinics, the cash transfer program will not pay out.

Cash transfers work to break down one barrier to families’ ability to access social services, namely the cost of the service. By addressing the ‘demand-side’ of issues related to alleviating poverty, cash transfer programs offer a complement to the ‘supply-side’ interventions which focus on increasing the availability of health, education, and nutrition services and programs.

The Save the Children report offers the following five recommendations:

1. Maternal and child benefits should be an integral part of child survival efforts in countries experiencing high rates of maternal and child mortality. Targets for expanding coverage should be set by the government in a way that makes sense for their national budget and administrative capacity.
2. Cash transfers should be implemented in combination with other policies and programmes.
3. Equity should be incorporated into the existing MDG framework so that the poorest and marginalized are not left behind. Reporting statistics on whether the poorest groups are receiving services intended for them should happen routinely.
4. The Partnership for Maternal, Newborn, and Child Health should include child and maternal benefits in the package of interventions it recommends for the Countdown to 2015 countries.
5. On the donor side, social protection programs – including cash transfers – should receive increased investment.

-Lisa Fleisher

Talking Health in Geneva

May 28th, 2009 12:49 PM UTC
By Eloise Todd

Last week I attended a high-level taskforce meeting on climate change and innovative financing that was part of the 62nd World Health Assembly in Geneva, Switzerland. This precedes a big conference in Paris this week on innovative financing for health.

Dr Philippe Douste-Blazy, Special Advisor to the Secretary-General of the UN in charge of Innovative Financing, proposed the creation of the I-8 Group for the Millennium Development Goals, which brings together United Nations agencies and civil society representatives.

The 8 finance mechanisms are (be prepared for a mouthful):

1. The International Finance Facility for Immunization, supporting the Global Alliance for Vaccines and Immunizations
2. UNITAID
3. The Advance Market Commitments for vaccines
4. The ‘Debt 2 Health’ initiative of the Global Fund to Fight AIDS, Tuberculosis and Malaria
5. (PRODUCT) RED
6. The Responsible Social Investment initiative of the Agence Française de Développement
7. The use of revenues from the Carbon Market
8. The Millennium Foundation for Innovative Finance for Health

Last week’s meeting in Geneva was the first meeting of the group. And it was certainly an impressive set of people sat around the table, including Ban Ki-moon (Secretary-General of the UN), Dr Margaret Chan (Director-General of the World Health Organization) and Michel Sidibé (Executive Director of UNAIDS).
Due to the current economic crisis, Ban Ki-moon pointed out that traditional forms of financing for health are under threat as commodity prices are falling and overseas development assistance is under pressure. He made a plea for innovative ideas and for innovative financing to close the gap between what is available and what we need to meet the Millennium Development Goals. He also emphasized that there is a need for creativity around innovative financing and new opportunities but that it is also critically important to strengthen current mechanisms.

Margaret Chan noted that there were 19 men around the table and only one woman, herself. She talked about maternal mortality and made the stark point that in some countries, women are not allowed to give birth when in labour unless they have the permission of the man.

Michel Sidibe, followed on from Chan, and said that this meeting could not have been more timely. The AfDB recently projected that another 27 million people in Africa are at risk of ill health and poverty. Predictable and sustainable financing is key and this innovative financing scheme must help build a fairer globalization. He concluded by saying the following: “If we are going to reach the Millennium Development Goals, we must avoid duplication, resist competition, and put people at the centre”.

-Eloise Todd

A Success in Addis Ababa

Apr 10th, 2009 12:23 PM UTC
By ONE Partners

Last night, I held a “Idol Gives Back” watch party here in Columbus, Ohio. After watching a segment on AIDS orphans Melanie Berichon, a ONE member who attended, shared the below story with us. I had her write it down so I could share it with all of you.

“This past summer, I was in Addis Ababa. I was able to spend quite some time at a wonderful orphanage for HIV+ children.

Once they started getting the ARVs that were needed and at a fair price, children stopped dying. And so money that they used to save to pay for children’s coffins is now being used for growth and development, empowering the organization to grow and help so many more people.

There aren’t words to describe the feeling I had when seeing so many life saving drugs arrive at the orphanage.”

–
I just wanted to share. Looking forward to seeing tonight’s show too.

-Katie Andrews, ONE regional field organizer

Maternal, Newborn, and Child Health at a Crossroads

Feb 26th, 2009 12:04 PM UTC
By Lisa.Fleisher

The Partnership for Maternal, Newborn, and Child Health (PMNCH) and the World Bank co-hosted a seminar last Wednesday on how to achieve MDGs 4 and 5 through strengthening health systems and increasing international and domestic financing for key maternal and child health interventions. MDG 4 calls for a two-thirds reduction in child mortality, and MDG 5 calls for a three quarters reduction in maternal mortality and increased access to reproductive health services. Countries are off-track to achieve these MDGs, and there has been almost no progress in reducing maternal mortality in Africa. Seminar participants discussed how to jump-start progress through more effective and efficient financing.

Financing for health systems has been dwarfed in recent years by financing for infectious diseases. While some progress has been made in the prevention and control of diseases like HIV, tuberculosis, and malaria, too many women and children in poor countries still die every year of diseases that are no longer issues in the wealthier world. The global community is now increasing its attention on building health systems in developing countries to maximize and sustain investments in infectious diseases and to address the root causes of poor maternal and child health.

The High-Level Task Force on Innovative International Financing for Health Systems is at the center of global efforts to estimate the resource needs to strengthen health systems and define the mechanisms that can accomplish this goal. Launched in September 2008 and co-chaired by World Bank President Robert Zoellick and UK Prime Minister Gordon Brown, the Task Force has among its members high-level policymakers from key donor and recipient country governments. Operating under the premise that more aid is necessary – but better aid is absolutely critical – the Task Force has two working groups estimating the global price tags and country-level costs of achieving the MDGs. A key emphasis of the ongoing work is on the right mix of innovative financing mechanisms to deliver aid more effectively and efficiently. Accountability for funding and the results it achieves is high priority for donors, recipient countries, and civil society. The Task Force will deliver the results of the working groups at the G8 meeting in July, including recommendations on the appropriate mix of financing mechanisms to strengthen health systems and ultimately improve maternal and child health outcomes.

-Lisa Fleisher

Meeting at the Global Health Council

Feb 23rd, 2009 12:06 PM UTC
By Ian McGroarty

ONE rubbed elbows with some of its many partners Friday at the Global Health Council’s community meeting with Dr. Christoph Benn, the Director of Partnerships, Communication and Resource Mobilization at the Global Fund to Fight AIDS, Tuberculosis and Malaria (a very lengthy title with an even longer list of responsibilities). The Global Fund is a partnership of many organizations created to increase and disburse performance-based grants to fight HIV/AIDS, TB, and Malaria, and it has helped drastically improve global health since its inception seven years ago. Nevertheless, many challenges remain. I had the opportunity to talk with Dr. Benn after the presentation, and he gladly accepted a ONE band to show his support.

Dr. Benn was proud to announce that HIV/AIDS treatment has expanded; however, prevention remains the dominant challenge. TB poses its own obstacles due to its extreme drug resistance and its complex/ expensive treatment. However, the Global Fund is beginning to see a decline in infection in Asia, though progress in Africa is slower. This may be in relation to the high prevalence of HIV in Africa; in effect weakening people’s immune systems and making them more susceptible to TB. Child mortality due to Malaria decreased 50- 70% in some countries thanks to mosquito net disbursement and increased access to affordable treatment and disease control mechanisms. We are making progress, and looking to the future, it is no secret that we are accelerating.

The demand for Global Fund grants is increasing at unprecedented levels, but with the global economic downturn tightening public budgets, the Fund is now facing critical funding gaps. As ONE members, will need to get out and make their voices heard!

-Ian McGroarty