2014 Partners' Forum
30 JUNE - 1 JULY | Sandton Convention Centre, Johannesburg, South Africa
Session 3A: Ending Preventable Maternal Mortality
Dr. Pablos-Mendez, Assistant Administrator, USAID, kick-started the Ending Preventable Maternal Mortality session by emphasizing the possibility of a grand convergence between rich and poor nations on maternal and child health. He announced the agreed global maternal mortality ratio of <70/100,000 live births and said that “we have this incredible opportunity to touch this target within a generation”. He warned that bending the curve will be much more of a challenge in Africa and said that the higher fertility rates in Africa speaks to the need to also expand access to family planning services. He pointed out the importance of guaranteeing both service delivery and financial protection through universal health coverage and stressed the importance of measurement, particularly in the case of maternal mortality which is very difficult to measure given that it is statistically a rare event. Dr. Pablos-Mendez touched on the role of technology, multisectoral interventions, the importance of partnerships and community engagement to make sure that the gains in maternal health are sustainable.
Dr. Lucia Knight from Western Cape University presented on behalf of a group of researchers on their work from 9 countries. The work clearly demonstrates and highlights the devastating economic and social costs of maternal death, and underlines the need to do the utmost possible to end preventable maternal mortality. Her simple but effective message to the audience was “investing in women pays”, and the benefits spill-over to future generations.
Dr. Lale Say from WHO described the process of achieving consensus on global maternal mortality targets among countries, international agencies and development partners and discussed the rationale behind having a global MMR target while customizing the target to country context to accelerate the “grand convergence” among countries. She explained that not only was an average global MMR of <70/100,000 set, but it was also unanimously agreed that no country should have an MMR >140/100,000 live births. These countries will need to pursue an accelerated maternal death reduction strategy but having such an upper limit would promote equity.
Ms. Ann Starrs, President, Family Care International, moderated a stimulating panel discussion that brought both public and private perspectives on achieving this goal. Dr. Addis Tamire, Director General of Health, Ethiopia, extorted the audience to move from talk to action. He spoke about the importance of equity and quality in the provision of health services and emphasized the need for countries to make their own fair choice towards universal health coverage. Using the Ethiopian experience, he stressed the importance of a multi-pronged approach (financial protection, multi-sectoral actions, leaving no one behind, fostering community engagement through health extension workers) when tackling equity and quality issues. In his words “excellence in leadership and governance” is also a critical aspect that should not be neglected.
Dr. Koki Agarwal from JHPIEGO focused her comments on the role that measurement plays in strengthening equity and quality, and the importance of collecting and utilizing disaggregated data (income, gender, geography, etc.). She used the example of how asset-based quintile analysis helped focus our attention on highly inequitable distribution of services such as skilled birth attendance. She spoke to the need to improve measurement in communities, and that only be recording each maternal death can we customize the interventions to reach every woman in need.
Dr. Priya Agrawal from Merck for Mothers noted the significant role that local private providers play in the provision of health services – over 50% in Africa and over 75% in Asia – and the need to facilitate and strengthen their reach through appropriate regulatory and financing arrangements. She provided some examples of using social franchising, accreditation and community accountability to address quality of care, cost of services, as well as ensuring that the private sector is incentivized to share data into the same national data system as public sector providers. Dr. Agrawal’s message was that “women should receive care wherever they seek care” and it is our responsibility to make sure that such care is of good quality and affordable.
Mr. Mishra from MOH, Nepal outlined how his country has overcome the challenges posed by poverty and terrain to improve health outcomes for mothers and children. He raised the crucial role that community plays not only in planning, implementing and monitoring programs at the grass-root level but also ensuring that these advances are sustained. He used the example of using mothers’ groups to improve the nutrition of a family, and the role of mobile technology in tracking the health of women and children. Mr. Mishra stressed the need to couple such interventions with adequate financing – in his view, bringing behavioral changes that can be habituated is the key to sustainable change.
During the very active Q&A session, the audience raised several interesting questions as well as offered comments on a range of issues around reaching marginalized populations such as refugee women, pastoral communities and assuring quality of education while rapidly building up a health work force.
Dr. Pablos-Mendez concluded the session by inspiring the international community to now act as we have reached the “turning point in maternal mortality”.