The whirlwind, week-long, study tour concluded on Friday with a local NGO site visit to the Negeri Sembilan Family Planning Association and Reproductive Health Association Melaka Clinic and Youth Program outside of Kuala Lumpur. Delegates toured the NGO’s health clinics and youth center to gain an overview of the NGO and its work. There, they met with NGO staff and the patients who are benefiting from the health services. Both this site visit, and Monday’s visit to the Putrajaya Health Clinic, gave delegates the unique opportunity to witness Malaysia’s health successes first hand. Overall, the week was success as the delegates left with a greater understanding of Malaysia’s health system and reproductive, maternal, newborn and child health successes, and the importance of investing in women and girl’s health worldwide.
By: John Ariale
John Ariale was a study tour delegate. This post is cross-posted, with permission, from his personal blog, Vantage Points. The original post can be found here.
Our week in Kuala Lumpur is almost over and we’ve had an amazingly busy and informative week of meetings, briefings and field visits. Whether visiting with the Malaysian government’s ministry of health, touring government facilities, sharing thoughts with one of the 4,000 delegates from around the world, or participating in roundtable discussions with experts in the field, I have been immersed in the issue and focus of the conference.
In 2000, all UN Member States committed to eight Millennium Development Goals (MDGs), which aim to significantly reduce extreme poverty and disease, ensure environmental sustainability, and enhance international coordination around development by 2015. That means that 189 countries committed to ending extreme poverty worldwide through the achievement of these MDG’s. The MDGs are the FIRST and ONLY international framework for improving the human condition of the world’s poor.
MDG 5 — Improve Maternal Health — set a target of reducing maternal mortality by three-fourths by 2015. And that has been one of the key focal points of this conference. Every year, between 350,000 – 500,000 girls and women die from pregnancy-related causes.
Medical solutions exist, but increased government attention is needed to implement policies to improve the supply of and demand for services that will help. While the numbers of deaths are decreasing, the progress is not enough or fast enough to meet the MDG goal by 2015. Almost all maternal deaths occur in developing countries; especially vulnerable are poor women. In fact, maternal mortality represents one of the greatest health disparities between rich and poor and between the rich and poor populations within every country.
Interestingly enough, providing the essential services needed to make significant improvements in maternal health are estimated to cost less than $1.50 per person in the 75 countries where 95% of maternal mortality occurs. The great majority of maternal and newborn deaths can be prevented through simple, cost-effective measures.
For instance, using a country closer to home, in Haiti, the maternal mortality rate is the highest in the Western Hemisphere with 350 deaths per 100,000 live births. In comparison, the rate in the U.S. is 12.7 deaths per 100,000 live births and Afghanistan’s rate was 1,600 deaths per 100,000 live births (2002). Several programs in Haiti have trained over 700 traditional birth attendants to assist with child birth since only 37% of all births in Haiti take place in a health facility.
Thanks to these attendants, pregnant women in Haiti have increased access to trained assistants who assist with safe deliveries. Identifying signs of high-risk pregnancies, and referring at-risk pregnant women to health facilities for care. In Afghanistan, thanks to skilled birth attendants and access to education about pregnancy, the maternal mortality rates went from 1,600 deaths per 100,000 live births in 2002 to 327 deaths in 2010.
Achieving MDG 5 is not only an important goal by itself, it is also central to the achievement of the other MDGs: reducing poverty, reducing child mortality, stopping HIV and AIDS, providing education, promoting gender equality, ensuring adequate food, and promoting a healthy environment.
The U.S. is a leader in funding these programs, but this is not just a U.S. government problem. It’s one that will take government, in partnership with other donors, governments, academia, the private sector, religious institutions, civil society and individual advocates.
Failure to invest in the maternal health of women in developing countries is a missed opportunity for development in those countries that need critical development gains the most.
The last day of the Women Deliver 2013 Global Conference focused on looking to 2015 and beyond. Of all of the Millennium Development Goals (MDGs) set to expire in 2015, MGD 5 is the furthest behind and it is critical to take a stock of why it is not being reached. To do so, delegates attended panels, plenaries, and sessions highlighting why the well-being of girls and women should be a top developmental priority in the new development framework. Delegates attended “To the Point” sessions which were similar in structure to TEDTalks. There, they heard MSH President and CEO Dr. Jonathan Quick speak about Why Universal Health Care is a Women’s Issue.
During the afternoon, the delegates had the opportunity to meet one-on-one with Melinda Gates and Chris Elias from the Gates Foundation. During the meeting, they were briefed on the Gates Foundation’s work and gained a better understanding of the role foundations play in advancing global health priorities. The day concluded with an interactive dinner discussion hosted by the Global Health Corps, Pathfinder International, and PSI, entitled “Smells Like Teen Spirit – A Look at the Role and Importance of Youth in Global Development Efforts. Delegates and youth facilitators discussed the unique services and interventions that young people need, why rolling out and implementing youth-specific policies are key,the important role young people play in health and development efforts, and where young people fit into the post2015 development agenda.
The fifth day of the tour started with a briefing at the US embassy, where delegates met with US Ambassador to Malaysia Paul W. Jones and other US officials. After the briefing, delegates headed back to the convention center to attend the Women Deliver Conference. The second day of the conference discussed reducing unmet needs to contraception for the 220 million women who lack access. In particular, the day focused on Millennium Development Goal 5, which calls for universal access to reproductive health to allow women to plan the number and spacing of their pregnancies. The panels and sessions explored how the global community can continue to address and decrease this unmet need and ensure that women around the world have safe and healthy pregnancies. In the evening, delegates attended the 2013 Impact Awards Reception, hosed by PSI and Women Deliver. The Impact Awards honored individuals from an array of sectors integral to women’s global health efforts.
The fourth day of the study tour marked the first day of the Women Deliver 2013 conference, which convened more than 4,500 participants from 149 countries to discuss women’s empowerment and the health and well-being of women and girls, with a particular look to the future of the development framework. Delegates attended high level plenaries, concurrent panels, and engaged in a lunch dialogue with Rosmanh Mansor, first lady of Malaysia. The first day’s theme highlighted the investments made in the health, education, empowerment, and rights of girls and women around the world. Delegates learned how healthy girls are more likely to attend school, have safe pregnancies and deliveries, and grow up to have healthy and educated children. They learned that when we invest in women and girls, they survive, and simply put, families, communities, and countries thrive.
The evening concluded with a dinner panel discussing the delivery of maternal, newborn, and child health services in fragile, post conflict states. Panelists presented on the challenges faced, and success achieved, in the delivery of maternal, newborn and child health (MNCH) and reproductive health (RH) services in fragile states, such as Afghanistan, Haiti, and Democratic Republic of the Congo. Delegates left the dinner with a stronger understanding of the political, economic, and health conditions in fragile states, the major barriers to MNCH and RH service delivery, and the roles leadership and governance play in saving the lives of women and children.
By Sandeep Bathala
This post is cross-posted, with permission, from New Security Beat, the Wilson Center’s Environmental Change and Security Program’s blog. The original post can be found here.
It’s funny when you bump into your neighbors on the other side of the world. Today I spoke about the Global Health Initiative’s recent collaboration with the Population Foundation of India at a regional briefing on health in South and Southeast Asia before the 2013 Women Deliver conference in Kuala Lumpur, Malaysia. The special roundtable was part of a week-long study tour for a group of U.S. Congressional staffers that work on foreign affairs.
Management Sciences for Health, CARE, the Center for Health and Gender Equity(CHANGE), the Global Health Council, PATH, Population Services International (PSI), andWomen Deliver all partnered to bring this study tour to Kuala Lumpur during the Women Deliver conference for briefings and site visits that demonstrate the importance of investing in global health. I participated in a briefing that provided the staffers with important insight on the diversity of the health needs of countries in South and Southeast Asia.
Progress and Challenges in India
Drawing on our dialogue in New Delhi last month and a forthcoming report summarizing its recommendations, I discussed the recent progress and remaining challenges in maternal health care in India.
India has made big strides over the past decade to reduce maternal mortality. A decade ago, close to 75,000 women died every year during childbirth or due to pregnancy-related causes. By 2010, this number had fallen to 50,000. The country’s maternal mortality ratio fell from 301 maternal deaths per 100,000 live births in 2003 to 212 in 2009.
But despite this, India is not on pace to reach the maternal mortality Millennium Development Goal of 109 or fewer maternal deaths per 100,000 live births by 2015. Twenty percent of all maternal deaths worldwide still occur in India. To close this final gap, special effort needs to be made to reach disadvantaged communities.
The National Rural Health Mission (NRHM), its rural health care workers, and the Janani Suraksha Yojana (a conditional cash transfer program for institutional births) have contributed positively to improving the Indian women’s access to health care. According to the 2009 Coverage Evaluation Survey, nearly three out of four births took place in institutions – up from less than 40 percent in 2005-06. More than two-thirds (69 percent) of pregnant women received at least three antenatal checkups, and around 90 percent received more than two tetanus toxoid injections.
Wide disparities and inequities in women’s access to healthcare continue to persist, despite the overall progress. Sadly, access to health services still depends on a woman’s education, wealth, the community she belongs to, and where she lives. For instance, although in total 73 percent of Indian women give birth in institutions, the number is much lower (54 percent) among women who have no education, who belong to the lowest wealth quintile (55 percent), are a member of the Scheduled Tribes (57 percent), or live in rural areas (68 percent).
The poorest women–those belonging to Scheduled Castes and Scheduled Tribes–have yet to be brought into the fold of an inclusive healthcare system in many parts of the country. For example, over a period of eight months in 2010, 26 maternal deaths took place in the Barwani district hospital in Madhya Pradesh. Tragically, 21 of these 26 women belonged to Scheduled Tribes. Even more alarming is that an inquiry commissioned by the government found all 26 deaths were avoidable.
Regional differences are also important. States like Assam, Rajasthan, and Uttar Pradesh have maternal mortality rates over 300 maternal deaths per 100,000 live births. Attention also needs to be paid to transient populations, including women who temporarily migrate to their birthplace for delivery.
As summarized by Executive Director of the Population Foundation of India Poonam Muttreja in a column for the Hindustan Times, seven strong conclusions emerged from the deliberations we helped organize in New Dehli:
One, we must recognize maternal morbidity as a serious health issue. For each woman who dies, an estimated 20 more suffer from infection, injury and disability during pregnancy and childbirth. Some women die, while for others, life is a living death experience. These complications range from fistula, uterine prolapse, painful sexual intercourse, reproductive tract damage and infections, anemia and even infertility. Maternal morbidity, like maternal mortality, can be easily prevented.
Two, we must integrate maternal health, reproductive health and family planning – now delivered as vertical programs – into a universal health coverage plan that recognizes woman’s health as a basic right. For example, anemia among girls needs to be addressed at a younger age. Waiting till they are pregnant and then treating them for the condition may be too late. Similarly, a substantial number of maternal deaths can be prevented by merely meeting the unmet need for family planning and providing access to safe abortion services. The government of India has taken a right step by announcing a comprehensive strategy on reproductive, newborn, child and adolescent health (RMNCH+A).
Three, we must focus on the marginalized. Within an overall framework of universal health coverage, India needs to adopt special and differentiated strategies to reach women in remote rural areas, those belonging to tribal communities, and the more disadvantaged groups in society.
Four, we must improve the quality of care by putting in place adequate guidelines, protocols, checklists and introducing a system of accreditation for facilities and services for both the public and private sector.
Five, address the shortage of human resources. Despite the more than 10-fold increase in institutional births over the past five years, there has not been a matching increase in staff strength. Skills of field functionaries such as auxiliary nurse and midwives (ANMs) have been lost as they have been instructed not to conduct deliveries. Many healthcare providers trained in the Indian systems of medicine fail to recognize clinical symptoms of an obstetric emergency.
Six, ensure greater accountability from the highest level instead of holding the frontline health worker or the Accredited Social Health Activist (ASHA) responsible. A greater involvement of the communities in monitoring the health services, which has begun under the NRHM, needs scaling up with adequate budget allocation.
Seven, gaps in knowledge must be addressed. Better monitoring and evaluation systems need to be introduced. A community perspective should be brought into the assessment of service delivery. A robust methodology should be developed for measuring morbidity and collecting real time data. More regular studies on maternal mortality and morbidity should be planned.
I also emphasized an eighth recommendation to the staffers: Social determinants to maternal health need to be addressed. Key among those are social customs, beliefs, and practices that occur across much of the world that contribute to poor health and inequity for women, including child marriage and early pregnancy, violence against women, and the political and economic disempowerment of women.
As Muttreja so eloquently says, “the last mile is always the most exhausting, exasperating and difficult to cover.” Collectively, we can do it. Whether here at global gatherings like Women Deliver or in New Delhi and Washington, DC, we need to continue to spread the message about the importance of investing in maternal health.
Read the Global Health Initiative’s full coverage from Women Deliver, part of our Advancing Dialogue on Maternal Health series with the Maternal Health Task Force and UNFPA.
Sources: Hindustan Times, UN.
Photo Credit: Schuyler Null/Wilson Center.
By: John Ariale
John Ariale was a study tour delegate. This post is cross-posted, with permission, from his personal blog, Vantage Points. The original post can be found here.
Getting here was a challenge and on the day we landed, we took advantage of our limited free time to explore the city. But on Sunday, the real work began! All day long, we participated in interactive and engaging round table discussions with some of the world’s most engaged and passionate people on the issues that I believe are vital to the United States. It was a pre-curser to the rest of our week in KL.
We are here to participate in the 2013 Women Deliver Global Conference. This is third international conference of its kind intended to bring world leaders and experts in the field together to discuss one aspect of our foreign assistance agenda. The Women Deliver conference builds on commitments, partnerships, and networks mobilized at the groundbreaking Women Deliver conferences in 2007 and 2010, fighting to end the deluge of preventable deaths that kill approximately 287,000 girls and women from pregnancy-related causes every year.
Many people back home wonder why the United States is engaged in funding activities like global health concerns and sometimes its hard to explain. But when you’re in a place like this, surrounded by people who address these concerns daily, it’s more than clear why.
Despite the fact that many people view foreign assistance as unnecessary – particularly in austere budgetary climates – I would argue that drastically reducing foreign assistance is not the answer to balancing the budget, nor is it our best interest as a nation.
To help frame the discussion, its important to note that sixty percent of people questioned in a CNN/ORC poll conducted early in 2012 said they’d like to put foreign aid on the budget chopping block; however, at the same time, the public grossly overestimated how much the U.S. is spending on foreign aid. Americans estimate that foreign aid takes up 10% of the federal budget, and one in five think it represents about 30% of the money the government spends. The reality is, it amounts to less than one percent of our budget and I contend, it may be one of the most important annual expenditures and investments we make.
We are a nation blessed with an abundance of wealth and opportunity and I firmly believe that we have a moral responsibility to invest in the world around us. For one percent of total federal spending, the United States is able to respond to humanitarian needs, promote a more secure world, help those most in need around the world, and spur economic development to improve people’s lives. But just as important as our moral responsibility in this arena is the fact that these precious taxpayer resources are an investment in America’s long-term national security.
No matter your political persuasion, it is a fact that the money we spend on global health and development is a cost effective investment. The threat of terrorism and extremism are two of this generation’s greatest challenges. Families all around the world want the same thing. A happy, healthy family, one that promotes and stabilizes the family unit, that leads to a strong village filled with hope and optimism for tomorrow, which leads to stable governments, stronger economies, more friends abroad, and ultimately, a peaceful world.
While it might sound naive, it is the truth….promoting peace and stability through effective foreign assistance ultimately means the promotion of healthy societies, which are often the best defense against extremism and protects our overall national security interests.
Today’s briefings and discussions focused more pointedly on women’s health and we had robust discussions with numerous groups working on the ground. We heard from advocates like Mandy Moore and Barbara Bush, plus numerous experts from the field. Funding programs that improve the health and lives of girls and women in the developing world is a smart investment for the United States. Every year of schooling for a girl increases her future earning potential between 10-20 percent. Simply ensuring skilled care during a delivery would reduce maternal deaths by 74%.
Women are important contributors to the global economy. They make up 40% of the global labor force and more than 60% of the workers in agriculture in sub-Saharan Africa. When women thrive, families flourish, communities do well, and nations grow.
The math is rather simple, investing in women pays dividends. I am looking forward to meeting experts from the field over the next few days and the dynamic conversations that will follow!
On Monday morning, the delegation visited the Ministry of Health, where they were briefed on the current investments in, and the successes of, the Malaysian healthcare system. The briefing identified how the Malaysian health system’s successes can be used as an example to achieve similar results in other countries and helps meet the Millennium Development Goals.
After the Ministry briefing, delegates visited the Putrajaya Health Clinic outside of Kuala Lumpur. There, they toured an integrated family health clinic with Malaysian government officials. Delegates gained an overview on the clinic’s holistic health services; saw the impact of family counseling, education, reproductive health, and family planning services; and gained a better understanding of health research and development, social marketing, and health promotion initiatives. The delegates also met directly with the women and children who are benefiting from the Putrajaya Health Clinic‘s services.
Sunday started with The Global Health Landscape roundtable, which discussed the landscape of global health development and what is being done today and what is needed for the future. The panel discussed how US investments in global health protect national security, build partnerships, demonstrate moral leadership, and improve public diplomacy. Speakers Mandy Moore and Jonathan Quick, and panelists Barbra Bush, Robert Clay, and Karl Hofmann also discussed the progress and challenges of current global health programs.
In the afternoon, a regional briefing on health in South and Southeast Asia was held. Regional experts briefed study tour delegates on the health status of countries in South and Southeast Asia with a special focus on maternal and child health. The briefing addressed the diversity of the countries and their health needs and what health progress has been made in the region, while also identifying the health challenges that remain.
After the regional briefing, delegated attended a roundtable discussion on US Global Health Engagement: Trends and Opportunities. The discussion highlighted how global health provides the US with opportunities to address some of the most important international challenges and discussed the fundamentals of US government engagement in global health, including what the US has done well and what future priorities should be.
In the evening, delegates attended a reception, co-hosted by MSH and PSI, with special guests US Ambassador to Malaysia Paul W Jones, Barbara Bush, and Mandy Moore. The reception highlighted public-private partnerships and how both public and private organizations can better confront global health challenges together.
After disembarking twenty (or more) hour flights, and doing some whirl-wind sight-seeing around Kuala Lumpur, the study tour kicked off in Malaysia on Saturday May 25th with a meeting to discuss the activities and main objectives for the week. Women Deliver President Jill Sheffield spoke to the group about the Women Deliver 2013 Global Conference and the importance of maternal health and women’s issues. The learning objectives for this trip were also addressed, stressing how the Malaysian government’s health investments, particularly in maternal health, have led to sustainable, wide-spread impact throughout the country.