Organized by Elizabeth Glaser Pediatric AIDS Foundation, Society for Maternal-Fetal Medicine, Treatment Action Group, and WHRC
Organized by Elizabeth Glaser Pediatric AIDS Foundation, Society for Maternal-Fetal Medicine, Treatment Action Group, and WHRC
American College of Nurse – Midwives, American Academy of Pediatrics, The American College of Obstetricians and Gynecologists, and Johnson & Johnson
Global Health and the Future Role of the United States Report Released
The National Academy of Sciences, Engineering, and Mathematics is releasing a report today on Global Health and the Future Role of the United States. In the report, the project committee makes the case for global health in light of current and emerging world threats. The report assesses the changing landscape of global health and outlines priorities for the U.S. government and key mechanisms by which global health engagement can be strengthened. A report launch event in Washington, DC, will be held on May 15, 2017, at which committee members will discuss the recommendations.
PATH Celebrates 40 Years of Innovation
On May 12, 1977, three family planning researchers – Gordon Duncan, Rich Mahoney, and Gordon Perkin — formed a small nonprofit organization with a mission of availing effective forms of modern contraception to couples around the world. The organization came to be known as PATH, and after succeeding at its early goals in contraceptive technology, it expanded its focus to include an array of health technologies. Today, PATH reaches an average of 150 million people in over 70 countries a year with life-saving innovations. The organization has garnered a reputation for excellence and collaboration, for partnering with the private sector, and for smart, effective solutions to global health problems. Congratulations PATH on this incredible milestone; GHC is proud to have you as a member. Read more.
A Call for Accountability to End Attacks on Health Facilities
The Safeguarding Health in Conflict Coalition (SHCC) released a new report which documents the alarming incidence of deliberate and indiscriminate attacks on health workers, patients, and health facilities during periods of armed conflict and civil unrest across the world. The report, Impunity Must End, is based on information received from UN agencies, independent non-government organization researchers, and local and international media in 23 countries that faced political turmoil and violence in 2016. SHCC is a coalition of more than 30 non-government organizations working to protect health workers and services threatened by civil war and unrest. Their latest report calls on the United Nations Security Council and countries to take concrete steps towards preventing attacks and ending impunity, as recommended last year by the UN Secretary General. Read the full report.
Integrating Health and Development to Save More Mothers
Johnson & Johnson, FHI 360, and UNICEF are working on a project to encourage the development of cross-sector partnerships delivering integrated solutions to end maternal and newborn deaths. The project, an online data tool, focuses on bridging critical data gaps in 16 countries where 70% of global newborn deaths are concentrated. Once completed, the Newborn Survival Map will provide a platform to expose cross-sector opportunities for closer collaboration among partners currently in close geographic proximity. In addition, the map will reveal critical gaps in cross-sector services that could prevent the deaths of many more pregnant women and newborns. To join this effort and get your project on the map, please create a new profile online.
This guest blog was written by Cesar Victora, Federal University of Pelotas in Brazil and the London School of Hygiene and Tropical Medicine and Kate Somers, Bill and Melinda Gates Foundation.
Improved data makes inequalities visible. Take for example the lives of two Nigerian girls—let’s call them Fara and Abimbola—who were born one month apart. Fara was born into a poor rural family of Hausa ethnicity in the country’s North West zone. Her 18-year old mother did not receive any antenatal care prior to delivering Fara at home without a skilled healthcare worker. By comparison, Abimbola was born into a wealthy urban family in a city in Nigeria’s South zone. Abimbola’s 27 year-old mother had ten antenatal care visits and delivered in a government-run health center with a skilled midwife. Abimbola weighed 3500 grams (over 7.5 pounds) at birth. In 2013 by age two, the girls’ health outcomes were substantially different. Fara’s growth was severely stunted and she was below the first percentile of the World Health Organization’s growth standards. Abimbola, however, was within the 30th percentile for height – well within the normal global range.
While their names are fictitious, the data is real and their life experiences show how unequal access to services and opportunities perpetuate poor health and nutrition outcomes, limiting the potential to lead a full life. This month the United Nations celebrates the 65th Anniversary of the formal establishment of Human Rights Day observed globally each December. We support a focus on measuring and improving equity for the world’s poorest and most vulnerable to achieve the new Sustainable Development Goals (SDGs) while advancing social justice and human rights.
The study of inequalities was nearly absent from the scientific literature on global maternal, newborn and child health and nutrition until the early 2000’s. This began to change in 2001 when analyses of socioeconomic inequalities within low and middle-income countries were made possible by the incorporation of household asset indices in Demographic and Health Surveys as highlighted in the World Bank’s publication of such analyses.
In 2003, the Lancet Child Survival Series boldly stated that “more of the same is not enough” in a plea for the incorporation of an equity dimension in monitoring, accountability, country-level programming and advocacy. The Lancet series helped launch the Countdown to 2015 initiative in 2005, which has since issued seven global reports where equity analyses play a major role. Several countries, such as Brazil, Mexico, Bangladesh and Peru started to employ explicit equity criteria to guide program implementation. UNICEF embarked on its own journey of prioritizing equity in child survival, health and nutrition. Today at a global level, the Health Equity Monitor at the World Health Organization keeps track of maternal and child health inequalities based on analyses carried out at the Federal University of Pelotas in Brazil.
While the Millennium Development Goals failed to include equity, the SDGs have placed this guiding principle squarely within our global remit, acknowledging that equity is central to sustainable global progress. Equity is a critical component of SDG 3 – ensure healthy lives and promote well-being for all at all ages; SDG 5 – achieve gender equality and empower all women and girls; SDG 10 – reduce inequality within and among countries; and SDG 17.18 which calls for countries to increase the availability of data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts by 2020. The global community realizes that measuring equity matters. The Lancet recently published a comment authored by more than 20 global maternal, newborn, and child health experts, who identified equity as one of five key principles to improve measurement and data use, along with focus, relevance, innovation and leadership.
If we want to ensure a more equitable future for children like Fara, we need to focus on three key dimensions of measuring equity: monitoring, evaluation, and action. First, we must continue to monitor equity. Fortunately, the global community has developed effective processes for how to measure equity through initiatives such as Countdown to 2015 and the WHO Health Equity Monitor where we can see whether coverage of health interventions are becoming more or less equitable across wealth quintiles, gender, and residence over time. Still, more can be done to monitor equity among ethnic groups, the urban poor, and wealth deciles. Second, the evaluation dimension of equity also requires better evidence and understanding. Program evaluations must produce disaggregated results to ensure that the neediest are being reached. We also need to ask ourselves what we are not measuring well enough today, such as women’s empowerment, in preparation for tomorrow. Third, we need action. We know enough about measuring equity today to identify the ‘Faras’ of the world who are experiencing these inequities and prioritize programs and resources to more effectively reach them.
Equity provides a platform for focusing on those who are being left behind. With the SDGs, we have a new global mandate before us. We need to carry forward the momentum we have built to tackle the measurement and programming challenges ahead. We need to invest in improving indicators, data sources, and communication tools to best measure equity and progress. In sum, a focus on equity is a powerful step towards better health, development, social justice, and human rights.
Fara is a typical example of the 13.8% of Nigerian children surveyed in 2013 who failed to receive a single intervention, out of a list of eight well-established life-saving interventions.
Early Easter morning, Paska and Esther, twin girls, were born in Kuajok, the capital of Warrap State, South Sudan. Their country is a perfect storm for poor maternal health, with one of the lowest number of midwives per population and the highest maternal mortality ratio—service coverage and quality remain elusive to most women.
But Paska and Esther were born with no problems, both weighing around 9 pounds! Their mother knew to seek prenatal care and give birth in a health facility (Kuajok Hospital) in case complications arose. Warrap State is where World Vision, contracted by donor agency South Sudan Health Pooled Fund, is supporting the Ministry of Health to implement a health system strengthening intervention aimed to improve Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services by improving staff capacity, access to adequate equipment, required infrastructure, and more.
According to a recent study by WHO on maternal and newborn health, it is necessary to go beyond maximizing coverage of essential interventions to accelerate reductions in maternal mortality. The study demonstrated that despite high coverage, many women still die due to hemorrhage and other disorders of pregnancy. This highlights the need for improved quality of maternal health care and a comprehensive approach to emergency care.
The challenges are many: Kuajok, far from South Sudan’s capital of Juba, is considered a hardship posting, making staff recruitment and retention difficult. Basic supplies must be trucked in from a distance; insufficient beds yield mattresses on the floor; storage space is limited; there is no centralized records database; water is precious and the land unbearably hot and endlessly dusty – at least until rainy season, when mud creates an additional level of challenge.
However, in a recent visit to the region, great strides in progress were undeniable. In recent weeks, a group of 18 staff attended a World Vision-sponsored multi-week CEmONC course led by a volunteer from Medical Teams International (see sidebar) in coordination with the hospital’s Senior Medical Officer and Senior Midwifery Officer. In addition to classroom-style teaching, attendees were able to practice with anatomical models and share experiences.
By the end of the third quarter of project implementation, CEmONC services are functional, meaning that all nine clinical functions to service obstetric and newborn complications are in place. In addition, an incinerator, vital for biohazard control, is nearly finished. Solar-powered lights are now installed in the maternity ward and sturdy examination tables have been delivered. A new ambulance serves the hospital’s referral area, and two shipping containers of supplies are soon to be delivered.
And demand for services is high—it has surpassed the proportion of all births in the CEmONC facility by 12 percent. This illustrates that rapid deployment of emergency obstetric care by INGO-supported public services in a fragile state context is feasible if the quality of emergency obstetric services are closely monitored.
The stronger South Sudan’s health system becomes, including remote areas like Kuajok, the more healthy babies like Paska and Esther will be born safely.