 18 March 2008
New York—A
new fund dedicated to improving
the health of mothers in
developing countries will
try out some innovative
approaches, offer original
arguments and set firm
performance standards as
it gears up over the next
four years, according to
those closest to the action.
The Thematic
Fund for Maternal Health opened
for business January
1 at UNFPA, the United
Nations Population Fund,
in response to developing-country
demand for a special focus
on this issue. Its goal
is to raise US$465 million
by 2011 and to leverage
those funds to have a significant
impact in the 75 countries
where maternal mortality
and disability rates are
worst.
Ireland was the first to
donate, pledging 2 million
Euros, and Spain was next
at 6 million Euros. Fund
coordinator Yves Bergevin
of UNFPA’s Technical
Support Division said “promising
discussions” with
governments, foundations
and some non-traditional
donors made him confident
that more is on the way.
"It is critical to
invest in women if we are
to achieve the Millennium
Development Goals,” especially
MDGs 4 (improve child health)
and 5 (improve maternal
health), said UNFPA Executive
Director Thoraya Obaid in announcing the Thematic
Fund. "We urge countries
to dedicate more resources
to improving national health
systems, training skilled
birth attendants and promoting
family planning.”
The launch follows renewed
global attention to stubbornly
high rates of maternal
and newborn death and disability
in the developing world,
in contrast to growing
overall life spans and
declining child deaths.
A woman still dies from
pregnancy-related causes
every minute – more
than 536,000 per year,
99 percent of them in the
poorest countries. Another
10 million suffer injury
or long-term disability,
and four million newborns
also die. The loss to families,
communities and countries
robbed of so much potential
creativity and labor has
been estimated at more
than US$15 billion per
year.
The landmark Women Deliverconference
drew 2,000 advocates to
London last October to
discuss the situation and
generate the political
will and new investment
needed. Participants agreed
that the tragedy is needless:
the deaths are virtually
all avoidable with known
techniques, and at reasonable
cost. “Millions of
deaths and disabilities
could be prevented if every
woman had access to reproductive
health services,” Obaid
said: basic care including
family planning; skilled
care during labor and delivery;
and emergency obstetric
care when needed for complications.
The World Health Organization
estimates that by 2015,
$6 billion a year will
be needed to provide such
services in the 75 countries
where 95 percent of maternal
deaths occur.
The investment would be
a good one, said the cabinet
ministers from 35 of those
countries in a joint statement
at Women Deliver: it “pays
off in terms of social
and economic benefits for
the family, the community
and society at large.” They
called for a special fund
and pledged to become advocates
at home for “increased
commitment of financial
and human resources to
address the causes of high
maternal and neonatal mortality.”
The timing of this raised
awareness is perfect, said
Bergevin. The new fund
will rely on partnerships
among governments, UN organizations,
non-governmental groups,
foundations and other international
actors to succeed. It will
coordinate with existing
initiatives, such as UNFPA’s
own programs to create
secure supplies of contraceptives
and end female genital
cutting and obstetric fistula;
the Global Campaign for
the Health MDGs, including
the International Health
Partnership initiated by
Prime Minister Gordon Brown
of the United Kingdom and
by Prime Minister Jens
Stoltenberg of Norway and
related initiatives; and
the global Partnership
for Maternal, Newborn and
Child Health. All aim to
accelerate the achievement
of the health-related MDGs
while strengthening countries’ health
systems and promoting the
harmonization of donor
aid to countries.
In the Thematic Fund’s
current startup phase,
the maternal health aspects
of the national health
plans in 40 African countries
are being evaluated by
UNFPA. Initial interventions
will occur in 25 countries
with favorable prospects,
most in sub-Saharan Africa
and south Asia. Rosters
of available technical
expertise and regional
institutions are being
drawn up, while field workers
assess national needs,
collect data and promote
the program among policy-makers
and community leaders.
Survivors of birth complications,
in particular obstetric
fistula [link here to UNFPA
program www.endfistula.org]
are on board as advocates
and to generate local and
global support and pressure
for change, especially
among women themselves.
Specific country goals will
be set that are more detailed
than previous assessments
have allowed, Bergevin
said. For example, a government
might decide to achieve
skilled care for 80 percent
of all deliveries in a
certain community by a
certain date, which requires
deciding how many midwives
must be recruited, trained
and deployed in what places
to make that possible.
The fund is considering
asking governments to use “performance-based
funding” as part
of their persuasive arsenal.
This innovative approach
might reward a clinic in
cash for every baby it
delivers safely, for example
(defining safe delivery
as one that occurs in a
well-functioning facility,
with skilled professionals
present who have recognized
midwifery competence and
where basic emergency care
and referral to advanced
emergency care are both
available if needed. Every
achievement would generate
more funding.
The prospect of direct reward
would thus be an incentive
to “scale up” – to
increase the clinic’s
overall capacities, the
quality of its personnel
and its general effectiveness,
and to make women in the
area aware that the services
are available. These are
all goals of the Thematic
Fund at every level – clinic,
hospital, health system
management and national
policy change.
The fund’s $465 million
over four years is only
two percent of the need,
Bergevin noted, so that
it can only be a catalyst:
mobilizing funds from other
sources and providing key
technical assistance, equipment
and supplies to promote
rapid scale-up. Specific
objectives will depend
on each country’s
capacity and situation.
Overall benchmarks for the
fund’s performance
will be results-based in
relation to the UN’s
indicators of global progress
toward MDG 5: proportion
of births attended by skilled
personnel, rate of contraceptive
prevalence, adolescent
birth rate, antenatal care
coverage and the unmet
need for family planning.
Such accountability is increasingly
important among donors
and non-traditional funders,
such as the smaller foundations
and selected corporations
that UNFPA is courting. “It’s
a change in philosophy
more than a change in accounting.
Everyone in the chain will
have to be thinking about
performance,” Bergevin
said.
The task is daunting but
it has been done before.
Malaysia, Sri Lanka and
Bolivia took six to ten
years to cut their maternal
mortality rates from 400
to 200 per 100,000 live
births, according to UN
and World Bank figures;
Sri Lanka cut it again
from 200 to 100 in another
six to seven years, and
Chile, Egypt, Colombia
and Thailand did the same.
Then Thailand joined Honduras
and Nicaragua in cutting
their rates from 100 to
50 per 100,000 live births
in another four to six
years. The Thematic Fund
hopes that success in its
first 25 target countries
will lead to additional
contributions so that it
can introduce its program
in the 50 remaining needy
countries between 2012
and 2015.
One important goal will
be recruitment of new health
care workers to help alleviate
the world shortage. Every
target country will be
encouraged to provide incentives
for recruitment, training
and retention of such workers
as well as to do more with
existing personnel. “If
people have decent working
conditions, drugs and supplies,
they will work even with
sub-optimal salaries,” Bergevin
said. “There are
many approaches to make
the money go farther.”
UNFPA will manage the new
fund as part of its Strategic
Plan 2008-2011, its Country
Programmes and Global and
Regional Programmes by
expanding its workforce
in the target countries
and working closely with
other UN organizations
and international partners.
Nobody is more excited about the Thematic Fund for Maternal Health than people working in the countries where it will operate. “Ethiopia aspires to take part in this program at the earliest possible stages” said Ethiopia’s Minister of Health Tedros Adhanom Ghebreyesus. “The Government is highly committed to attaining the MDG targets and maternal health has been reflected in the HSDP III [Health Sector Development Programme III] as a priority area of intervention. Currently, big effort is going on to ensure universal primary health care coverage through an Ethiopian flagship program called Health Extension Program and accelerated expansion of health facilities and human resources, which will address issues of maternal mortality and improve access to maternal health services. It is my sincere hope that more resources will be available by development partners for the same and I look forward to working closely with the Maternal Health Thematic Fund to make the future maternal survival much promising to our mothers and for all Ethiopians.”
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