19 June 2012

Will a New Private-Public Partnership Ease the Burden of Maternal Mortality?

A version of this originally appears in the PSI Healthy Lives Blog.

Millennium Development Goal 5 outlines a three-quarters reduction in maternal deaths by 2015. The world is behind on the mark and will require rapid changes in order to meet the target. Among the many events, panels and announcements that took place at last week's Child Survival Call to Action, one of the biggest came from pharmaceutical giant, Merck.

A multi-partner effort, Saving Mothers, Giving Life will support the aggressive reduction of maternal mortality in countries with the highest mortality rates. The partners are putting some serious money behind the effort to the tune of $200 million over five years. The founding partners include the US Global Health Initiative (GHI), Merck for Mothers, American College of Obstetricians and Gynecologists (The College), Every Mother Counts (EMC), and The Government of Norway.

Of the estimated 3 million women that die from complications due to pregnancy and childbirth, the majority take place in the developing world. Of that total, 90% of maternal deaths are believed to be avoidable. Hundreds of thousands of lives can be saved by focusing on the countries with the highest burden of maternal mortality. "A mother's death is a tragedy because it destroys one of the most fundamental human connections – the bond between a mother and her child. Compounding this tragedy is the way this death unravels families and communities. The effects of a mother's loss can echo for generations. Merck is supporting Saving Mothers, Giving Life through our Merck for Mothers initiative because we need to make a change," said Kenneth C. Frazier, Merck's chairman and CEO.

By ensuring that mothers are healthy, children are provided with a greater opportunity to survive and thrive. The program says it will focus on accomplishing the following three objectives:
  1. Develop models of quality maternal health services through district health network strengthening to achieve maximum, sustainable impact
  2. Galvanize the American public to create a domestic constituency to support saving mothers’ lives around the world
  3. Engage new public and private partners around the world to co-invest in saving mothers
Uganda and Zambia will serve as the start point for the program. In Uganda, the program will hone in on the districts of Kabarole, Kibaale, Kamwenge, and Kyenjojo. In Zambia, the partners will a focus on the districts of Lundazi, Nyimba, Kalomo, and Mansa. If the objectives are achieved, Saving Mothers, Giving Life expects to reduce maternal mortality by 50% in the nations' targeted districts.

Secretary of State Clinton voiced her support for the partnership earlier in the month when speaking in Oslo, Norway. "I am very pleased that the United States will be a part of the Saving Mothers, Giving Life partnership, along with Merck for Mothers, Every Mother Counts, and the American College of Obstetricians and Gynecologists. We’re not focusing on a single intervention, but on strengthening health systems."

The focus on a systems approach was echoed by Geralyn Ritter, Merck's Senior Vice President for Global Public Policy & Corporate Responsibility. "We're really trying to leverage the infrastructures in place by multilateral partners and the governments themselves," she explained. Such a push could signal a shift away from the vertical approach that has come to dominate global health programming.

For Merck, the partnership is both practical and an extension of its commitment to health. "The humanitarian drive is really central to this. It is a part of the corporate culture and why people come to and stay with Merck. It is an important driver," explained Ritter. "It is also in our long term business interests. This helps the organization learn how to deliver care to populations around the world."

According to the WHO maternal mortality worldwide dropped by almost 50% between 1990 and 2010. Such remarkable gains have been celebrated, but the 3.1% rate of decline still falls short of MDG 5 which requires a 5.5% rate. 99% of the burden is in felt in developing countries. For the wealthier nations, maternal mortality is a story of the past. It means that the known solutions do in fact work and the goals set forth by the MDGs and the Saving Mothers, Giving Life partnership are attainable.

"Saving Mothers, Giving Life builds on the U.S. government's longstanding commitment to global health, including PEPFAR and USAID's host of maternal and child health programs," remarked Rajiv Shah, administrator of the U.S. Agency for International Development (USAID). "We look forward to working with the partners to leverage these and other platforms to make an accelerated impact on the health of women and newborns in need."

With actual money behind it, this stands out among the other announcements, pledges and partnerships that came out of the Call to Action. The need for relatively strong governance and infrastructure to carry out the program lead to the decision to start in countries that have high maternal mortality rates, but pale in comparison to countries like Sudan and the Central African Republic.

A targeted reduction of 50% in targeted districts is an ambitious goal by the partnership. With a series of partners and significant financial backing, this will be an intervention that is worth tracking