19 February 2013

Nigeria: Impatient Optimists and Maternal Health


It was Bill and Melinda Gates founders of Bill and Melinda Gates Foundation that coined the phrase 'Impatient Optimists".

It's underpinned their resolute and resilience to support the global effort to improve Maternal Health. It is a phrase that resonates well with every development worker. Although in many developing countries, the Millennium Development Goal (MDG) 5 of improving Maternal Health by 2015 will not be achieved, however we should all be optimistic and impatient to continue doing what we can to reduce the burden of maternal death which will positively reduce the burden of newborn and child mortality.

To significantly impact on the lives of women and children globally and locally, we should also be working as a team to have a strong voice and commitment that will help us to see the light at the end of the tunnel. It is in that light that the Global Maternal Health Conference came to being to create that space for the maternal health community to get together to discuss challenges and solutions so that we can improve programs.

The recent successful Global Maternal Health Conference 2013: Improving Quality of Care in Arusha, Tanzania achieved much more than creating a space but it created a momentum for change, inspiring a movement. The research presented at the conference helped to break through some of the false dichotomies in maternal, newborn and child health: "care delivered at home versus at a health facility, focus on the mother versus the baby, urban versus rural poor, and sexual reproductive health versus maternal health." This discussion helped to move the agenda forward towards a common platform for maternal health. The plenary on "respectful" services brought to the fore the human rights, ethics, and quality of services perspectives of midwives, community groups and champions for governance and accountability. And the panel on urban maternal health brought in the social, economic determinants and the urban poor context.

The Momentum

As I reported sometime back, a standing ovation followed Professor Mahmoud Fathalla's presentation at the closing of the conference, as he brought us along on a historical journey dating back to the Lady of Laetoli who left the earliest known human footprints, 3.6 million years ago in Laetoli, Tanzania. He concluded by saying: "We thank and we appreciate; we regret and we apologize; we promise, and yes, we can." The regrets refer to the fact that still 800 women die every day although women in the twenty-first century "do not have to give up their lives when they give us a new life". We can save lives and appreciate the drop in maternal mortality by 33 percent between 1990 and 2010; and yes, we can do more. Also helping to create a momentum for change was the high level engagement from political leaders in the region, with Hon. Salma Kikwete, the First Lady of Tanzania, and Hon. Mohamed Gharib Bilal, the Vice President of Tanzania, attending the conference, and the contribution of the Minister of Health of Rwanda, Hon. Dr. Agnes Binagwaho. Broad representation across geographies, disciplines, and age groups, including young researchers and activists, helped fuel the momentum as well. The many scholarships that the Maternal Health Task Force had given to young researchers enabled them to travel to the conference and share their data.

A vision for moving forward

The meeting resulted in a manifesto which was presented by Richard Horton, editor of The Lancet, to contribute to the platform for moving forward and to the discussions about new global health goals, post 2015. Included in the recommended actions going forward are: setting a new and challenging goal for maternal mortality post-2015; redefining the continuum of care to make women central to Reproductive, Maternal, newborn and child health (RMNCH), and include quality, HIV, malaria, and social determinants; reaching women who are socially excluded because of, for example, culture, geography, and education; listening to voices of women in policy and making sure women have a platform and power to shape their futures; addressing stillbirths and newborn mortality; strengthening measurement, information, and accountability about maternal outcomes; and, empowering women to connect to services when they need them through the power of mobile technology.

Implication to local efforts

With all the steps taking at the global community to work together between donors, researchers, academia, government, civil societies and media, if one look at how fragmented our work is in Nigeria among the above mentioned stakeholders, it leaves much to be desired. Everyone is a lone champion and wants to go alone in the crusade to improve the lives of women and children. We are yet to have a common space for repeated dialogue and action and we are yet to have a common strong voice that resonates with a compelling message that are repeatedly echoed until actions are taken and results are assured.

It is time to begin to talk to each other, widen the space of dialogue and develop an annual mechanism of engagement to curve the burden of maternal and child mortalities.

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