The High-level Political Forum on Sustainable Development (HLPF) took place in New York from 8 to 17 July 2024. This annual gathering brought together world leaders, policymakers and stakeholders to review progress on the 2030 Agenda for Sustainable Development and the 17 Sustainable Development Goals (SDGs). This year's focus was on accelerating action to achieve the goals by 2030.
SDG 3 relates to good health and wellbeing, with a sub-category for child and maternal health. Making progress against this goal is vital in Africa and Asia given the high maternal and child morbidity rates, preventable deaths and significant disparities in healthcare access. These challenges require comprehensive efforts to improve health outcomes and ensure equitable access to quality healthcare services.
We sat down with four leading technical experts from Malaria Consortium to discuss the pressing issues surrounding maternal and child health in their respective countries. Click here to find out more about our experts and read on for some key takeaways from our conversations:
Q: What are the main barriers to ending preventable deaths among women and children in your countries?
Anthony (Uganda): We face what we call the 'three delays model' -- delays in decision-making at the household level, delays in reaching health facilities, and delays in receiving adequate care at those facilities. Low health literacy, poverty and long distances to health facilities all contribute to these delays.
Fantche (Togo): We're dealing with a maternal mortality rate of 401 deaths per 100,000 live births, with haemorrhages accounting for nearly 50 percent of these deaths. Key barriers include limited access to health facilities, a shortage of midwives, insufficient capacity to deliver quality services, and financial barriers for women seeking care.
Sonia (Mozambique): Only 60 percent of our population has access to health facilities, with rural areas being historically excluded. We also struggle with a shortage of skilled healthcare professionals, and funding gaps for essential health services.
Melanie (Cambodia): Poverty and limited access to healthcare services are significant issues, especially in rural areas where transportation is difficult. Our health system still has gaps in diagnostics and professional training. Additionally, there's a strong reliance on traditional medicine and private healthcare providers, which can lead to incorrect diagnoses or treatments.
Q: How is Malaria Consortium helping to address these barriers?
Anthony: Using community health workers to deliver health services in communities and refer severe cases to health facilities can reduce the burden on health facilities for simple services like general screening. We've implemented integrated community case management (iCCM) projects and introduced maternal and newborn care measures at the community level. We're also working on strengthening linkages between community and facility levels to increase access to life-saving medicines and services.
Sonia: Our upSCALE programme works with community health workers to bring diagnosis, treatment and prevention services directly to communities through the use of a mobile phone application. At the community level, the upSCALE digital health platform has been used to improve the quality and coverage of health services. We're also delivering seasonal malaria chemoprevention -- a safe, effective and cost-effective preventive measure -- to protect children under five from malaria.
Melanie: We're taking a multi-faceted approach. We're developing a human papillomavirus (HPV) and cervical cancer diagnosis programme, aiming to provide quick diagnoses and even first-line treatments at health centres. We also support knowledge building, facilitate disease prevention campaigns, and distribute protective tools such as long-lasting insecticidal nets.
Q: What factors are hindering progress in achieving the SDGs?
Fantche: The COVID-19 pandemic significantly impacted both the supply of and demand for health services. COVID restrictions limited access to health facilities, fear surrounding the outbreak impacted on demand from individuals, and the urgency of responding to COVID cases disrupted procurement of medical supplies. Extreme weather events and conflict have also had an impact on access to health services. We've faced challenges from floods during the rainy season and security issues in some northern regions bordering Burkina Faso and Benin, making certain areas difficult to reach.
Sonia: Climate change has hit us hard, with cyclones and heavy rains displacing populations. We're also dealing with conflicts, that affect programme implementation, particularly in Cabo Delgado province. In the fight against malaria, we're facing new challenges like antimalarial drug resistance and insecticide resistance in mosquitoes.
Melanie: Climate change is intensifying health risks, particularly dengue fever. We're also seeing changes in people's eating habits that increase the risk of developing diabetes and cardiovascular diseases. Antimicrobial resistance is another growing concern, especially with free access to antibiotics without prescriptions.
Q: Why is it important to address inequalities and how can we do this?
Anthony: Maternal and newborn health is not a one-sided issue. It requires a comprehensive, multi-sectoral approach. We need to address not just health services, but also the social determinants of health. This includes improving education -- particularly for girls -- addressing gender imbalances and tackling cultural practices that may be harmful. By taking a holistic approach, we can ensure that we're addressing the inequalities that contribute to maternal and child health outcomes.
Fantche: Caregivers, who are often women, play a crucial role in administering seasonal malaria chemoprevention to their children. When we empower women, we give them the ability to make decisions about their health and their families' health. In some successful models, women's groups highlight the importance to their communities of using health facilities for antenatal care and family planning. By involving women and caregivers in community health structures, we can make health programmes more equitable and impactful.
Sonia: Addressing inequalities is so important because most of Mozambique's population lives in rural areas, where preventable diseases are more prevalent. We have an unequal distribution of health facilities and skilled healthcare workers, with remote areas being neglected [and] we often face medication stockouts in public hospitals. This forces people to buy medicines from private pharmacies, which many cannot afford. By tackling these inequalities, we can ensure that quality health services are accessible to everyone, regardless of their location or economic status.
Melanie: The populations with the most limited resources are often more exposed to health risks and can contribute to the spread of infectious outbreaks. Addressing inequalities is key for social cohesion and the sustainability of the Sustainable Development Goals. By focusing on the marginalised groups, we're not only helping individuals, but also contributing to broader public health and societal goals.
The path to 2030
As we work towards achieving the Sustainable Development Goals by 2030, these insights from Malaria Consortium experts highlight the complex challenges and innovative solutions being implemented across different countries. It's clear that a multi-faceted, collaborative approach is essential to improve maternal and child health outcomes globally.
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Cambodia
Melanie Hubault is the Cambodia Country Director for Malaria Consortium. Melanie has over 20 years of experience in senior management for public health organisations in different settings including NGOs, donors and philanthropic organisations. She has been living in Cambodia for the past three years.
Mozambique
Sonia Maria Enosse is the Mozambique Country Technical Coordinator at Malaria Consortium. Sonia oversees projects, particularly in malaria epidemiology, surveillance and drug resistance, and has authored numerous scientific papers. In 2024, she was ranked eighth out of 100 top scientists in Mozambique by the AD Scientific Index.
Togo
Fantche Awokou is the Togo Country Technical Coordinator for Malaria Consortium, where he provides technical oversight for all country programmes and research projects. Fantche is a medical doctor and malaria public health specialist with over 20 years of experience in the fields of public health, infectious and tropical diseases, and programme management.
Uganda
Anthony Nuwa is the Uganda Senior Country Technical Coordinator for Malaria Consortium. In this role, Anthony provides technical support and leadership to the country programmes. He has over 20 years' experience as a medical doctor and expertise in research and monitoring and evaluation on malaria prevention, diagnostics and case management.
