Partnership for Maternal, Newborn and Child Health

Encourage unified and effective approaches

Von Francisco Songane / Weltgesundheitsorganisation WHO

The Partnership for Maternal, Newborn and Child Health is a global health partnership launched in September 2005 to accelerate efforts towards achieving Millennium Development Goals 4 and 5. The Partnership's aim is to intensify and harmonize national, regional and global action to improve maternal, newborn and child health. It is made up of a broad constituency of more than 80 members representing partner countries, UN and multilateral organizations, non- governmental organizations, bilateral donors, foundations, health professional associations and academic and research institutions. The Partnership joins together the maternal, newborn and child health communities to encourage unified and effective approaches that promise greater progress than in the past.

The challenge of the Millennium Development Goals 4 and 5 is significant. Each year, more than 60 million women deliver their babies without skilled care, about 514,000 women die from pregnancy-related complications, almost 11 million children die before they reach the age of five years. Of those children who die before their 5th birthday, almost 40% die in the first month of life, and about three quarters of these deaths occur in the first week after birth. Also, there are 4 million still-births globally each year. Obstructed labour and preterm birth, and many other conditions of pregnancy, can cause severe disabilities amongst those who survive. The numbers are staggering, difficult to grasp. We have to remember that the death of a mother or her young child will affect her family and her community deeply.

UN Millennium Development Goals:
Reduce child mortality - Improve maternal health

At the 2000 UN Millennium Summit, world leaders from rich and poor countries alike committed themselves - at the highest political level - to a set of eight time-bound targets that, when achieved, will end extreme poverty worldwide by 2015.

Goal 4: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.
Goal 5: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

"We will have time to reach the Millennium Development Goals – worldwide and in most, or even all, individual countries – but only if we break with business as usual. We cannot win overnight. Success will require sustained action across the entire decade between now and the deadline. It takes time to train the teachers, nurses and engineers; to build the roads, schools and hospitals; to grow the small and large businesses able to create the jobs and income needed. So we must start now. And we must more than double global development assistance over the next few years. Nothing less will help to achieve the Goals." (UN Secretary-General Kofi A. Annan)


www.un.org/millenniumgoals
www.millenniumcampaign.org
www.who.int/mdg

 

Not only are these numbers very high, disparities between industrialized and developing countries, and between the rich and poor within countries, are shameful. For example, the "maternal mortality ratio", which is a reflection of the number of pregnancy-related deaths amongst every 100,000 live births, ranges from 920 in countries in sub-Saharan Africa and 540 in South Asia, to 14 in Europe. Indeed, the chances of dying during pregnancy and childbirth over a lifetime are as high as 1 in 16 in sub-Saharan Africa, compared with 1 in 3,800 in industrialized countries. No other health indicator shows this degree of disparity and severe disregard for a fundamental human right.

Some countries, even several very poor ones (Bangladesh and Sri Lanka, for example), have been able to substantially reduce mortality; however, progress on the whole is unspeakably slow. Trends have stagnated, even reversed, particularly in sub-Saharan Africa. Why? One factor has been, of late, a plethora of vertical programs addressing single issues. Many vaccination programs, for example, provide services for the child, but not the mother. Other programs may address the pregnant woman (some anti-retroviral drug distribution programs, for example) but not her newborn. Vitamin A capsule distribution programs may reach the preschooler, but miss the post-partum mother. Very often underlying causes of mortality, such as severe anemia, are left unaddressed. Such vertical programs have created what I can term "boutiques" within service delivery arms of Ministries of Health. One laboratory is lavishly funded because it deals with a particular program while another just down the corridor lacks even basic supplies. Health-care professionals are compartmentalized, lessons are not learned and applied, resources are wasted, impacts are lost -- worst of all, families and communities are not reached with life-saving services and technologies.

There are other problems as well. Total investments for maternal, newborn and child health are much too low, given the scale of the challenge. There has also been competition amongst different professional groups, and programs have suffered. Sound programs that should be well-funded lack the resource levels needed to make a sustained impact. To this rather long list, I have to say as well that there has been a lack of understanding of the role of referral services to deal with the complications of childbirth. Emergency obstetric care is too often perceived as unaffordable by developing countries and has been neglected; this is a key service provision if we want to address maternal mortality.

The Partnership and its work

The Partnership brings together three different entities, each with their own strengthens, talents and constituencies. These are the Partnership for Safe Motherhood and Newborn Health, the Healthy Newborn Partnership, and the Child Survival Partnership. Our task, at the global level is to speak with one voice, to align resources and policies, and above all to support countries' efforts to move the agenda for mothers, their newborn and young children steadfastly forward. The Partnership has developed a comprehensive strategy and work plan, which includes a number of ambitious goals and objectives, to be published very shortly.

A feature of the Partnership's work is its country focus. The Partnership supports and promotes the implementation at scale of effective, evidence-based packages of interventions. Intervention packages need to be integrated into existing programs, which themselves need to be strengthened and expanded. This work is built on the concept of Continuum-of-Care. This approach promotes care for mothers from pre-pregnancy to pregnancy through to delivery, the immediate post-natal period, and childhood. Another continuum links the household to the clinic, and the clinic to the referral level, through improving practices in the home and encouraging families to seek the care they need. Improving quality of care is an important aspect of improving access, and health-seeking behaviors.

The Continuum-of-Care incorporates the following features and benefits:

  • Specific interventions delivered in a specific time frame have multiple benefits. For example, improving care during childbirth improves maternal and newborn survival, and reduces still-births and child disability
  • Providing services in packages can reduce costs by allowing greater efficiency in training, monitoring and supervision, and strengthening supply systems
  • Integrating services increases uptake and promotes continuation of positive behaviors. For example, counseling for exclusive breastfeeding in the immediate post-partum period provides an opportunity for promoting better care of both the mother and her newborn
  • Intergenerational benefits are more easily achieved. For example, improving the nutritional and educational status of young girls and adolescents, and providing the means to avoid unintended pregnancy, improves birth outcomes for the next generation.

So, using its combined strengthens, the Partnership aims to improve access to essential services at country level, promote integrated policies and approaches, and coordinate technical support to countries. Initially, this work focuses on countries with high maternal, newborn and child mortality. An important point here is that the Partnership will galvanize support for one country plan, embedded in the national health sector strategy. The Partnership will not support parallel plans, or separate, "stand alone" delivery systems. The Partnership works towards building cohesion, reducing fragmentation, and rapidly and equitably scaling up essential services to those who need them most. This is the only way to save lives on a national scale. One of the key messages the Partnership sends to officials in Ministries of Health and to donors alike, is that time for pilot projects is over. We know what works. Certainly there is always scope for refining packages, and there is much room for developing innovative and new delivery mechanisms. This work will certainly continue, and the Partnership will be involved in pushing these frontiers. Supporting countries to implement packages of known and proven (or "evidence-based") interventions at scale will is the Partnership's main task.

Another important aspect of the Partnership's work is to increase accountability, of donors, of a whole range of global and regional institutions, but also of developing country governments. We are all too familiar with politicians' promises that are broken once elections are held, the pledges made by donors that are all too soon forgotten. The Partnership is working towards incorporating an accountability index in the tracking of resource flows for maternal, newborn and child health, at country, regional and global levels.

Looking to the future

It is of course very exciting to have been asked to assume the Directorship of this new and dynamic Partnership. The many challenges that the Partnership will surely face in its country-support work, I have dealt with during my five years as Minister of Health in Mozambique. These include a weak resource base, a fragile health system, inadequate human resources, and others. Addressing these issues, and bringing services to those who need them -- whether in the remote rural areas or the large hospitals in the poor urban areas -- and addressing the mother, her infant and her child, is the mission of the Partnership. I am looking towards achieving strengthened health systems that put into practice the Continuum-of-Care approach, and thus reduce significantly the needless deaths of women and children in the developing world.

*Francisco F. Songane was named Director of the new Partnership for Maternal, Newborn and Child Health (PMNCH) is December 2005. A former Minister of Health from Mozambique, Dr Songane is recognized nationally and internationally for innovation and leadership. Dr Songane’s wide-ranging involvement with the international community includes work as Executive Committee Member and Board Member of the Global Alliance for Vaccines and Immunization and helping to set up the Global Fund to Fight AIDS, Tuberculosis and Malaria. He was also a member of Task Force Four of the UN Millennium Project (2002-2004), analyzing the practicalities of achieving the goals related to maternal and child health. Dr Songane has published extensively on maternal health issues and is presently enrolled in a doctoral programme in Maternal Health at the Karolinska Institute in Stockholm, Sweden.

The Partnership for Maternal, Newborn & Child Health is made up of a broad constituency of more than 80 members representing partner countries, UN and multilateral agencies, nongovernmental organizations, health professional associations, bilateral donors and foundations, and academic and research institutions. For more information please contact: Jacqueline Toupin, Communications Officer, Toupinj@who.int, www.pmnch.org