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Health workers in many Kenyan clinics brave community health care alone

2014 November 18

By Melissa Wanda

Melissa Wanda is Advocacy Program Officer for FCI Kenya. This article originally appeared on the blog for the Frontline Workers Health Coalition

In a village in rural Kenya, a woman in labor travels miles along rutted dirt roads to get to the nearest health center. She wants to give herself and her baby the greatest possible chance of surviving childbirth and returning home to begin new and healthy lives. When she arrives however, the gates are locked; the nurse has gone home.

Kenya, with only 11.8 health workers per 10,000 people (more than 40% below WHO’s recommendation of 22.8 per 10,000), is one of 57 countries — including 36 in Sub-Saharan Africa — with a critical shortage of health workers.

Many local health facilities have only one health worker, often a nurse, to provide all patient care. This puts a heavy strain on the health worker, and means that many intended 24-hour health facilities are often closed for extended periods of time. Kenya’s news media has also reported recent health worker strikes in reaction to late or non-payment of wages.

The Government of Kenya has committed to strengthening human resources for health in the public health system. Several civil society organizations (CSOs) working to improve reproductive, maternal, newborn, and child health (RMNCH) have come together to advocate for the fulfillment of this urgently important promise. This alliance, co-led by Family Care International (FCI) and the African Women’s Development and Communication Network (FEMNET) under FCI’s Mobilizing Advocates from Civil Society (MACS) project, is conducting advocacy at the county level in Kenya, since counties are responsible for making many health spending decisions in Kenya’s recently decentralized administrative structure and health system.

With support from the MACS project, Deutsche Stiftung Weltbevoelkerung (DSW), a member of the advocacy alliance in Kenya, has surveyed community perceptions of the need for more health workers, and explored how effectively county governments have invested in addressing those needs. Working in two urban and two rural counties, DSW conducted research at various levels of the health system, including outpatient dispensaries, health centers, and hospitals. DSW found that counties are not budgeting or investing spending adequately enough to ensure that facilities have enough health workers to provide high-quality services. Although special funding has been set aside nationally to hire new health workers, counties have mainly been spending this money to pay current staff. DSW is sharing these findings with MACS and county health authorities, leading to one county already committing to hire an additional 72 nurses.

Kenyan health workers share frustrations and challenges of working at understaffed health centers.

Kenyan health workers share frustrations and challenges of working at understaffed health centers.

DSW also brought together community members and health facility staff to discuss the state of care at local health facilities. Community members complained that lack of staff meant an absence of essential services, especially at night and on weekends. Health workers expressed the frustrations of working alone, often lacking the drugs and supplies they need to treat their patients, and the low morale that comes from working under those conditions. For example, one nurse described a recent evening when she was the lone nurse caring for six women in labor!

These community meetings opened new channels of communication, fostering greater understanding and accountability between health workers and the communities they serve. This enabled health system users and health workers to join together in search of practical solutions.

Peter Ngure, DSW’s project lead, shared with me a story about one community in which participants said they prefer to come to the hospital — a long distance from their homes —in the afternoon, so they have time in the morning to travel there. In response, the hospital rearranged staff work schedules, deploying more nurses in the afternoon than morning hours. Similarly, community members learned that the hospital holds Monday afternoon staff meetings, helping to explain why appointments are often unavailable at that time, which had been a repeated source of frustration and confusion.

“This dialogue between community members and health workers helped to build much-needed goodwill during these very challenging times,” said Mr. Ngure.

FCI, DSW and the members of the civil society advocacy alliance will use these findings and experiences to hold county governments accountable for addressing the health worker shortage. When the Kenyan Ministry of Health releases its upcoming human resources for health strategy, which will provide specific guidance on exactly how many health workers should be assigned to each health facility, alliance members will work to make sure that counties follow that national policy, so that every Kenyan mother, seeking care for herself and her baby, will be greeted by open gates and a health worker with the skills and resources to ensure their survival and good health.

 

The true cost of a mother’s death: Calculating the toll on children

2014 October 23
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By Emily Maistrellis

Emily Maistrellis is a policy coordinator at Harvard University’s FXB Center for Health and Human Rights and a research study coordinator at Boston Children’s Hospital. This article originally appeared on Boston NPR station WBUR’s CommonHealth blog. 

COPE Tharaka August 07  049_FamilyCareInternational

A health worker interviews a client at a health care facility in Tharaka, Kenya. (Photo: Family Care International)

Walif was only 16 and his younger sister, Nassim, just 11 when their mother died in childbirth in Butajira, Ethiopia.

Both Walif and Nassim had been promising students, especially Walif, who had hoped to score high on the national civil service exam after completing secondary school. But following the death of their mother, their father left them to go live with a second wife in the countryside. Walif dropped out of school to care for his younger siblings, as did Nassim and two other sisters, who had taken jobs as house girls in Addis Ababa and Saudi Arabia.

Nassim was married at 15, to a man for whom she bore no affection, so that she would no longer be an economic burden to the family. By the age of 17, she already had her first child. Seven years after his mother died, Walif was still caring for his younger siblings, piecing together odd jobs to pay for their food, although he could not afford the school fees.

In all, with one maternal death, four children’s lives were derailed, not just emotionally but economically.

More than 1,000 miles away, in the rural Nyanza province of Kenya, a woman in the prime of her life died while giving birth to her seventh child, leaving a void that her surviving husband struggled to fill. He juggled tending the family farm, maintaining his household, raising his children and keeping his languishing newborn son alive.

But he didn’t know how to feed his son, so he gave him cow’s milk mixed with water. At three months old, the baby was severely malnourished. A local health worker visited the father and showed him how to feed and care for the baby. That visit saved the baby’s life.

As these stories illustrate, the impact of a woman’s death in pregnancy or childbirth goes far beyond the loss of a woman in her prime, and can cause lasting damage to her children — consequences now documented in new research findings from two groups: Harvard’s FXB Center for Health and Human Rights, and a collaboration among Family Care International, the International Center for Research on Women and the KEMRI-CDC Research Collaboration.

The causes and high number of maternal deaths in Ethiopia, Malawi, Tanzania, South Africa, and Kenya — the five countries explored in the research — are well documented, but this is the first time research has catalogued the consequences of those deaths to children, families, and communities.

The studies found stark differences between the wellbeing of children whose mothers did and did not survive childbirth:

  • Out of 59 maternal deaths, only 15 infants survived to two months, according to a study in Kenya.
  • In Tanzania, researchers found that most newborn orphans weren’t breastfed. Fathers rarely provided emotional or financial support to their children following a maternal death, affecting their nutrition, health care, and education.
  • Across the settings studied, children were called upon to help fill a mother’s role within the household following her death, which often led to their dropping out of school to take on difficult farm and household tasks beyond their age and abilities.

How do we use these new research findings to advocate for greater international investment in women’s health?

At a webcast presentation earlier this month, a panel of researchers, reproductive and maternal health program implementers, advocates and development specialists discussed that question.

Central to the discussion was the belief that the death of a woman during pregnancy and childbirth is a terrible injustice in and of itself. The vast majority of these deaths are preventable, and physicians and public health practitioners have long known the tools needed to prevent them. And yet, every 90 seconds a woman dies from maternal causes, most often in a developing country.

The panelists expressed hope that these new data, which show that the true toll of these deaths is far greater than previously understood, can help translate advocacy into action.

It’s important to recognize that, beyond the personal tragedy and the enormous human suffering that these numbers reflect — some hundreds of thousands of women die needlessly every year — there are enormous costs involved as well. -Panelist Jeni Klugman, a senior adviser to the World Bank Group and a fellow at the Harvard Kennedy School of Government.

“So quantifying those effects in terms of [children’s] lower likelihood of surviving, the enormous financial and health costs involved and the repercussions down the line in terms of poverty, dropping out of school, bad nutrition and future life prospects are all tremendously powerful as additional information to take to the ministries of finance, to take to the donors, to take to stakeholders, to help mobilize action,” said Klugman.

Just what does “action” mean? Currently, the countries of the world are debating the new global development agenda to succeed the eight Millennium Development Goals, an ambitious global movement to end poverty. Advocates can use this research to make the case that reproductive, maternal, newborn, and child health should play a central role in this agenda, given that it reveals the linkages between the health of mothers, stable families, and ultimately, more able communities, according to Amy Boldosser-Boesch, Interim President and CEO of FCI.

Panelists also called for more aggressive implementation of the strategies known to prevent maternal mortality in the first place; as well as for the provision of social, educational, and financial support to children who have lost their mothers; and for continued research that outlines the direct and indirect financial costs of a woman’s contributions to her household, and what her absence does to her family’s social and economic well-being.

But action is also required outside of the realm of health care, said Alicia Ely Yamin, lecturer in Global Health and Population at the Harvard School of Public Health and policy director of the FXB Center.

In fact, the cascade of ill effects for children and families documented by this research doesn’t begin with a maternal death. The plight of the women captured in these studies begins when they experience discrimination and marginalization in their societies: “It [maternal death] is not a technical problem. It’s because women lack voice and agency at household, community, and societal levels; and because their lives are not valued,” she said.

Klugman added that this research adds to work on gender discrimination, including issues like gender-based violence, which affects one in three women worldwide.

It’s a tall order: advancing gender equality, preventing maternal, newborn, and child death, and improving the overall well-being of families. But panelists were hopeful that this research can show policy makers, and the public, that these issues are intertwined, and must be addressed as parts of a whole.

As Aslihan Kes, an economist and gender specialist at ICRW and one of the researchers on the Kenya study concluded, this research is “making visible the central role women have in sustaining their households.”

This is an opportunity to really put women front and center, making all of the arguments for addressing the discrimination and constraints they face across their lives. -Aslihan Kes

 

Making a human-rights and socioeconomic case for preventing maternal mortality

2014 October 22
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By Katie MillarKatie Millar is a technical writer for the Maternal Health Task Force (MHTF), where this article originally appeared. 

Panel at Women's Lives Matter

Photo: MHTF

On October 7, 2014, a panel of experts in maternal health—moderated by Dr. Ana Langer, the Director of the Maternal Health Task Force—gathered at the Harvard School of Public Health to discuss the socioeconomic impact of a maternal death on her family and community. Several studies were summarized and priorities for how to use this research were discussed by the panel and audience at “Women’s Lives Matter: The Impact of Maternal Death on Families and Communities.”

What does the research say?

In many countries around the world, the household is the main economic unit of a society. At the center of this unit is the mother and the work—both productive and reproductive—that she provides for her family. A study in Kenya, led by Aslihan Kes of the International Center for Research on Women (ICRW) and Amy Boldosser-Boesch of Family Care International (FCI), showed great indirect and direct costs of a mother losing her life. This cost is often accompanied by the additional cost and care-taking needs of a newborn. “Once this woman dies the household has to reallocate labor across all surviving members to meet the needs of the household. In many cases that meant giving up other productive work, loss of income, hiring an external laborer, girls and boys dropping out of school or missing school days to contribute [to household work],” shared Kes. In addition, the study done in Kenya determined that families whose mother died used 30% of their annual spending for pregnancy and delivery costs; a proportion categorized by the WHO as catastrophic and a shock to a household.

Similar research was conducted in South Africa, Tanzania, Ethiopia, and Malawi by Ali Yamin and colleagues. In addition to similar socioeconomic findings to those in Kenya, Yamin found that less than 50% of children survived to their fifth birth if their mother died compared to over 90% of children whose mothers lived. An even more dramatic relationship was found in Ethiopia with 81% of children dying by six months of age if their mother had died. In South Africa, mortality rates for children whose mothers had died were 15 times higher compared to children whose mothers survived.

Increasing the visibility of maternal death

While a family is grappling with grief they are also making significant changes in roles and structure to meet familial needs. Dr. Klugman emphasized this point when she said, “Quantifying [the] effects [of maternal death]… and the repercussions down the line—in terms of poverty, dropping out of school, bad nutrition, and future life prospects—I think are all tremendously powerful. [This] additional information [is] very persuasive—to take to the ministries of finance, to take to donors, to take to stakeholders—to help mobilize action for the interventions that are needed.”

Apart from the economic and social costs, is a foundation of human rights violations and gender inequalities. The high rate of preventable maternal mortality is no longer a technical issue, but a social issue. “Maternal mortality it is a global injustice. It is the indicator that shows the most disparities between the North and the developing world in the South. It’s not a technical problem, it’s because women lack voice and agency at household, community, and societal levels and because their lives are not valued. Through this research of showing what happens when those women die, it shows in a way how much they do [and how it] is discounted,” said Dr. Yamin, whose research focuses on the human rights violations in maternal health.

Leveraging this research for improved reproductive, maternal, newborn, and child health

The research findings are clear: prevention of maternal mortality is technically feasible, the right of every woman, and significantly important for the well-being of a family and a community. Boldosser-Boesch provided three reasons why making the case for preventing maternal mortality is critical at this time.

  1. These findings strengthen our messaging globally and in countries with the highest rates on the importance of preventing maternal mortality, by increasing access to quality care, which includes emergency obstetric and newborn care.
  2. This research supports integration across the reproductive, maternal, newborn, and child health (RMNCH) continuum to break down current silos in funding and programs.
  3. “We are at a key moment… for having new information about the centrality of RMNCH to development, because… the countries of the world are working now to define a new development agenda, beyond the MDGS, post-2015. And that agenda will focus a lot on sustainable development… and we see in these findings… , connections to the economic agenda…, questions of gender equality, particularly what this means for surviving girl children, who… may experience earlier marriage or lack of access to education,” shared Boldosser-Boesch.

In order to move the agenda forward on preventing maternal mortality and ensuring gender equality, ministries of health and development partners must be engaged. In addition, donors can fund the action of integration to address a continuum approach and media outlets should be leveraged to disseminate these findings and hold governments accountable for keeping promises and making changes. The prevention of maternal mortality is a human rights-based, personal, and in the socioeconomic interest of a family, community, and a society.

This panel included:

  • Ana Langer, Director of the Maternal Health Task Force
  • Alicia Yamin, Lecturer on Global Health at the Harvard School of Public Health
  • Amy Boldosser-Boesch, Interim President & CEO, Family Care International
  • Jeni Klugman, Senior Adviser at The World Bank Group
  • Aslihan Kes, Economist and Gender Specialist, International Center for Research on Women

Watch the webcast here.

UNGA week shows maternal and newborn health are central to development challenges

2014 October 10
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Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the Healthy Newborn Network (HNN) blog.  

CD cover 2This year’s UN General Assembly was full of high-profile moments that reinforced the need for investment and action to improve reproductive, maternal, newborn and child health (RMNCH): the launch of a Global Financing Facility to Advance Women’s and Children’s Health; the release of reports tracking stakeholders’ fulfillment of commitments to Every Woman Every Child; new data on maternal, newborn and child survival from Countdown to 2015; and a plethora of side events focusing on strategies and country progress toward MDGs 4 and 5. For Family Care International, which advocates for improved reproductive, maternal, and newborn health, this unprecedented level of attention to women’s and children’s health is a welcome sign that our advocacy is having an impact, and that global commitment to ending all preventable maternal and child deaths is stronger than ever.

RMNCH was a key theme in many other important discussions during the week, demonstrating the centrality of the health of mothers and newborns to a range of development challenges.

  • Events began with a Climate Summit that brought together leaders from more than 120 countries. The Partnership for Maternal, Newborn & Child Health noted during the Summit that “women and children are the most vulnerable to the effects of a changing climate, and those who are more likely to suffer and die from problems such as diarrhoea, undernutrition, malaria, and from the harmful effects of extreme weather events such as floods or drought.”
  • There was a special session to review progress towards achieving the International Conference on Population and Development Programme of Action. The ICPD agenda highlights the importance of ensuring universal access to sexual and reproductive health and rights and the importance of quality and accessible maternal health care, recognizing that healthy girls and women can choose to become healthy moms of healthy babies.
  • The UN Security Council held an emergency meeting where President Obama called for swift action on the Ebola epidemic that is destroying lives and decimating African health systems. This crisis highlights already-fragile health systems that lack sufficient health workers, supplies, and essential medicines–the same failures that contribute to maternal and newborn mortality. A recent news story details how pregnant women who are not infected with Ebola risk dying in West Africa due to lack of access to maternal health services, and the same risk exists for newborns and young children. The loss of skilled healthworkers, particularly midwives, could have enormous long term impacts on the ability of women, newborns and children to access life-saving care.
  • Finally, the UNGA week included high-level meetings on humanitarian crises in Syria, South Sudan and many other countries. According to the State of the World’s Mothers 2014 report, more than half of all maternal and child deaths occur in crisis-affected places. Discussions of humanitarian response in crisis settings included recognition of the disproportionate impact on women and children of violence, including gender-based violence, displacement, lack of access to food and lack of access to crucial maternal health services and early interventions for newborns. These crises and fragile health systems make achieving the Every Newborn Action Plan recommendations on ensuring quality care for mothers and newborns during labor, childbirth and the first week of life more difficult, but also more critical.

While this long list of world crisis may seem overwhelming, there is some good news on maternal, newborn and child survival. As the UN Secretary-General reminded us, the world is reducing deaths of children under the age of five faster than at any time in the past two decades and significant declines in maternal mortality have occurred in the past 10 years. As the world works together to shape the post-2015 development goals, these experiences during UNGA show that the new agenda must prioritize continuing to address maternal, newborn and child mortality which is linked to many of the world’s pressing development challenges, including poverty. As a recent editorial in The Lancet says, “As governments slowly come to an agreement about development priorities post-2015, it is clear that maternal and newborn health will be essential foundations of any vision for sustainable development between 2015 and 2030.”

Women’s Lives Matter: The impact of a maternal death on families and communities

2014 October 1
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The sudden death of a woman from largely preventable causes during pregnancy or childbirth is a terrible injustice that comes at a very high cost. Her death is not an isolated event, but one that has devastating repercussions on her newborn baby (if it survives), her children, husband, parents, other relatives, and community members.

On October 7th, 2014, FCI will join with the FXB Center for Health and Human Rights and the International Center for Research on Women (ICRW) to host a live webcast to explore new research documenting the dramatic economic and social impacts of a woman’s death during pregnancy or childbirth. We will feature new findings from Tanzania, Kenya, Ethiopia, Malawi and South Africa, which advocates can use to argue for efforts to save the lives of nearly 300,000 women who die each year from pregnancy- or childbirth-related causes, almost all of which are preventable.Women's Lives Matter_7Oct2014 promo graphic

A mother’s death, tragic in its own right, impacts her family’s financial stability and her children’s health, education, and future opportunities. According to the Kenya study we conducted with ICRW and the KEMRI-CDC Research and Public Health Collaboration, when a mother dies in or around childbirth, her newborn baby is unlikely to survive. Surviving children are often forced to quit school or if they continue their studies, they become distracted from grief or new household responsibilities. Also, when a woman dies, funeral costs present a crippling hardship to her family, while the loss of a productive member disrupts the family’s livelihood.

The studies conducted by the FXB Center also revealed increased child mortality. Qualitative research illustrated a link between maternal mortality and the survival, health, and well-being of children. In Tanzania, for example, the FXB Center’s researchers found that children whose mothers had died during pregnancy or childbirth have a higher risk of being undernourished.  The loss of a mother, the central figure responsible for the care and education of her children, often results in the dissolution of her family.

Although countries have made great strides to improve maternal health, too many countries still have a high burden of maternal death. The most recent Countdown to 2015 report noted that of the 75 Countdown countries, which together account for more than 95% of all maternal, newborn, and child deaths, half still have high maternal mortality ratios (300–499 deaths per 100,000 live births), and 16 countries—all of them in Africa—have a very high maternal mortality ratio (500 or more deaths per 100,000 live births). The studies that will be presented in this webinar provide urgently-needed evidence that advocates can use to persuade governments, donors, and policy makers that investments in women’s health and maternal health are also investments in newborns and children, in stable families, in education and community development, in stronger national economies and, ultimately, in sustainable development. As the report, Investing in Women’s Reproductive Health, notes:

[I]nvestments in reproductive health are a major missed opportunity for development. Effective and affordable interventions are available to improve reproductive health outcomes in developing countries, and the challenge is less about identifying these interventions but rather in implementing and sustaining policies to put proven packages of interventions and reforms into practice.

Pregnancy and childbirth should never cost a woman her life. But this research shows that the true price of a maternal death is even higher than that. It is a premium her family will continue to pay long after she’s gone.

The live webcast will include the following panelists:

  • Dr. Ana Langer (moderator), Director of the Women and Health Initiative
  • Alicia ElyYamin, Lecturer on Global Health, Department of Global Health and Population, Harvard School of Public Health; and Policy Director, FXB Center for Health and Human Rights
  • Rohini Prabha Pande, Lead Researcher on A Price Too High to Bear, Independent Consultant on Gender and Health
  • Jeni Klugman, Author of Investing in Women’s Reproductive Health (2013) and lead author, Voice and Agency (2014)
  • Amy Boldosser-Boesch, Interim President and CEO, Family Care International

Please join us on October 7, 2:30 – 3:30 PM! View the webcast live and submit your questions to the panel in real time: bit.ly/WomensLivesMatter

A Price Too High to Bear: The costs of maternal mortality to families and communities

2014 October 1
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by Amy Boldosser-Boesch

Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the MDG456Live Hub, curated coverage of women and children during the UN General Assembly. 

During the UNGA this week, many partners are committing to deliver on promises to accelerate progress on MDGs 4 and 5. There has also been a renewed focus on the importance of solid data to track progress on reproductive, maternal, newborn and child health and to hold governments and other stakeholders accountable for meeting their commitments. New research conducted in Kenya by Family Care International (FCI), the International Center for Research on Women (ICRW), and the KEMRI-CDC Research and Public Health Collaboration has the potential to increase the momentum of efforts to save the lives of nearly 300,000 women who die each year (5,500 of them in Kenya) from causes related to pregnancy and childbirth.

FCI_Masaki mother and child

The study, A Price Too High to Bear, reveals the costs of maternal deaths on families and communities in Kenya.

Each of these avoidable, premature deaths is a tragedy in its own right, and a terrible injustice. Each of these women — some of them barely more than girls — has a right to life and health, and to a standard of health care that protects her from preventable illness, injury, and death.

But we who work to improve maternal health have argued for years that each of these deaths also brings countless additional layers of loss, pain, and destruction. The tragic, sudden death of a woman in the prime of life — in many cases already a mother and often the most economically productive member of the family — begins a cascade of loss and pain that upends the lives of those around her: her newborn baby (if it survives) and her older children, husband, parents, and other members of her family and community. The cost of a maternal death is, quite literally, a price too high to bear.

This new study provides urgently needed data to help persuade governments, donors, and policy makers that investments in women’s health and maternal health are also investments in newborns and children, in stable families, in education and community development, in stronger national economies and, ultimately, in sustainable development.

Based on interviews and focus group discussions with families, across a poor rural area in Siaya County in western Kenya, that had lost a family member to maternal death over a two-year period, we found that:

  • When a mother dies in or around childbirth, her newborn baby is unlikely to survive.
    Of 59 maternal deaths in the study, only 15 babies survived their first two months of life.
  • A mother’s death harms the educational and life opportunities of her surviving children.
    Many children had to leave school because the loss of a mother’s income meant that they couldn’t pay tuition fees, needed to work for a living, or had to take up essential household chores.
  • The cost of emergency care (even when unsuccessful), combined with high funeral costs, puts families under a crushing economic burden.
    Families spent more on funerals than their total annual expenditure on food, housing, and other household costs, after having already spent 1/3 of their annual consumption expenditure on medical costs.
  • Loss of income and high, unexpected costs send many families into a spiral of debt, poverty, and instability.
    Many families, under desperate financial pressure, had to sell household property, borrow from moneylenders, or move children out of the family home.

At the national launch of the research findings, Kenya’s Cabinet Secretary for Health, Hon. James Macharia, said, “A mother’s death ignites a chain of disruption, economic loss, and emotional pain that often leads to the death of her baby, diminished educational and life opportunities for her surviving children, and a deepening cycle of poverty for her family.” As the MDG deadline approaches and the post-2015 development agenda is defined, we hope this research will help to catalyze renewed commitment to ending preventable maternal mortality, so that no woman has to pay the high price of losing her life, and so that families, communities and nations no longer have to bear the burden of maternal death.

Learn more: On October 7th, 2014 (2:30 – 3:30 PM EDT), Harvard’s FXB Center for Health and Human Rights, Family Care International (FCI), and the International Center for Research on Women (ICRW) will host Women’s Lives Matter: The impact of a maternal death on families and communities, a live webcast. The webcast will feature research findings from the Kenya study as well as those from four other African countries which document the dramatic economic and social impacts of a maternal death. Panelists will also discuss opportunities and strategies for using these important findings to advocate for political commitment, policy change, and sustained investment in reproductive, maternal, and newborn health in the context of the evolving post-2015 global health and development agenda.

More information on the webcast and subsequent Q&A:http://bit.ly/WomensLivesMatter

New advocacy tool: briefing cards on SRHR and the post-2015 development agenda

2014 October 1
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Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the MDG456Live Hub, curated coverage of women and children during the UN General Assembly.

SRHRAs we move into the intergovernmental negotiations for defining the post-2015 development agenda, continued advocacy will be needed to link sexual and reproductive health and rights (SRHR) to sustainable development. Do you have the talking points you need to make the case that governments must ensure the comprehensive inclusion of sexual and reproductive health and rights within the post-2015 development framework?

A new tool Briefing Cards: Sexual and Reproductive Health and Rights (SRHR) and the Post-2015 Development Agenda can help. The briefing cards detail the linkages between SRHR and other key development issues including environmental sustainability, gender equality, economic growth, educational attainment, and broader health goals. Produced by FCI, with support from the UN Foundation, and co-authored by partners in the Universal Access Project, each one page card provides advocates with succinct arguments and key Facts at a Glance about the impact of SRHR on the broader development agenda. Each card also includes recommendations for inclusion of SRHR in the post-2015 development framework in a cross-cutting way, for example, by encouraging targets and indicators that address and measure the strong connections between girls’ education and their sexual and reproductive health and rights. All of the partners involved in developing the Briefing Cards hope that they will be a useful tool for advocates worldwide working to shape the social, economic and environmental aspects of the post-2015 sustainable development agenda. The cards are available for free download; please share them with your partners and help us make the case with governments and other stakeholders in the post-2015 process that sexual and reproductive health and rights are integral to the achievement of all shared development goals.

For more information, please email contact[at]familycareintl.org or womenandgirls[at]unfoundation.org

 

 

 

Midwives and misoprostol: Saving lives from PPH

2014 August 25
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Shafia Rashid is a senior program officer for Global Advocacy at Family Care International.

For women around the world, compassionate and competent care from a midwife can mean the difference between life and death. We know that midwives provide life-saving care during pregnancy, childbirth, and in the postnatal period. Midwives, and other mid-level and community health providers, can administer essential medicines, such as oxytocin and misoprostol, which are safe and effective for preventing and treating life-threatening postpartum bleeding or hemorrhage (PPH), the leading cause of maternal death in most developing countries. Access to misoprostol is particularly important in developing countries, and especially in rural areas, because (unlike oxytocin) it requires neither refrigeration nor injection: it can be used in poorly equipped health facilities and even home births.

A midwife meets with a client during an antenatal care visit.

A midwife meets with a client during an antenatal care visit.

In order for midwives to provide life-saving maternal health care, they need the support of policies that enable them to provide a full range of medical interventions.  In some countries, however, midwives are not legally authorized to administer oxytocin and/or misoprostol —despite evidence that administration by low and mid-level health providers is feasible and effective. But physicians sometimes resist or oppose expansion of midwives’ scope of practice, based on notions of “professional territoriality” and concerns about their capacity to correctly and safely administer these medications.

Most women in low-resource settings give birth in lower-level health facilities or at home, attended by a midwife or other mid-level health provider. So restrictive policies requiring that administration of medications be carried out only by physicians limits women’s access to essential medicines they need for safe pregnancy and childbirth. Placing misoprostol in the hands of non‐physician providers, for example, can expand access to timely PPH treatment. In remote and rural areas, where transfer for emergency obstetric treatment at a higher-level facility may be delayed, difficult, or impossible, misoprostol could be administered by a low-level provider as a “first aid” treatment to stop bleeding.[1]

The global health community can play an important role in addressing and removing policy and regulatory barriers, and ultimately in improving women’s access to essential medicines. Making this happen will require that governments, in many countries, revise policies that allow administration of medications only by physicians.  In 2012, WHO issued guidelines  on task-shifting for maternal and newborn health. They called for a “more rational distribution of tasks and responsibilities among cadres of health workers …[to]  significantly improve both access and cost-effectiveness – for example by training and enabling ‘mid-level’ and ‘lay’ health workers to perform specific interventions otherwise provided only by cadres with longer (and sometimes more specialized) training.”  This makes excellent sense.

The leading global health professional associations focused on pregnancy and childbirth, the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO), can work together to ensure that these international recommendations translate into changes in national norms and in clinical practice. Earlier this year, ICM and FIGO issued a joint statement, Misoprostol for the treatment of postpartum hemorrhage in low resource settings, which called on partners to:

  • Promote task-sharing approach
  • Ensure that skilled health providers (and not just doctors) can administer uterotonic drugs like misoprostol and oxytocin
  • Challenge regulatory and policy barriers that limit access to high quality maternal health care
  • Advocate for increasing the midwifery workforce
  • Implement innovative strategies to strengthen the role of midwives and non-physician providers in providing high-quality maternal health services

Health professionals, policy makers, and other partners must work together to ensure that every woman has access to the uterotonic medicines that can protect her from the suffering and potential death that can be caused by postpartum hemorrhage.

 

[1] Beverly Winikoff, Why misoprostol in the hands of non-physician providers matters, Presentation at the ICM Trienniel Congress, Prague, June 3, 2014.

Mapping maternal health advocacy in Uganda and Zambia

2014 July 16
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Shafia Rashid is a senior program officer for Global Advocacy at Family Care International.

Civil society organizations (CSOs) around the world are working to improve maternal health and make a difference in the lives of women, families, and communities. In many countries, CSOs play a critical role in the health sector by providing quality maternal health services, and by supporting advocacy to ensure government policies are implemented, funds invested and tracked, and health outcomes measured and published.

A Zambian mother with her child © 2009 Arturo Sanabria, Courtesy of Photoshare

A Zambian mother with her child © 2009 Arturo Sanabria, Courtesy of Photoshare

In 2013, with support from Merck Inc. through the Merck for Mothers Program, Family Care International (FCI) completed a comprehensive mapping of the maternal health advocacy environment in two countries, Uganda and Zambia. Data for the mappings were collected at the national level (and at the district level in Uganda) using a multi-dimensional methodology which triangulated data from key informant interviews, focus group discussions, and desk research.

The mapping examined each country’s maternal health policy framework, identified stakeholders working in maternal health advocacy, and analyzed opportunities and challenges for maternal health advocacy organizations.  It also highlighted the potential for engaging the private sector on maternal health, and put forward a set of recommendations for strengthening maternal health advocacy efforts, and the role of CSOs in particular.

In Uganda, the mapping found that while there is a relatively active health advocacy sector and strong policy framework in place for maternal health, advocacy organizations are not coordinating efforts well, leading to a fragmented advocacy environment. In addition, maternal health advocacy organizations face critical resource constraints, and are not effectively measuring the impact of their advocacy work. For additional information, the full mapping report can be accessed here.

In Zambia, there exists a favorable policy environment for maternal health, and a strong evidence-based decision-making ethos in government. While Zambia is a signatory to a number of commitments to improve maternal health services, the maternal health advocacy environment is not particularly strong or robust. More information is available in the full mapping report here.

The findings from these mappings revealed a number of common themes and recommendations for supporting the critical role of CSOs in both countries:

  • Establish or enhance a coordinating mechanism through which the growing and diverse body of advocacy organizations can work together and advance common messages, agendas, and strategies.
  • Support local advocacy organizations, which often operate with limited resources, staffing, and capacity, to build their administrative, management, and planning capabilities in conducting effective advocacy.
  • Strengthen monitoring and evaluation of maternal advocacy efforts by supporting maternal health advocacy organizations in the development of tools, indicators, and mechanisms for measuring advocacy outcomes and impact.

Sustained and long-term investments in supporting CSOs to conduct effective advocacy for maternal health are needed now, more than ever. Without these investments, we will continue to be far behind in reaching national and global commitments for maternal health.

A health worker in Uganda counsels a client. © 1996 Center for Communication Programs, Courtesy of Photoshare

A health worker in Uganda counsels a client.
© 1996 Center for Communication Programs, Courtesy of Photoshare

 

Uganda_mapping_cover

To reduce death and ensure health, The Lancet launches Midwifery Series

2014 June 24
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by Family Care International

By Katie Millar

Katie Millar is a technical writer for the Maternal Health Task Force (MHTF), where this article originally appeared. 

Today, at the London School of Hygiene and Tropical Medicine, The Lancet launched its newest series Midwifery. This series provides concrete actions for stopping preventable maternal and newborn death and ensuring perinatal health. The knowledge that midwives are key to preventing perinatal death is not new. However, scaling up the utilization of midwives on a systems level is lacking, which has prevented this solution from becoming a reality.

The Midwifery Series was created to provide concrete guidance and frameworks on how to utilize midwives and a new standard of care for Quality Maternal and Newborn Care (QMNC). At the center of this model of care are the needs of women and their newborn infants. Even though the needs of women across the world seem to differ greatly, this series clarifies that no matter where a woman lives, care led by a midwife is the answer to ensuring health. The series comprises four separate papers which were created by a multidisciplinary group, including academics, researchers, advocates for women and children, clinicians, and policy-makers. This multidisciplinary approach is necessary for addressing current gaps in perinatal care.

The current maternal and newborn health landscape often offers fragmented solutions and interventions to address the needs of women and their newborns. This fragmentation is a barrier to adequate perinatal care. These gaps in care lead to 98% of the annual 289,000 maternal deaths, 2.6 million stillbirths, and 2.9 million neonatal deaths. In order to mitigate these preventable deaths, improvements in the quality throughout the continuum of care and emergency services are imperative. The series supports a whole-system approach to improving perinatal care by ensuring skilled care for all.#2 FOR EVERY WOMAN AND EVERY NEWBORN CHILD

The Lives Saved Tool (LiST) was used in the series to model different levels of scale-up of essential interventions for reproductive, maternal, and newborn health (RMNH) which are within the scope of practice of a midwife. In low-resource settings even a 10% increase in the interventions covered by midwifery would decrease maternal mortality by 27%. Therefore, more rigorous scale-up could have an incredible impact on reducing maternal mortality.

The standard for QMNC presented in the series is globally applicable as it not only focuses on the scale-up of essential interventions, but also the harmful effects and necessary mitigation of over-medicalization of birth and perinatal care. Professor Petra ten Hoope-Bender, of the Instituto do Cooperación Social Integrare, Barcelona, Spain, said, “Although the level and type of risks related to pregnancy, birth, postpartum and the early weeks of life differ between countries and settings, the need to implement effective, sustainable, and affordable improvements in the quality of care is common to all, and midwifery is pivotal to this approach. However, it is important to understand that to be most effective, a midwife must have access to a functioning health-care service, and for her work to be respected, and integrated with other health-care professionals; the provision of health care and midwifery services must be effectively connected across communities and health—care facilities.”

In order to assist the development of health systems and their integration of midwives, the series provides three new tools:

  1. The Framework for Quality Maternal and Newborn Care is applicable to all countries on not only what needs to be implemented, but how to implement strategies to reduce maternal, neonatal, and infant mortality and morbidity, improve quality of care, and increase efficiency of health systems.
  2. Country diagrams can be used to identify the most important elements required to strengthen a country’s health systems to provide quality midwifery services.
  3. Pragmatic steps provide a guide to initiate or further develop their midwifery services.

Midwives not only provide care at the time of birth, but work with women from before their pregnancy through their newborns infancy to prevent death and ensure health. This life course approach is essential for having a large impact on the needless numbers of deaths and morbidities. Check out The Lancet’s Midwifery Series for more details on how midwives will make a large difference in the lives of women and their children in the coming years as the post-2015 agenda is implemented.

To learn more visit the official website of the Midwifery Series and follow the conversation on twitter by following @midwiferyaction and #LancetMidwifery.

Advocacy for Misoprostol, Advocacy for Saving Lives

2014 June 16
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By Katie Millar

Katie Millar is a technical writer for the Maternal Health Task Force (MHTF), where this article originally appeared. 

Hundreds of thousands of women die every year giving birth. The leading causes of these deaths—hemorrhage, infection, and eclampsia—are mostly preventable and treatable. Yet, proven treatments for these conditions are not reaching the women who need them most. In the poorest parts of the world, one in six women will die giving birth, compared to one in 30,000 in Northern Europe. To die giving birth must not be an expectation; we must make it the rarest exception.

Post-partum hemorrhage (PPH), the leading cause of maternal mortality, is mostly preventable. The onset of PPH is usually sudden, and if a woman is not giving birth in a well-equipped facility, she will face many delays getting care—delays that could cost her life. Since PPH needs immediate and effective treatment, prevention is a better option, especially for women who live far from a facility.

A prevention strategy has been discovered. The drug Misoprostol is a tablet that, when given immediately after the baby is born, can prevent life-threatening PPH. Misoprostol works by causing strong uterine contractions, putting pressure on potentially leaky blood vessels. Although this strategy is simple and inexpensive, there are many controversies surrounding its implementation.

Despite the WHO adding misoprostol to its essential medicines list for all countries, some contest its scale-up. One reason is that misoprostol can be used to cause abortion if taken before the clinically indicated period, or the time immediately following birth. To advocate for this life-saving commodity, Family Care International has created an advocacy tool to facilitate the uptake and scale-up of misoprostol to save lives.miso brief

miso briefThis publication, available in English and soon in French, provides national advocates and civil society organizations guidance in conducting effective advocacy for the successful uptake of misoprostol for prevention and treatment of PPH. Through case studies and an Advocacy for Access Framework, the publication provides concrete examples to support misoprostol’s availability and use at the national level.

If you are working to prevent maternal mortality, please take a moment to explore this resource. Advocating for the scale-up of misoprostol can have a profound effect on decreasing the number of women who die giving birth each year.

Are you currently working in preventing PPH and/or the scale-up of misoprostol? Please contact Katie Millar if you are interested in being a guest blogger for the MHTF. We, and many others in the field, would benefit greatly to hear about your experiences.

Making the case for midwifery

2014 June 10
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by Amy Boldosser-Boesch

Amy Boldosser-Boesch is FCI’s Director of Global Advocacy. This article originally appeared on the Global Motherhood section of Huffington Post

In 1998, Fatimata Kané was still a practicing midwife, visiting a local village when she met Kadija.* Kadija was pregnant and nearing the end of her third trimester. Fatimata could immediately see that Kadija was not well: she looked exhausted, was severely anemic, and had edema in her lower extremities. If she didn’t seek care right away, both she and her baby could die during labor. Fatimata told the woman and her family that she needed to get to a hospital quickly, but the family did not understand. Kadija had many children and had never once received pre-natal care or been to a hospital. All of her babies had been delivered at home, and she used the traditional medicines available in her village. She lived over 10 miles from a hospital and the trip was expensive.

After a lot of persuading, Fatimata convinced the woman’s family to let her deliver in the hospital. Sadly, they could not get to the hospital fast enough to save the baby, but were able to save Kadija’s life. Fatimata often replays the moment over and over in her head. Had she not been there, and had she not been trained as a midwife, she would not have known that Kadija was in urgent need of care.

Fatimata, now the director of FCI-Mali, is using her firsthand knowledge of the need for quality reproductive, maternal and newborn health care at the community level to advocate full time for improved maternal and newborn health care in Mali. She makes the case for strengthening midwifery through increased investments in training and supportive policies so that midwives can continue to provide lifesaving care to pregnant women and newborns, including pre-natal and post-natal care and family planning, in their communities.

Midwives, like Fatimata, can be a profound and powerful voice for change in their countries. If their services were available and accessible to all women and babies who need them, midwives could help avert two-thirds of the nearly 300,000 maternal deaths and half of the 3 million newborn deaths that occur each year, provided they are well-trained, well-equipped, well-supported and authorized. Midwives understand the health care needs of women and newborns, because they work to meet those needs every day. They see the gaps in the health care system — in resources, staffing, facilities, and policies — because they struggle to fill those gaps, day in and day out. And they are uniquely positioned to speak the truth about midwives’ need for training, for support, and for enabling policies – because they have dedicated their lives to doing this crucial job for women and their families.

In partnership with Johnson and Johnson, the International Confederation of Midwives and UNFPA, Family Care International (FCI) is helping to prepare midwives to advocate for improved maternal and newborn health services using evidence from a new report on The State of the World’s Midwifery. Although providing quality midwifery care will always be their first priority, midwives can also be champions for their profession, helping to hold governments accountable for keeping the promises they’ve made to women and babies, and ensuring that young midwives just starting out in their careers will enter a workplace that recognizes, values and supports their role.

National midwives associations have already been successful in advocating for new policies ranging from a policy for development of a national education system for midwives in Afghanistan to a policy on improving quality family planning services to improve maternal health in Nigeria.

Enis Banda, a midwife from Malawi, said on this year’s International Day of the Midwife that “life starts in the hands of a midwife.” With tools to support their advocacy efforts, stronger policies and programs to improve midwifery care and maternal and newborn health can start in the hands of a midwife too.

How will you help make the case for midwifery in your community?

 

*not her real name

The SoWMy 2014 report recommends four key actions to strengthen the profession of midwifery and ensure quality health coverage. (Infographic: UNFPA, ICM, and WHO)

The SoWMy 2014 report recommends four key actions to strengthen the profession of midwifery and ensure quality health coverage. (Graphic: UNFPA, ICM, and WHO)

Budgeting for better maternal and child health

2014 June 3
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Catherine Lalonde is FCI’s senior program officer for Francophone Africa.

I just returned from a week in Senegal where I attended a regional workshop to train civil society, parliamentarians and the media on budget analysis and advocacy for maternal and child health.

For years now, countries across the globe have said that maternal health is one of their top priorities; they’ve made statements, built coalitions, and developed strategies. On the surface, it seems as though a lot is happening in the realm of reproductive, maternal, newborn and child health (RMNCH). Despite all the rhetoric, little progress has been made in improving the health of mothers and children, especially in the poorest countries in the world.

Since I started working at FCI a year ago, I have mainly been involved in advocacy projects aimed at keeping governments accountable to their commitments. In Burkina Faso, Mali and Kenya, we and our partners are constantly asking governments to invest in and implement programs that will improve RMNCH in their countries.  Whenever we question why contraceptives aren’t available in the villages or why health centers are not staffed with qualified personnel, we almost always gets the same answers: there’s no money, we don’t have the funding, and we can’t afford it.

A budget is the single best indicator of a country’s priorities and the best way to tell whether a country is putting its money where its mouth is and whether or not it has taken steps towards fulfilling its maternal and child health commitments.

Fatimata Kané

Fatimata Kané, FCI-Mali national director, explains the importance of budget advocacy in improving RMNCH outcomes.

Organized by Harmonization for Health in Africa, UNICEF, WHO, the Partnership for Maternal, Newborn & Child Health (PMNCH), Save the Children, the InterParliamentary Union and FCI, the three-day budget advocacy workshop brought together members of local NGOs and reporters, along with parliamentarians and representatives from the ministries of finance and of health from the Democratic Republic of the Congo, Niger, Mali, Burkina Faso and Senegal.

A budget is public property; it represents the money that belongs to each and every citizen of a country and therefore, the public should have a genuine say in how the money is distributed and spent. But the countries represented in the workshop had budgets that rank among the least transparent in the world, according to the International Budget Partnership’s Open Budget Survey, which reveals what information is made public and when, as well as who gets to contribute to the process and how often. Of the workshop’s participating countries, Burkina Faso’s budget had the best transparency score– a measly 23 out of a 100; Niger, with the least transparent budget, scored a depressing 4 out of 100, with zero meaningful opportunities for civil society to contribute to the country’s budgeting process.

The workshop facilitators emphasized the important role the budget plays in RMNCH and the financial costs of not investing in RMNCH. It also taught how good health policies are developed and costed, and provided options for increasing fiscal space – the money to fund these policies – within the existing budget. This workshop provided participants with an outline of the budgeting process, and all of the opportunities in which civil society should be able to contribute. At the end, each of the delegations developed advocacy objectives and strategies to improve civil society’s contribution to the budgeting process in order to prioritize health. For example, the Burkina Faso delegation chose to advocate for increased investment in information systems to better track health data while the Malian delegation chose to focus advocacy on ensuring that Mali meets the Abuja declaration pledge to dedicate 15% of its budget to health.

A good friend of mine who works in finance once told me that talking about money scares people, that people often feel as though they don’t have enough knowledge to contribute and are too embarrassed to say so. The organizers and I were afraid that the workshop would be too long, too technical and hard to follow, but we couldn’t have been more wrong. The participants lapped up every word on every slide, and were thrilled to be equipped with the knowledge of the role they can play in ensuring that their country’s budget prioritizes maternal and child health.

The presentation on increasing fiscal space even got a standing ovation!

 

 

Advocacy success story: Burkina Faso broadens access to misoprostol, an essential maternal health medicine

2014 April 22
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By Brahima Bassane, MD

[Version française ci-dessous]

Brahima Bassane, FCI’s national director in Burkina Faso, is a public health physician.

Postpartum hemorrhage (PPH) — excessive, uncontrolled bleeding after childbirth —remains the leading cause of maternal death worldwide.  In countries like Burkina Faso, where many births still occur at home, the drug misoprostol offers a number of advantages for preventing and treating PPH because (unlike oxytocin, considered the ‘gold standard’ medicine for PPH) it can be easily administered and does not require cold storage. In settings with limited infrastructure and lack of skilled birth attendants, misoprostol may be a woman’s only chance for surviving PPH.

Access to high-quality medicines is part of every citizen’s right to the highest attainable standard of health. But in spite of misoprostol’s proven safety and efficacy, decision-makers in some countries have been reluctant to authorize its widespread availability, or are unaware of the available evidence. Many governments have not included misoprostol in their national essential medicine list (EML), which is often used as the basis for importation, distribution, and marketing of medicines for the public health system.

FCI works to support wider understanding, acceptance, and use of misoprostol for PPH. This year in Burkina Faso, our efforts — with a range of advocacy partners — to persuade government officials to deem misoprostol for PPH an essential medicine were successful. This success story offers a potential model for effective, collaborative, focused advocacy in other countries where misoprostol’s lifesaving benefits are not yet broadly available.

Our advocacy began in earnest last September, when FCI convened a meeting  to share the latest research on misoprostol for PPH and to develop advocacy strategies that would convince the government to take action. These committed and motivated maternal health champions called for the widespread availability of misoprostol, stating that the inclusion of misoprostol in the national EML was an urgent national priority.

Following the meeting, a small advisory committee was assigned the task of reaching key government decision makers. The committee submitted a letter and technical note to the Director-General of Pharmacy, Medicines, and Laboratories (DGPML) requesting inclusion of misoprostol on the EML. A DGPML technical committee then reviewed the submitted application, gathering all available evidence on misoprostol. During this review period, FCI and our partners met again with the Director-General of the DGPML, who stated his support for misoprostol as a critical tool for reducing the burden of PPH in Burkina Faso. FCI and partners also met with the Secretary-General of the Ministry of Health, who affirmed the government’s responsibility for ensuring the availability of misoprostol for PPH at public health facilities. He also came out in support of misoprostol distribution at the community level, and recommended ongoing supervision and training to ensure its correct use.

In February of this year, all of these advocacy efforts paid off: the 2014 revision of the national EML (Liste Nationale Des Medicaments et Consommables Medicaux Essentials, Edition 2014) includes misoprostol both for prevention and for treatment of PPH.

While this is an important step in making misoprostol available in the government health system, FCI and our partners will continue advocating and working to ensure that all women have access to a uterotonic , like misoprostol or oxytocin, for effective prevention and treatment of postpartum hemorrhage. These efforts are critical for countries’ efforts to fulfill the promise of MDG 5 and put an end, once and for all, to preventable maternal death.

Learn more about FCI’s work on misoprostol for PPH here.

To join an online community on misoprostol for PPH, please click here.

 

Réussite exemplaire du plaidoyer : Le Burkina Faso élargit l’accès au misoprostol, un médicament essentiel de la santé maternelle

Par Brahima Bassane, MD– médecin en titre

Directeur national de FCI au Burkina Faso, Brahima Bassane est médecin de santé publique.

L’Hémorragie du post-partum (HPP) — des saignements excessifs, difficiles à arrêter survenant après l’accouchement — demeure la principale cause de décès maternels à travers le monde. Dans des pays tels que le Burkina Faso où un nombre important des accouchements surviennent encore à domicile, le médicament misoprostol fournit nombre d’avantages pour la prévention et le traitement de l’HPP dans la mesure où il peut être facilement administré et ne nécessite pas une conservation à dans un réfrigérateur (contrairement à l’ocytocine qui est considérée comme le médicament ‘de référence’ pour l’HPP).Le misoprostol peut représenter la seule chance de survie d’une femme en proie à l’HPP dans les milieux communautaires qui disposent d’un nombre insuffisant de centres de santé et d’accoucheuses qualifiées.

L’accès à des médicaments de haute qualité est un des droits de chaque citoyen pour lui permettre de jouir du meilleur état de santé possible. Toutefois, en dépit de l’innocuité et de l’efficacité reconnues du misoprostol, les décideurs ont été dans certains pays, réticents à autoriser sa mise à disposition généralisée ou ils ignorent les données disponibles. Plusieurs gouvernements n’ont pas inclus le misoprostol dans leur liste des médicaments essentiels (LME) qui est souvent utilisée comme critère pour l’importation, la distribution et la commercialisation de médicaments pour le système de santé publique.

FCI œuvre en vue de soutenir une meilleure compréhension, acceptation et utilisation du misoprostol pour l’HPP. Au Burkina Faso, nos initiatives —de concert avec un éventail de partenaires du plaidoyer —visant à convaincre cette année les responsables gouvernementaux de considérer le misoprostol pour l’HPP comme un médicament essentiel, ont été couronnées de succès. Cette réussite exemplaire fournit un modèle potentiel de plaidoyer efficace, mené en collaboration et bien ciblé dans d’autres pays où les avantages salvateurs du misoprostol ne sont pas encore largement disponibles.

Notre plaidoyer a véritablement débuté en septembre 2013 lorsque FCI a organisé une réunion en vue de partager les résultats des toutes dernières recherches sur le misoprostol pour l’HPP et de mettre au point des stratégies de plaidoyer qui convaincraient le gouvernement à prendre les bonnes décisions. Ces défenseurs engagés et motivés de la santé maternelle se sont prononcés pour la mise à disposition généralisée du misoprostol en indiquant que l’inclusion du misoprostol dans la Liste nationale des médicaments essentiels était une priorité nationale.

Suite à la réunion, la tâche de prendre contact avec les principaux décideurs gouvernementaux a été confiée à un petit comité consultatif. Le comité a présenté au Directeur Général de la Pharmacie, du Médicament et des Laboratoires (DGPML) une lettre et une note technique sollicitant l’inclusion du misoprostol dans la LME. Un comité technique de la DGPML a ensuite examiné la demande soumise en recueillant toutes les données disponibles relatives au misoprostol. Au cours de cette période d’examen, FCI et nos partenaires se sont réunis avec le Directeur Général de la GPML qui a exprimé son soutien pour le misoprostol comme outil crucial pour alléger le fardeau de l’HPP au Burkina Faso. Cette équipe restreinte de FCI et ses partenaires s’est également réunie avec le Secrétaire Général du Ministère de la Santé qui a affirmé la responsabilité du gouvernement à assurer la disponibilité du misoprostol pour l’HPP dans les établissements de santé. Il s’est également prononcé en faveur de la distribution du misoprostol jusqu’à l’échelle communautaire  tout en recommandant une supervision suivie et la formation afin de garantir son utilisation adéquate.

En février au cours de cette année 2014, toutes ces initiatives du plaidoyer ont porté leurs fruits : la révision en 2014 de la LNMCE (Liste Nationale Des Médicaments et Consommables Médicaux Essentiels, Édition 2014) comprend notamment le misoprostol pour la prévention ainsi que le traitement de l’HPP.

Bien que la mise à disposition du misoprostol dans le système public de santé constitue une étape importante, FCI et nos partenaires continueront à plaider et à œuvrer pour veiller à ce que toutes les femmes aient accès à un utérotonique tel que le misoprostol ou l’ocytocine pour une prévention et un traitement efficaces de l’hémorragie du post-partum. Ces initiatives sont cruciales pour les efforts des pays à tenir leur promesse pour l’OMD5 et à définitivement mettre un terme aux décès maternels évitables.

Trouvez de plus amples informations relatives aux travaux de FCI sur le misoprostol pour l’HPP.

Veuillez cliquer ici pour intégrer une communauté virtuelle sur le misoprostol pour l’HPP.

A Price Too High to Bear: Showing Kenya the devastating costs of maternal death

2014 March 20
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Martha Murdock is FCI’s vice president for regional programs.

Last week in Nairobi, a range of partners — from the Kenyan government, UN agencies, donor countries, and many NGOs and research organizations from the national and county levels — came together for a presentation of new research that has the potential to increase the momentum of efforts to save the lives of nearly 300,000 women who die each year (5,500 of them in Kenya) from causes related to pregnancy and childbirth.

Each of these avoidable, premature deaths is a tragedy in its own right, and a terrible injustice. Each of these women — some of them barely more than girls — has a right to life and health, and to a standard of health care that protects her from preventable illness, injury, and death.

But we who work to improve maternal health have argued for years that each of these deaths also brings countless additional layers of loss, pain, and destruction. The tragic, sudden death of a woman in the prime of life — in many cases already a mother and often the most economically productive member of the family — begins a cascade of loss and pain that upends the lives of those around her: her newborn baby (if it survives) and her older children, husband, parents, and other members of her family and community.

Up until now, however, we haven’t had the hard data to support our case, to help us persuade governments, donors, and policy makers that investments in maternal health are also investments in children, in stable families, in education and community development, and ultimately in stronger national economies. Now, thanks to a study conducted in Kenya by FCI, the International Center for Research on Women (ICRW), and the KEMRI-CDC Research and Public Health Collaboration, we know that the data behind that argument is very powerful indeed.

Based on interviews and focus group discussions with every family, across a poor rural area in Siaya County in western Kenya, that had lost a family member to maternal death over a two-year period, we found that:

  • When a mother dies in or around childbirth, her newborn baby is unlikely to survive.
    • Of 59 maternal deaths in the study, only 15 babies survived their first two months of life.
  • A mother’s death harms the educational and life opportunities of her surviving children.
    • Many children had to leave school because the loss of a mother’s income meant that they couldn’t pay tuition fees, needed to work for a living, or had to take up essential household chores.
  • The cost of emergency care (even when unsuccessful), combined with high funeral costs, puts families under a crushing economic burden.
    • Families spent more on funerals than their total annual expenditure on food, housing, and other household costs, after having already spent 1/3 of their annual consumption expenditure on medical costs.
  • Loss of income and high, unexpected costs send many families into a spiral of debt, poverty, and instability.
    • Many families, under desperate financial pressure, had to sell household property, borrow from moneylenders, or move children out of the family home.

When this moving and compelling report was launched in Nairobi last Friday, I was proud to stand at the dais and introduce eminent leaders of efforts to improve women’s and children’s health in Kenya, including the U.K. High Commissioner for Kenya, Dr. Christian Turner (representing the U.K. Government, which funded this important research together with the John D. and Catherine T. MacArthur Foundation and the Partnership for Maternal, Newborn & Child Health). Dr. Turner, in turn, introduced Kenya’s Cabinet Secretary for Health, Hon. James Macharia. With us in the room were important policy makers from the Ministry of Health, national parliamentarians, and high-level representatives from UNICEF, WHO, UNFPA, USAID, and a range of other agencies and organizations.

We came together that morning, I said, “because we are all resolved, together with so many colleagues and partners here in Kenya and around the world, to work together to finally put an end to a tragic toll of maternal and newborn death that goes back to the beginnings of human history.” We have long known that far too many women were dying.  What we lacked, until now, was hard data to help us fully understand the financial and social impact of a mother’s death — the costs to the health and well-being of thousands of surviving children, families, and communities. We and our partners undertook this study because we saw that filling this critical knowledge gap will offer advocates and policy makers a powerful tool for bringing further attention and investment to maternal health.

The messages that emerge from this research were expressed clearly and succinctly by Hon. James Macharia as he presided over the official launch of the report:

A mother’s death ignites a chain of disruption, economic loss, and emotional pain that often leads to the death of her baby, diminished educational and life opportunities for her surviving children, and a deepening cycle of poverty for her family.

The cost of a maternal death is, quite literally, a price too high to bear.

 

(An excellent in-depth news report on the study and its launch, by a leading Kenyan television network, can be viewed here: