President and CEO of BRAC USA
While the UN says that the world is on track to reach the first Millennium Development Goal of cutting poverty in half by 2015, progress toward goal #5, to reduce maternal mortality by 75% by 2015, remains the target for which progress has been most disappointing. While there is progress, as highlighted by the Lancet’s recent estimates of falling maternal mortality rate, which is worth celebrating, the sense of urgency has not, and should not, abate.
According to Karl Hofmann’s recent article in the Huffington Post, with an additional $10 billion annually by 2010 and $20 billion by 2015 — there is just enough time to achieve MDG 5. The G8 summit gets underway today in Muskoka, Canada, is timely in that a focus of the summit is a new G8 initiative — conceived and led by Canada — to improve maternal, newborn, and child health in poor countries. With almost $3 billion already pledged by the Canadian government and the Bill and Melinda Gates Foundation, more commitments are expected from G8 partners for what is now being called the Muskoka Initiative. Is the problem not enough money? At this year’s Global Health Council Conference, Lynn Freedman argued against that notion. The prevailing belief that technical inputs with political will and enough investment will result in functioning services is inaccurate, and draws attention to the disconnect between global conversations and local progress. The former has been focused on developing the right packages of clinical interventions as well as generating political messaging. The latter deals with implementation and the microdynamics of the social system that underpins access, distribution, power and resource allocation. The lesson learned is that having the right clinical package is not the harbinger of effective implementation. To effectively reduce maternal mortality, we need solutions that not only deliver proven interventions within poorly resourced health systems, but are designed to navigate complex social dynamics that neglect, exclude and disempower those who most need them. Therein lies the challenge and the opportunity to innovate. BRAC, through the Manoshi project operating in the urban slums of six Bangladeshi cities, is rising to the challenge. Using a model grounded in developing community health solutions, the Manoshi Maternal, Neonatal and Child Health Program develops health care seeking behavior, leverages community linkages and technology to provide access to key services at the household level and creates an effective interface between the institutional health system and the community. Manoshi, and many other initiatives are creating and proving models that form a comprehensive solution to maternal mortality. For global impact, these models need to be scaled and adapted. As maternal health takes the spotlight at the ongoing G8 summit, the global community now needs to focus on expanding the conversation and focus on effective and impact-driven implementation.