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‘The Lancet’ on Achieving Maternal Health Goals in the SDG Era: Tackling Diversity and Divergence
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Between 1990 and 2015, there was an incredible 44 percent decrease in global maternal mortality rates. But these impressive gains still fell short of the Millennium Development Goal of reducing the global maternal mortality ratio by three quarters.
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No Mother Left Behind: How Conflict Exacerbates the Global Maternal Health Challenge
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Since the end of World War II, the number of wars between states has declined significantly, but the number of intrastate civil conflicts – as seen in Syria and Afghanistan – has increased.
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History’s Largest Generation Isn’t Getting the Health Care It Needs to Thrive
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At 1.8 billion strong, the current generation of 10 to 24 year olds is the largest in human history. Approximately 90 percent of these adolescents live in less developed countries. This poses an unprecedented challenge for health systems and social policies which largely struggle to meet the unique needs of young people, according to a new Lancet commission.
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How Zika Is Shaping the Sexual and Reproductive Health and Rights Agenda
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“The Zika outbreak is a result of something; it is the result of the lost attention to sexual and reproductive health issues as a human right and women as subjects of rights,” said Jaime Nadal Roig, the United Nations Population Fund representative to Brazil, at the Wilson Center on April 12. [Video Below]
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Rethinking Business As Usual: Leveraging the Private Sector to Strengthen Maternal Health
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In 2013, nearly 300,000 women died during pregnancy and childbirth. The majority of those deaths were in developing countries and entirely preventable. Much of the effort towards reducing this number has been focused on what governments should do differently, but the private sector plays just as important a role as the public sector, said a panel of experts at the Wilson Center on September 17. [Video Below]
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Accounting for 1 in 3 Maternal Deaths, Health Disparities Persist in South Asia
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The state of maternal health in South Asia is difficult to assess. Although rates of maternal mortality are declining between 2 and 2.5 percent a year overall, the region’s massive population – one fifth of the world and over 1 billion people in India alone – means it still accounts for one out of three maternal deaths. [Video Below]
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Measuring Maternal Health in a Post-MDG World
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As the international development community looks back on the Millennium Development Goals and ponders what remains to be done under the proposed Sustainable Development Goals, the maternal health field has some reflecting to do, said Dr. Ana Langer, professor and director of Harvard’s Maternal Health Task Force at the Wilson Center on December 1. [Video Below]
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Maternal and Newborn Health as a Priority for Strengthening Health Systems
›Among the many initiatives that have recently been launched to strengthen health systems in the developing world, there is little consensus on execution. Traditional strategies for improving the health system, such as the vertical approach, which prioritizes communicable diseases, or the horizontal approach, which prioritizes non-communicable diseases, are limited in scope and fail to include a comprehensive gender lens.
To overcome the shortcomings of these two health financing approaches, the “diagonal” strategy combines them by “clearly defining priorities and utilizing these priorities to drive general improvements of the health system,” said Julio Frenk, dean of the Harvard University School of Public Health, at the Global Health Initiative’s third event in the “Advancing Policy Dialogue on Maternal Health” series.
Along with panelists Helen de Pinho of Columbia University, and Agnes Soucat of the World Bank, Frenk discussed how prioritizing key maternal health indicators can improve health systems and support the implementation of evidence-based interventions.
Putting Women and Health First
Drawing on his experience as Mexico’s minister of health, Frenk said that clearly defining a set of priorities grounded in “women and health” drove the improvement of Mexico’s health system. “Picture three concentric circles. The core of these concentric circles is the prevention of maternal mortality and disability; the second circle [includes] other aspects of sexual and reproductive health in addition to pregnancy and delivery; the third circle includes other fundamental areas of women’s health and the intersection of women with the health system,” said Frenk.
Mexico used maternal mortality rates to measure quality of care and rectify weaknesses in the health system. “Every maternal death triggered an audit that could lead to a hospital losing its license to operate,” said Frenk. Additionally, these audits helped to identify gaps and prioritize investments in “equipment and supply of drugs…and networks [for] obstetric emergencies,” he added.
“This illustrates how you can take a specific set of priorities and drive them through,” argued Frenk. “Global health needs to get out of the traditional confines that have split the community between vertical and horizontal and adopt more integrated frameworks like the notion of women and health,” he said, which “will leave behind a better health system to deal with the next challenge.”
Measuring Maternal Health
The maternal health community agrees that to reduce maternal mortality rates, access to emergency obstetric care (EmOC) must be improved. “A simple assessment of an emergency obstetric care facility combines a number of aspects that are core to strong health systems,” said de Pinho. To reduce maternal mortality, a strong health system must be able to positively answer these key questions:
These questions monitor the availability, utilization, and quality of care, which signals whether “the health system is actually responding to the woman’s needs when they need it,” said de Pinho. These maternal health indicators “paint a picture for where next steps need to be taken,” she said.- Are there enough facilities providing EmOC and are they well distributed?
- Are women with obstetric complications using these facilities?
- Is the quality of the EmOC services adequate?
Rwanda’s Innovations in Health Financing
“When we talk to ministries of health we ask them what are the low-hanging fruits we can reach in the six years” until the deadline for meeting the Millennium Development Goals (MDGs), said Soucat. To implement methods with proven results, additional research data, monetary support, and political will are all necessary. Rwanda’s ministry of health used the health-related MDGs—particularly MDG 5 to reduce maternal deaths by 75 percent—to reform the health system and hold institutional and individual actors accountable.
Rwanda’s health system was reformed through five key pillars:
“The heart of the reform is to increase accountability to its citizens,” said Soucat. Rwanda’s results-based financing offered “incentives and salary supplements to workers who saw more patients and provided higher quality of care,” she said. Impact assessments demonstrate that all income groups in Rwanda benefited from this health care scheme; in three years family planning tripled and assisted deliveries increased by 13 percent –“something that has never been observed in Africa,” she said.- Fiscal decentralization increased community participation and allocated funds to district governments
- Performance contracts were established between the president and district mayors
- A performance-based financing system distributed money to health facilities based on results
- Community health insurance increased access and reduced out-of-pocket expenditures
- Autonomous health facilities were allowed to hire and fire personnel
Rwanda’s Ministry of Health conducted rigorous assessments to ensure quality services and demonstrate impact to the Ministry of Finance. “When talking about maternal health a strong dialogue between the Ministry of Health and Ministry of Finance is needed more than ever and centered around the production of results,” argued Soucat. Scaling up the results-based finance scheme in other African countries is possible, she said, but additional research is needed to better understand this scheme at the decentralized level.
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