Promises

Brown launches global health campaign

British Prime Minister Gordon Brown thinks millions of lives can be saved if the International Health Partnership (IHP) is implemented. It as the first part of the Global Campaign for the Health Millennium Development Goals.

«Today we come together - donor governments, health agencies and developing countries - with the certainty that we have the knowledge and the power to save millions of lives through our efforts,» said Prime Minister Gordon Brown on Wednesday 5 September. He was host to health ministers from Asia and Africa along with the Norwegian Prime Minister Jens Stoltenberg.

The Global Campaign is an umbrella for various initiatives to provide better health care in poor countries and fulfil the Millennium Developments Goals (MDG). The International Health Partnership (IHP) has the specific aim of ensuring that international donors and partners work better to strengthen the national health plans of poor countries.  Partners are also committing to providing longer term and more predictable funding.
«Every third second a child under five dies of causes which are preventable and every minute a woman dies in childbirth. As a father, economist and politician, I regard this as morally unacceptable and a great constraint on the development of poor countries. Only by strengthening the health care system in poor countries, will we be able to create a marked improvement  in the work to achieve the health millennium goals,» says Stoltenberg in support of the initiative.

The need for better coordination of health aid is acute. By 2015 there will be a global shortage of four million health workers. Much of the health aid is not focused and wastes resources.  Internationally there are over 40 bilateral donors, 26 UN agencies, 20 global and regional funds and 90 global health initiatives.
According to the British Department for International Development (DFID), in developing countries over 1500 person hours can be spent in meetings developing a proposal for one donor. Cambodia is a case in point. Last year there were 22 different donors in the health sector providing support through 109 separate projects.

The first wave of IHP-aid will target seven countries in Africa and Asia. The health ministers of Burundi, Ethiopia, Kenya, Mozambique, Zambia, Cambodia and Nepal have all committed themselves to increasing public funding for healthcare and ensuring that their poorest citizens have cheap access to medical assistance.

Better co-ordinated efforts and support by donors are already showing positive results.
* The use of Zambia’s health services has increased by 40 percent since being made cost-free in rural areas;
* The number of front-line health workers has doubled in Ethiopia from 6,000 to 12,000 in two years;
* In Burundi, the number of children receiving health care has nearly doubled since becoming free for under-fives last year

The World Health Organisation (WHO), UNICEF and a number of other agencies have welcomed the new partnership:
«The renewed political interest in strengthening health systems gives us the important opportunity we need to redouble our efforts to meet the challenge of the MDGs head on. Strengthening health systems means addressing key constraints related to health worker staffing, infrastructure, health commodities, logistics, tracking progress and effective financing.»

The Global Campaign is a step-by-step global effort to harness more resources and use them better.

In three weeks time the Norwegian Prime Minister Jens Stoltenberg will present a comprehensive plan in New York aimed at reducing child mortality and improving maternal health. Result-based financing of projects supported by a global advocacy campaign will be key elements.

The Canadian government in partnership with UNICEF is part of the Global Campaign with its Catalytic Initiative to Save a Million Lives. The primary goal is to resolve problems in local health systems in poor countries.

Giving new hope and life

«Being a fistula surgeon is to give new hope and life to women who have been living in darkness.»

In his quiet way Chebeya Bonane Justin (picture) knows the transforming impact a relatively simple operation can have on the lives of the despairing women who come to the Panzi Hospital in Bukavu in the Democratic Republic of Congo.
«These women have been living without hope, abandoned by their husbands, family and neighbours,» the young doctor explains. He deals  mainly with two types of fistula:

* Obstetric fistula develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labour. The tissues die and a hole forms through which urine and/or feces pass uncontrollably.
* Traumatic fistulas caused by rape, in particular gang rape, or the forcing sticks or a knife into the vagina -  as is not uncommon in the Congo.

Justin points out that the high occurrence of both forms of fistula in the Congo is a result of the continuing conflict. Rape by the army and the different militias is widespread.
«Due to the war pregnant women either have been forced to flee into the bush or they do not dare leave their homes to go to health clinics for fear of being kidnapped and raped. A high number of births take place without assistance, and when the women are under twenty the danger of long and obstructed labour increases, » says Justin.
Working with fistula patients at the Panzi Hospital since 2005, Justin was one of the first doctors to be trained in fistula operations in Bukavu. He thinks it is very important for the hospital to have an outreach service, whereby a medical team goes out into the villages both to inform about fistula and to find women with the condition.
«A wife suffering of fistula experiences a continual urine leakage and smells bad. She is often abandoned by all, and feels the need to hide. Some do not have the courage to come to us, so we have to travel to where they are hiding,» he tells.
The fistula programme supported by the Christian Relief Network involves outreach work, treatment and the training of doctors and nurses.
«It is important that doctors know how to operate fistula. If they make a mistake or do not manage, it makes the hole even more difficult to repair. Post-operation treatment is also vital,» Justin underlines.
One of the highlights of 33-year-old’s career was when he operated a 60-year-old woman:
«She had lived with fistula for 40 years. She got it before I was born. One week after the operation she was back on her feet, her life completely changed. She was so happy, and kept thanking me, repeating ‘God bless you, God bless you’.»
While in Norway Justin has met with the Norwegian Medical Students´Humanitarian Campaign who are busy collecting funds for the Panzi Hospital.
«I get touched when I see foreign people wanting to help our work in the Congo. It is important. We operate on these women for free. They are too poor to pay for treatment. Were there is war, there is poverty. This campaign will allow us to help more women back into society,» says Dr. Chebeya Bonane Justin.

A campaign in need of renewal

Why is the women’s movement not in the forefront of the campaign to reduce child- and maternal mortality?  asks Ann Pettifor, Executive Director of Advocacy International.

She is doing advocacy research in connection with the global campaign on Millennium Development Goals 4 & 5.
“Aids is a big issue, mother and child mortality is not, “ she says. While four million people die of Aids-related sicknesses every year, more than 14 million women and children die in and around childbirth.
According to Pettifor there is virtually no awareness  among Joe public about the extent of mother and child mortality. She regards this as a major failure of the women’s movement, especially in the light of the issue being one of women’s rights:
“The women’s movement as always seen motherhood as a source of oppression and not mobilized on behalf of these women. “
Ann Pettifor was the driving force behind the Jubilee 2000 campaign that in 1999 saw the world’s richest nations writing off $100 billion of the national debts of the 42 poorest nations. Apart from giving advocacy advice to The Partnership for Maternal, Newborn and Child Health, she is assisting the Church of England in its campaign to get the government to legislate strict environmental laws to reduce Carbon Dioxide emissions and working on a new campaign for the Children’s Defence Fund.
This year sees the 20th anniversary of the launch of the global Safe Motherhood Initiative, yet the mortality numbers remain high.
If a new global campaign is to be more than a discussion group among the already converted, it must learn from past mistakes and build on the experience of successful campaigns such as Jubilee 2000.
“It is hard for an organization of professional health workers to become a campaign. Professionals are always defensive of their own turf. The debt campaign was not run my bankers or finance people, but by ordinary people,” says Pettifor.
The first task is to raise public awareness of the fact that this is a much greater health problem than Aids and TB. In her view child and maternal mortality is the greatest indicator of inequality between the north and south of this world.
Pettifor’s advice is that the message must be simple and if necessary radical:
“The Safe Motherhood Initiative was framed to satisfy the Republican right in the USA and could not ignite anyone. Go for what you want and deal with the hostile social forces as they arise.”
For her it is important that people around the globe feel angry and demand national health services as part of the solution.
“Only a grassroot social mobilization will raise expectations and put pressure on governments to act. The movement must build a culture that does not accept that women die in childbirth,” says Pettifor.
“We have not yet arrived at the one thing, the silver bullet, that will get people to understand and mobilize on this tragedy.”

© JM

Global Plan takes shape

Accelerated progress to improve mother and child health is dependent on better coordination and more efficient aid, result-based financing and mobilizing political leaders.

«The basic concepts and key activities are taking shape. The Global Business Plan to accelerate progress towards Millennium Development Goals 4 & 5 will be completed by the middle of August. This is in good time before the New York launch of the plan in September,» says Tore Godal, Special Advisor to the Prime Minister of Norway.

The Global Plan is a result of an initiative taken by Norwegian Prime Minister Jens Stoltenberg.  It has been shaped by a myriad of proposals, research projects, meetings between experts and political discussions. UN bodies, The World Bank, NGOs, various governments and individual experts have given constructive feedback on a concept paper for the Global Business Plan.

«Ultimately the success or failure of the Plan will be measured by a reduction of child and mother mortality at the village level. To achieve this international health assistance has to be consolidated and become more efficient » says Godal.

The Norwegian special advisor highlights three key aspects of the Global Plan:

* The need to streamline the architecture of global health funding. At present there are over a 100 health initiatives, each with their own plans and demands on recipient governments. The plan’s aim is to achieve agreement among donors to concentrate funding in support of the national health plans of individual countries.
* The African Union and many governments already have plans for reducing maternal and child mortality. This requires increased access to services aimed at saving life and improving health and well-being for mothers, newborns and children. The UN and UNICEF have a central role in following up and supporting these programs.
* There is a need for innovative solutions to improve health services.  The plan proposes introducing and scaling up results-based financing of development projects so that increases in the number of people receiving care leads to a corresponding increase in funding.

«Results-based financing of projects is a new concept in development aid,» underlines Godal. The hope is that aid recipients will implement strategies and adopt practices that lead to success, and thus ongoing funding. This is probably one of the more controversial aspects of the plan.

Godal admits that the follow-up of the Global Plan is dependent on the mobilisation of active support from political leaders.
«We want as many as possible to feel an ownership of the plan,» he says.

Work is already well underway to build political commitment to intensify efforts to reduce maternal, newborn and child deaths. Norwegian Prime Minister Jens Stoltenberg has collaborated with Prime Minister Gordon Brown (initially as Chancellor) and Bill and Melinda Gates for some time.  President Bachelet of Chile, President Yudhoyono of Indonesia, President Guebuza of Mozambique, Prime Minister Singh of India, Prime Minister Aziz of Pakistan and President Kikwete of Tanzania, along with child rights leader Graca Machel have since joined The Network of Global Leaders for MDG 4 & 5.
The Plan will be launched in New York on 26 September in conjunction with the Annual Meeting of the Clinton Global Initiative and the annual opening of the UN General Assembly, and will be followed up at the Women Deliver Conference in London 18 - 20 October.

JM

Anniversary of failure?

20 years on and the Safe Motherhood Initiative still tells a depressing story. It is an anniversary of an ongoing struggle to save the lives of women.

The success of the initiative has been to put the issue of keeping mothers safe before, during and after pregnancy on the global health agenda. The fact that one in sixteen women still die from complications during childbirth – 529.000 women every year – indicates a global health failure.
With increased donor focus on maternal healthcare and a massive «Women Deliver» conference in London in October perhaps a paradigm shift will take place.
At the World Health Assembly in May, WHO Director-General Margaret Chan (picture), underlined that there can be no safe future, without safe motherhood.
«Women are agents of change. They can lift households and communities out of poverty,» she said.
With Norway, Britain and the Bill & Melinda Gates Foundation presenting a global plan to reduce child and maternal deaths at the United Nations at the end of September the focus will turn to the building of viable primary health services in countries with high maternal and infant morality rates.
(JM)
Photo: WHO

New plan to fight child mortality

Norway, Britain, Tanzania, Indonesia, Mozambique and the Bill & Melinda Gates Foundation have joined forces to launch a common plan to fight child mortality.

"This is a cooperation between the private sector and political leaders. The aim is to ensure efficiency in every step of the work to save children's lives," said Norwegian Prime Minister Jens Stoltenberg when addressing the world's health minister in Geneva this week.

A global business plan is being formulated by the Norwegian government, Chancellor Gordon Brown from the UK and the Gates Foundation. Already, Tanzania, Indonesia and Mozambique have signaled that they will join the effort.

- Fighting child mortality is a key development issue to me. You as health ministers have a particular responsibility for ensuring that the measures taken in the fight against child mortality are effective and reach the children, said Stoltenberg. 

Prime Minister Jens Stoltenberg was a specially invited guest speaker to the WHO meeting for health ministers from 193 countries.

” The worlds’ health ministers have to give top priority to health care for children in order to fight child mortality,” said Jens Stoltenberg. (JM)

Saving the lives of mothers & children

Norwegian Prime Minister Jens Stoltenberg is the driving force behind the initiative to form partnerships with other political leaders and to build global alliances to ensure a marked reduction in child- and maternal mortality by 2015.

While Norway gives broad support to all eight Millennium Development Goals (MDG), priority is given to goals four and five.

A reduction in child mortality and an improvement in maternal health by 2015 is in the view of the Prime Minister, the litmus test for our common desire to reduce poverty and create a healthier global society. He has a strong personal commitment to child survival, thus giving added value to the UN initiative.

According to the World Health Organisation (WHO) the amount spent on child and maternal healthcare has to be increased by 9 billion US dollars annually if the Millennium Goals are to be realized by the 75 countries with the highest mortality rates. This requires a massive mobilization of political will, private initiative and global effort. (JM)
Photo: Bjørn Sigurdsøn/SMK