FROM September 30th, 2018

Wife of the Senate President, Toyin Ojora Saraki has emphasised that government investment in strengthening health insurance systems is paramount to achieving Universal Health Coverage (UHC) in Nigeria and around the world.

Saraki who stated this while addressing the United Nations General Assembly on Thursday, noted that Civil registration and vital statistics systems must be implemented and strengthened to allow Governments to prepare for epidemics and allocate investment where it is needed the most.

According to Saraki, Investment in family, community and primary healthcare, along with hospitals where needed to bolster healthcare wherever people need it, in rural areas and urban, cities and villages.

She said, “Only two countries in Africa have met the Abuja declaration to pledge 15% of their government budgets to health. Meanwhile, tuberculosis kills more than 4,000 people every single day. This can be avoided.” She said.

“Too many people are plunged into poverty by health emergencies that they or their families experience. Non-communicable diseases kill over 41 million people every year” She added.

Saraki lamented the murder of young midwife and mother, Saifura Hussaini Ahmed Khorsa in Nigeria last week, saying that the incident must spur Governments and global institutions on to strengthen security provisions for frontline health workers, adding that their training and pay conditions must also be improved.

FROM September 24th, 2018

Mrs Toyin Ojora Saraki has sounded a warning bell as the United Nations General Assembly convenes in New York.

Saraki cautioned that unless significant progress is made, the Sustainable Development Goals will not be met by the global community.
“Only two countries in Africa – Rwanda and South Africa – have met the Abuja declaration to pledge 15 per cent of their government budgets to health.
“Meanwhile, tuberculosis kills more than 4,000 people every single day, non-communicable diseases kill over 41 million people every year, and 80 per cent of deaths in childbirth could be avoided with techniques that should be available across the globe. There has also been a distinct lack of progress in delivering upon the World Health Assembly 2017 Sepsis Resolution and improving water, sanitation and hygiene in healthcare facilities, schools and communities.”
Mrs Saraki said that she will be advocating for five key interventions which must be urgently made at UN meeting this week.
“Investment in family, community and primary healthcare – along with hospitals where needed – to bolster healthcare wherever people need it; in rural areas and urban, cities and villages. The murder of young midwife and mother Saifura Hussaini Ahmed Khorsa in Nigeria last week must spur Governments and global institutions on to strengthen security provisions for frontline health workers. Their training and pay conditions must also be improved.
“The Wellbeing Foundation Africa’s Emergency Obstetric and Newborn Care programme, operated with its global partners Johnson & Johnson and the Liverpool School of Tropical Medicine, can serve as the benchmark for health worker training. We have shown that qualified midwives can and do lead the way with quality care.
“Civil registration and vital statistics systems must be implemented and strengthened to allow Governments to prepare for epidemics and allocate investment where it is needed the most. 1.8 billion people, according to the World Bank’s latest statistics, have no Government identification. Their health needs are consequently highly likely to not be met and they will be especially vulnerable during disease outbreaks,” she said.
She added that “government investment in strengthening health insurance systems is paramount – in Nigeria and around the world, too many people are pushed into poverty by health emergencies that they or their families experience. Non-communicable diseases kill over 41 million people every year. The Director-General of the WHO, Dr Tedros, has rightly highlighted the NCD crisis and it must be a core focus of all Government programmes. Whilst progress has been made in many areas, I feel compelled to speak out as too many women, children and communities are being left behind. We have the opportunity to change the course of history, but it is a chance that is slipping away. Urgency is the order of the day.”
During the UN General Assembly, Mrs Saraki is also scheduled to meet with fellow African philanthropists and global partners, and to deliver high-level United Nations advocacy speeches on child health and malaria, frontline health workers and the steps required to achieve Universal Health Coverage.
Toyin Saraki is Founder-President of the Wellbeing Foundation Africa, Global Goodwill Ambassador for the International Confederation of Midwives, Special Adviser to the World Health Organization regional office for Africa and Wife of the Senate President of the Federal Republic of Nigeria.

FROM May 28th, 2018

To commemorate this year’s International Day of the Midwife on Tuesday, Toyin Saraki, wife of Senate President, Bukola Saraki and UN Population Fund highlighted the important role that midwives play in the health sector as well as the need to provide better working conditions for them.

Dr Dienne Keita, Resident Representative, UN Population Fund (UNFPA), advocated for adequate policy framework and working condition for midwives to ensure enhanced maternal and neonatal indices in Nigeria in Abuja.

The country representative underscored the need to expand midwifery programmes, maintain high global standard and promote enabling environment to effectively serve the need of a woman and her family.

She noted that midwives have supported many women to exercise their sexual and reproductive health services.
Keita said the services help to ensure healthy, wanted pregnancy and safe delivery, but “yet far too many women die in Nigeria due to the lack of adequate access to reproductive health services’’.

“UNFPA strongly supports the training of midwives in more than 100 countries including Nigeria.

“In 2009 UNFPA in collaboration with partners support midwifery services and training in Nigeria. UNFPA also sends the National Midwifery Association to the training on how the association can enhance regular midwifery framework to ensure accountability,’’ Keita said.

She said the theme for 2018 is: “Midwife: Leading the way with quality care’’, resonates with UNFPA key midwife strategic direction of quality, equity and leadership.

According to her, UNFPA in collaboration with the National Association of Nurses and Midwives provided free medical outreach to hundreds of women and children in Gwagwa and Rigasa communities in line with theme of the event.

The benefitting communities were located within the Federal Capital Territory and Kaduna State, respectively.

Earlier, Mr Abdulrafiu Adeniyi, National President, National Association of Nigerian Nurses and Midwives, decried the lingering crises and industrial action within the health sector.

Adeniyi said the association would work to ensure that everything was put in place to prevent industrial actions in the health sector.

He therefore called on government and other key stakeholders to think proactively on the best way to keep industrial disharmony in health sector at bay.

Mrs Toyin Saraki, wife of the President of the Senate and Founder, Well Being Foundation, said the evidence shows that midwives can lead the way with quality and equity in healthcare delivery.

“We are not only celebrating the importance of midwives within the health sector but we are showing the evidence that midwives can bring the change we need to deliver quality care to people,’’ Saraki said.

She said the foundation had inaugurated a major WASH campaign in collaboration with global water 2020, WHO and other partners.

She added that the campaign aimed at taking hygiene to health facilities to wipe out sepsis and enhance the survival rate of women and children in the country.

Saraki noted that the expertise had shown that Nigerian midwives were key health professionals we can trust to take healthcare delivery to the grassroots.

May 5 is the internationally recognised day for highlighting the work of midwives.

The News Agency of Nigeria (NAN) recalls that the International Confederation of Midwives (ICM) introduced the idea of the ‘International Day of the Midwife’ following suggestions and discussion among Midwives Associations in the late 1980s.

The ICM then launched the initiative formally in 1992.

FROM March 3rd, 2018

March 2018


In my role as the Founder-President of The Wellbeing Foundation Africa (WBFA), I have dedicated 13 years to ensuring that mothers and children have full access to the health services and social support that they require; when pregnant, during childbirth and in those critical early days and months once a baby is born.

What has struck me as I meet with thousands of mothers, their babies and their families in my native Nigeria and across sub-Saharan Africa, are the infrastructural deficiencies that still exist in health systems; and the many miles that families must travel to see a doctor, nurse or health worker; the lack of information and education regarding health conditions and health choices.

Many families struggle to access the care they need, and in cases where access is granted, huge financial and social burdens are often incurred by the family.

There is a solution. Universal Health Coverage (UHC).

The WHO defines UHC as a system in which all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. As a special adviser to the Independent Advisory Group (IAG) Regional Office for Africa, I support the leadership of the WHO, in particular its first African Director-General Dr Tedros Adhanom Ghebreyesus, which has made UHC a strategic priority.

It is promising to see commitments such as those made by MSD for Mothers last year in support of its mission to reduce maternal mortality. Working in collaboration with the Global Financing Facility, MSD for Mothers announced $10 million in support of the UN Every Woman Every Child initiative, which will help to ensure that key maternal health indicators are met, and that women and children have improved access to healthcare. USAID also announced last year a new development impact bond aimed at reducing maternal and newborn deaths in India. It is interventions like this that are leading the way in the pursuit of UHC, and I hope that others will follow the example set.

UHC is not a concept to be imposed upon a country, however, but rather one that we should develop ourselves – not eschewing the help of partners, but incorporating their support into our own systems. The role of education within UHC is a good example – educating health workers to provide up-to-date information and educating patients to make informed health decisions. Educating and upskilling our nurses, midwives and health workers to deliver improved health services, and providing education to patients accessing services has a domino effect on those who receive it – on individuals, their families and their communities at large. It is for this reason that at the Wellbeing Foundation Africa we developed our own education programmes, comprised of emergency obstetric and newborn care – with our partners at Johnson & Johnson and the Liverpool School of Tropical Medicine further education training for midwives, and antenatal, intrapartum and postpartum education classes for expectant parents. A powerful combination, and one which brings about real change to the lives of women, their babies and the communities which they go on to positively impact.

Primary healthcare presents a critical piece of the puzzle in achieving UHC, and should be prioritised accordingly. In Nigeria, I have a vision to strengthen primary healthcare centres to the standards of medical referral centres, to deliver costed, insured, and funded community health to a high quality for all. An ambitious goal but one which I believe is attainable, and certainly a step in the right direction toward achieving UHC.

We must also recognise the importance of a well-designed civil registration and vital statistics (CRVS) system in order to collect and produce accurate data – and thereby ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies in Nigeria. At the WBFA we designed the Personal Health Record (PHR), a book in which the medical records of each mother and child are recorded and stored for future reference and analysis. The PHR evolved from a child immunisation and growth record to a comprehensive CRVS tool. Without a centralised health database for many families to rely upon to keep them informed of the necessary health processes in a child’s first thousand days of life, the PHR came as an innovation that placed this knowledge directly into the mothers’ hands, and empowered her to provide, analyze and follow-up on her own data. A comprehensive CRVS system in Nigeria will enable us to deliver health for all as a measurable demographic dividend.

In 2017, Nigeria edged noticeably closer to achieving UHC – for example, the Senate’s resolution to mandate the Committee on Appropriations to include the one percent Consolidated Revenue Fund (CRF) for the Basic Health Care Provision Fund (BHCPF) was ground-breaking.This has heralded positive and sustainable public health improvements in the country, and I hope that this momentum can be maintained and accelerated in 2018. UHC: coming to a village near you.

The content of this blog is solely the responsibility of the author and does not represent the official views of MSD. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ USA.

FROM August 31st, 2017

Toyin Saraki never saw her baby who died. At first, when she asked to see the second of her twin girls, Saraki was told she’d been taken to another hospital. Even now — 25 years on — she doesn’t know where the baby is buried.

“In our culture, we don’t really deal with grief,” she tells me. “You don’t bury your child, so every time I go to a funeral, I am always checking to see if my child is there. One of my husband’s uncles knows [where she is] but he won’t tell me. Imagine being unable to put flowers on a grave.” This fostered a false hope. “I used to look at the faces of children about my baby’s age and think: ‘Maybe she didn’t die — maybe someone stole her’.”

Her loss led Saraki — the First Lady of Kwara state in Nigeria — to found the Wellbeing Foundation, a charity to improve reproductive, maternal and child health, which runs “Mamacare” clinics for expectant mothers. Over the course of two days in Lagos with Saraki, a dual Anglo-Nigerian national who was born in Nigeria, came to the UK to board at Roedean School in Sussex and now lives between the two countries, we visit two clinics, the first in a military compound, the 9th Brigade, and the second in more rural Awoyaya.

We first meet in her opulent home in Lagos, all perfectly plumped cushions and enviable art, where the calm is only broken by her dogs. Saraki is 52, though could pass for much younger, with no wrinkles around her kohl-rimmed eyes. When in London, her clothes are Western; here, she’s in bright swirling prints — teal, yellow and pink. Her approach is loving yet no-nonsense: there’s a throaty laugh that comes easily, she insists the mothers call her “Toyin” instead of “her excellency” and later, in a restaurant, she drops her handbag down on the floor before a waitress can bring a stool for it (“I’m not one of those precious people”).

Saraki is a connections queen. She knows the Obamas, Ban Ki-moon and Princes William and Harry. The latter contacted her about sharing research with his charity Sentebale: “Those boys bring a youthful face. It’s rare to see boys innovating in development. They show it’s not a sin to have feelings as a guy.”

She applauds Harry’s work in particular. “His approach is one of respect. I don’t like the beneficiary narrative — my Mamacare mums are mums, not beneficiaries. If people need help in their life, you should be grateful you are in a position to help them.”

Saraki knows trauma first-hand. Aged 25 and pregnant, she travelled from London to Nigeria for her wedding (Nigerian nuptial celebrations can last a year). At 28 weeks pregnant, the day before her wedding, Saraki realised the amniotic sac was hanging out, although her waters hadn’t broken.

She recalls being “carried off, legs spread-eagled”. At the hospital, she turned on her back to get an epidural. They didn’t offer them. The first baby, Tosin, emerged but the doctor realised the other baby was on its side: “It was ‘Push, push, push!’ Then suddenly it was ‘Don’t push!’” Saraki had an emergency Caesarean but the baby died.

When she awoke, Tosin, who weighed 1.2kg, was in an incubator. She was so tiny Saraki’s relatives went to Harrods to buy dolls’ clothes for her. Saraki’s grandmother piled eight bibles up in the corner of her hospital room and encouraged her to pray.

Once, Tosin stopped breathing and was turning blue. Saraki ran to find the paediatrician, who revived her. Saraki made a promise to God that if Tosin survived she’d strive to help families in this position. “Whenever I’m tired I look at my daughter and get scared of God again.” Tosin, now 26, was discharged six weeks later but for months afterwards Saraki would put a mirror to Tosin’s mouth while she slept to check for mist.

Saraki, who has since had another three children, reveals that she felt blamed for the baby’s death. “I’d given them names so people blamed me because it’s bad luck to name a baby here until seven days after birth. I was made to feel like it was me.”

But it wasn’t her. And it wasn’t just babies dying but women too. In 2015, around 303,000 women globally died giving birth. Nigeria has the second highest rate of maternal mortality and accounts for around 14 per cent of global maternal mortality. So 14 years ago Saraki began counting deaths: ““I realised there were so many women who were ‘unlucky’. When I went to Kwara — which to a Lagos person is how a Londoner looks at Wales — I counted 1,000 births, and 200 [women] had died.” Afterwards, Saraki went to meet the health minister and began her crusade.

As she talks, she becomes animated, then apologetic. “I get fierce, I’m sorry. But why are we the only country in the world that accepts women dying?” she asks. “After 40 days your husband can remarry. God forbid, if I died today, within 40 days even my family would be bringing my husband replacement wives. They’d use different excuses: ‘the children need somebody’. The truth is that it’s a man’s world but we women are the ones bearing the brunt. I didn’t like that.”

Initially, Saraki paid women’s bills — when they needed a C-section, say (hospitals may demand the money in advance). Then, when she went to London to have her next child (a son) – “I ran to London the minute I was pregnant and just sat there” – she came across the red books healthcare workers give pregnant women for their children to record immunisations and their health. “I realised we needed this in Nigeria,” she explains. She tracked down the makers and had thousands printed. She later hosted midwives to be trained and persuaded insurers to give cover to pregnant women — switching from paying people’s bills to their insurance.

At first, Saraki had focused on doctors. “Eventually, I thought ‘why am I struggling with these doctors?’ Midwives are the ones that are with these women and they’re not so hoity-toity that they won’t listen. It’s an alliance.”

Nigeria had focused on traditional birth attendants, TBAs, who are cheaper to train than midwives, but Saraki feels the midwives are the ultimate asset. “There is a trust between my midwives and the mums, and they’re so dedicated — I’ve known them give their own blood to patients… When the TBAs oversee the birth, if the baby gets stuck they’ll get a wheelbarrow — the local form of an ambulance — and may dump her at the hospital door. By then, it’s too late.” Her midwives, in turn, are devoted to her. One, Eunice, tells me: “I love to call her my boss.”

Saraki launched the Mamacare clinics two years ago and has educated more than 200,000 mothers about birth and children’s health. Subjects such as drugs, domestic violence and savings are discussed too. “By the time a woman’s done eight months of Mamacare classes she’s got a new worldview.” Since many babies are anaemic, women are also taught to breastfeed in the classes, using a jacket “with a fake boob”.

In the classes I see, the Mamacare midwives joke with the women but their training is more professional than other midwives. They each have their style, Saraki says: “Mrs K is grandmotherly: even I feel like resting on her bosom! The pictures from my midwife Rita of the post-natal visit always have the mother holding the baby unless it’s a multiple pregnancy. But Mrs K is always holding the baby herself.”

They are trained use anatomical models since Saraki partnered with a company which makes pelvic models. Saraki has been ensuring other midwives get this training too. “One the midwives – who’s over 50 – said to me: for the first time I feel confident when I’m evacuating a placenta. I thought: ‘my God, you’ve been doing this for 25 years, what was happening before?’”

The results are remarkable: they haven’t lost a Mamacare mother yet. “I’ve seen triplets – born at 24 weeks – all survive. We did kangaroo care, with the mother, the grandma and the aunt.”


Saraki still ends up paying sometimes. Recently she was called by one of her midwives at 2am, the night before a flight to London. A mother was having triplets and didn’t have money for a Caesarean. Saraki tried to do “development diligence”, protesting that the midwife should make a formal request through the accountant. But at 5am her “niggling, beatitude to God thing” took over, and she headed to Abuja General Hospital.

“I didn’t even know the name of the mum! I said, ‘Is there a Mamacare Mum here?’ A woman popped out of bed and said, ‘It’s me!’ By the time I landed in London at 3pm she’d had the babies — a boy and two girls. Gorgeous children!” Not only that but they found her husband, who’d lost his job, new work with a senator: “We’ve turned into an employment agency too!”

In the long run, Saraki dreams of a more equitable healthcare system. When her son was born at the Portland, she noticed her obstetrician only visited in the morning and evening. “This man charging me all that money was in the Chelsea and Westminster, where they’re getting him for free!” she says, with mock outrage. “That’s what I want here: it should not matter whether you’re rich, let the public system be good enough.”

The immediate focus, though, is education: “Empowering a pregnant woman is empowering two people’s lives.” The Foundation now works more with adolescents (in Nigeria, Saraki says, sex education is called “skills and drills”). When giving a lecture at a university recently she asked the women if they were using contraception. There was silence. “I left the podium and went, ‘Come on girls! You can’t be serious! You’re in a university with boys and you don’t know about contraception?’”

She told them: “Having a child that’s unplanned is the most disastrous thing. Abortion is painful — it’s not birth control. You’re better off practising safe sex.” The students gawped. “I said: ‘close your mouths and let’s have a frank chat.’”

Back in the Mamacare class, Saraki says how much she loves her work. “I know this isn’t sexy work – and I’m not saving the world, but one mother at a time. They are living. They are actually living. For me, that’s fulfilling.”

The classes begin and end with prayers – both Muslim and Christian. Afterwards, as we head out into the scorching Lagos sun for the obligatory photos, Saraki turns to me, beaming with pride: “Now the women can do more than pray.”

FROM June 19th, 2017

Midwives could save a million women and children’s lives every year, but midwifery is still chronically neglected and underfunded by governments and communities around the world. It is time for midwifery to receive the attention that it deserves as a practical, highly cost-effective solution to a global health problem.

TORONTO – The past few decades have brought incredible progress for women and children’s health. Since 1990, preventable child deaths have declined by 50%, and maternal mortality has fallen by 45%. But far too many mothers and newborns are still dying from preventable causes. With access to qualified midwives, many of their lives could be saved.

Each year, one million children, on average, still die during their first day of life; more than a million babies are stillborn, and more than 300,000 mothers die during pregnancy and childbirth – a death toll exceeding the entire population of Namibia. A majority of these deaths – 56%, to be precise – are preventable.

If all women had access to a midwife during pregnancy and labor, not to mention facilities equipped to provide basic emergency care, one million lives would be saved every year. And yet midwifery is still chronically neglected and underfunded by governments and communities around the world.

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