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Students and Distinguished Guests,

My name is Toyin Saraki, and I am the Founder and President of The Wellbeing Foundation Africa, an NGO headquartered in Nigeria which works to improve health and wellbeing outcomes for women and children across the country. WBFA prioritises frontline impact with global advocacy, in alignment with the United Nations Sustainable Development Goals. It is with great honour that I join you today to provide the keynote address at this year’s LSE Africa Summit. This summit, renowned for its commitment to exploring the complexities and opportunities across Africa’s socio-economic landscape, is a testament to the collective dedication towards shaping a more prosperous future for our continent.

The theme of this year’s summit, “African Minds Transforming Futures: Building Resilient Education Systems,” highlights one of the most critical pillars of development in Africa: education, and is especially attuned to the African Union theme of this year: “Educate an African fit for the 21st Century: Building Resilient Education Systems for Increased Access to Inclusive, Lifelong, Quality, and Relevant Learning in Africa”.

Even with a substantial increase in the number of African children with access to basic education, a large number still remain out of school, with nearly 20.2 million children in Nigeria not in school even though primary education is officially free and compulsory, and according to UNESCO out of the 244 million children aged 6 to 18 not in school globally, more than 40%, or 98 million of them, live in sub-Saharan Africa. This reality calls for concern.

Education is not merely about acquiring knowledge, it is the cornerstone upon which resilient societies are built, economies flourish, and futures are transformed. Without education, where would any of us be today? Every single person in this room knows education transforms lives, economies and societies. However, the reality we face across much of Africa, particularly in Nigeria, highlights the urgency of addressing the myriad challenges plaguing our education systems, which continue throughout the span of life, from post-secondary education or upskilling much later on in a profession.

What are the barriers preventing children, women and the most marginalised communities from accessing education? The answers are multifaceted but rooted in systemic issues such as poverty, gender inequality, cultural norms, and inadequate infrastructure. For many children in Nigeria, especially girls and women living in rural areas, the journey to school or university is fraught with obstacles, ranging from long distances to lack of proper facilities and safety concerns.

Furthermore, the quality of education offered, even for those fortunate enough to attend school, often falls short of providing the necessary skills and knowledge to thrive in an increasingly competitive global landscape. The brain drain from Nigeria has also had a severe impact on the country’s educational system, as the lack of qualified teachers and professors has been especially detrimental to providing quality education opportunities to many citizens.

Education is in serious crisis, and progress towards the attainment of United Nations Sustainable Development Goal 4 on education, needs to be enhanced. Globalisation patterns and pressures in our increasingly interconnected world have brought remarkable gains yet, we are keenly aware that the benefits are yet to reach all. Equitable inclusive access to lifelong quality education for all, ensuring that people, especially, women and children match the 21st century global and local marketplaces, will enable adolescents and adults with knowledge and competency to participate in socio-economic, political and civic life.

Despite having the largest economy in Africa, Nigeria faces a shortage of skilled workers hindering its growth. The roots of Nigeria productivity crisis burrow deep into the failures of its education sector. As per UNESCO’s data, Nigeria’s illiteracy rate was a staggering 59% among youths and 65% among adults over 15 years old. Despite the glaring need for reform, the government’s budget allocation to education has consistently been less than the recommended 26% by UNESCO. Addressing these challenges require a concerted effort from all stakeholders – governments, civil society, the private sector, and the international community. 

Education is indispensable to productivity, progress and prosperity, and as the African Union promises to contribute towards revitalised, quality, relevant, and harmonised education systems responsive to the needs of Africa, it is necessary to take into account Africa’s aspiration and capacity in terms of human and material resources for sustainability, longevity and equality. We must prioritise investments in education, not as an expenditure but as an investment in the future prosperity of our nations. 

This means allocating sufficient resources to improve infrastructure, train teachers, and ensure that every child and adolescent, regardless of gender or socio-economic background, has access to quality education. Moreover, we must tackle the root causes of inequality which perpetuate the cycle of educational deprivation. This entails empowering marginalised communities, particularly women and girls, and addressing cultural norms that hinder their access to education. 

When a girl is educated, she grows up into a woman who has the adequate knowledge, information and skill to ensure the welfare of her family, the health and wellbeing of her children and the impact her actions have on her community. As the Founder and President of the Wellbeing Foundation Africa, I am proud to say that we are committed to playing our part in this transformative journey. 

The Wellbeing Foundation Africa has been at the forefront of prioritising education and investing in the lives of children, adolescents, adults and the elderly in Nigeria and across Africa. Since inception in 2004, WBFA has actively engaged in advocacy, writing of educational materials, policy papers and articles to promote education and implementation of health education programmes in collaboration with its local and global partners. Our learnings, guidance and recommendations are currently being actualized through various programmes such as our Adolescent Skills and Drills, Personal, Social and Health Education and Water, Sanitation and Hygiene programme, implemented by a team of committed experts in public health and education who lead our on the ground community trusted grassroots programming. 

We are working tirelessly to ensure that every girl, child, adolescent and adult in Nigeria has the opportunity to fulfil their potential through education, but our efforts alone are not enough. We need collective action, collaboration, and innovation to build resilient education systems that can withstand the challenges of today and prepare our youth for the opportunities of tomorrow. This requires thinking beyond traditional models of education and embracing technology, entrepreneurship, and interdisciplinary approaches to learning. 

Nelson Mandela famously called education “the most powerful weapon which you can use to change the world.” The future of Africa depends on the investments we make in education today, equipping our children, youth and adults with the tools, skills, and possibility of imagination necessary to shape and transform the Africa around them, making their community and society better, more prosperous, and, hopefully, more peaceful in the years ahead.  

It is evident today, as you take part in the summit and share dialogue, that each student of the London School of Economics has the drive and resources to be the force behind the realisation of our shared educational vision. Each of  you is armed with knowledge, passion, and a commitment to excellence, embodying the African minds capable of transforming futures and building resilient education systems. Each of you has ideas, advocacy, and unwavering determination, to not only shape the future of Africa but also inspire global change. I look forward to continuing to support the students of LSE and the Programme for African Leadership, as through our joint efforts we will truly create a world where education is the key to unlocking the full potential of every African child, every African community, and every African nation.      

Thank you. 

With the goal of “Empowering Africa: Unveiling the Hidden Drivers Shaping Tomorrow,” I am honoured to have delivered my keynote address at the 10th Annual St Andrews Africa Summit, a commendable student-led and university-supported initiative dedicated to the challenges and opportunities we face on the continent.

I am particularly heartened by the summit’s focus on women and children’s health alongside science and technology, especially as we commemorated the United Nations International Day of Women and Girls in Science, yesterday, emphasising women’s leadership in science to foster a new era for sustainability, while driving socio-economic development.

From improving health to combating climate change, women and girls play a critical role in the science and technology communities, and it is essential that their participation is strengthened, especially since STEM is widely regarded as critical to national economies across Africa.

I urged each student to seize the opportunity to be inspired, to learn, and to commit to action, as we are reminded of the transformative impact that collective action can have. Through platforms like such, we can foster open and respectful political dialogue, inspire technical innovation, and mobilise sustainable resources, leading to the unveiling of the hidden drivers shaping tomorrow’s Africa, a future defined by hope, resilience, prosperity, and boundless opportunity.

Watch the Keynote:

Written Keynote:

Ladies and gentlemen, esteemed guests, and students of St. Andrews,

It is with immense pleasure that I join you today on this momentous occasion, as we gather for the 10th annual St. Andrews Africa Summit. For a decade now, the St. Andrews Africa Summit has served as a platform for dialogue, collaboration, and action on the pressing issues facing Africa—a testament to the unwavering commitment of this student-led initiative and university-supported endeavour towards a more empowered Africa.

As the Founder-President of the Wellbeing Foundation Africa, and Inaugural Global Health Ambassador for the World Health Organization, I am deeply honoured today to join you in exploring this year’s theme: “Empowering Africa: Unveiling the Hidden Drivers Shaping Tomorrow.” This theme resonates profoundly with the challenges and opportunities we face on the continent, and I commend the organisers for their foresight in selecting such a vital topic, especially as 18 African countries, a third of the population in Africa, head to the polls in 2024.

The importance of democratic governance cannot be overstated. Democracy empowers citizens, especially our youth to participate in the decision-making process, ensuring their voices are heard and their needs addressed. With a flourishing youth population, the voices and votes of young people have the power to drive meaningful change and pave the way for a more inclusive and prosperous Africa.

As we reflect on the journey of the St. Andrews Africa Summit over the past decade, we are reminded of the transformative impact that collective action can have on shaping the future of our continent. It is through platforms like this one today, in which we can foster open and respectful political dialogue, inspire technical innovation, and mobilise sustainable resources to ensure Africa prospers.

I am particularly heartened by the focus on women’s and children’s health, empowerment, and socio-economic development—a cause that lies at the very heart of the Wellbeing Foundation Africa’s mission. For too long, women and children have borne the brunt of inequality across Africa, while being denied access to essential and quality healthcare, education, and economic opportunities.

Yet, as we gather here, we stand on the cusp of change—a change that begins with each and every one of us. At the core of the Wellbeing Foundation Africa’’s initiatives lies a commitment to holistic healthcare, education, and advocacy. Through strategic programming, advocacy and global partnerships, WBFA tackles the root challenges of maternal, newborn and child health while uplifting and empowering communities to build a healthier, brighter future.

Beyond policies and programmes, it is our collective will and determination that will truly drive progress. It is the belief that every individual in Africa has inherent worth and potential—that no one should be left behind—that will propel us forward on this journey of empowerment and transformation.

As we embark on this summit, I urge each and every one of you to seize this opportunity to be inspired, to learn from one another, and to commit to action. For it is through our joint efforts that we will unveil the hidden drivers shaping tomorrow’s Africa—a future defined by hope, resilience, and boundless opportunity.

Together, let us empower Africa and unleash its full potential.

Thank you.

From Davos, Switzerland at the 54th World Economic Forum:

The Wellbeing Foundation Africa Delegation was thrilled to join in launching forthcoming research by the McKinsey Health Institute and the World Economic Forum with leaders across the public, private, social, and philanthropic sectors for an action-oriented convening to explore the latest data powering the effort to draw awareness to the women’s health gap.

The report titled “Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies,” emphasizes that investments addressing the women’s health gap would add years to life and life to years – while potentially boosting the global economy by $1 trillion annually by 2040.

When discussing the challenges in women’s health, a common rejoinder is that women, on average, live longer than men. But this neglects the fact that women spend 25% more of their lives in debilitating health. Closing the women’s health gap would allow 3.9 billion women to lead healthier, higher-quality lives.

The report identifies four primary areas that need addressing to close the health gap: Science, Data, Care Delivery, and Investment, and to move forward, the report suggests action on five fronts: investing in women-centric research, strengthening the collection of sex-and gender-specific data, increasing access to women-specific care, creating incentives for investment in women’s health innovation, and implementing policies supporting women’s health.

Closing the women’s health gap is a moral imperative, as addressing these gaps would reduce the time women spend in poor health by almost two-thirds, adding an average of seven days of healthy living for each woman annually.

Together, we have a chance to lift millions of women out of poverty, improve future generations’ health, and foster healthy aging. We cannot succeed when half of us are held back.

It has been a huge honour and an incredibly valued privilege to serve the International Confederation of Midwives as its Inaugural Goodwill Ambassador since the first of June 2014.

On that day in Prague, as I addressed world midwives on the theme, ‘Education: the bridge to midwifery and women’s autonomy’, I looked at the faces of the midwives, and I pledged to walk focused, fearlessly and fervently with you all. My commitment was to actualise a rightful yearning for recognition, remuneration and much-deserved respect in a line of duty that so palpably personified care, continuity and courage. I was all too aware that it would be a daunting task, but I knew also, that it would be a fulfilling one.

The journey had actually begun in May 2011 when I attended the launch of Monique and the Mango Rains – a multi-layered tale of midwives’ realities which amplified the heroic voices of a Malian midwife and a Peace Corps volunteer. This midwife had so tenaciously mobilised resources while vividly demonstrating the numerous responsibilities that are so often synonymous with midwives and echoing their primary charge too; standing with women right up until the point of their life’s most anticipated introduction. That particular story immediately caused me to recall the names of the midwives who had laboured with me as I welcomed my own children into the world. As a result, I instantly became a convert-interlocutor, on a mission determined to amplify the ethos of recognition, rights and a much-needed redemption of respect for the ancient and modern profession that was, and still is Midwifery.

I embraced the global call to action in 2014, to increase respect for midwifery education, in order to join the ICM as it stands with hundreds of millions of women who had and would labour and deliver new life – and as I walked with the world midwives of the ICM, so did my Wellbeing Foundation Africa, by intentionally and immediately placing midwives at the heart of our unique institutional actions.

It is of utmost importance to me that all healthcare professionals are given opportunities to upskill, progress and demonstrate the highest level of competency, repeatedly.

Midwifery in particular, is a daily-charge, an exercise of accountability and a lifelong commitment directed towards holistically practicing what I as an advocate, and midwives as front-line professionals, work so intentionally hard to preach. So together with the ICM Midwives, and armed with the goals of the Midwifery Services Framework, I have travelled far and wide proudly bearing the responsibility of being the first Global Goodwill Ambassador.

2014 saw us address American Midwives in Washington DC, and the following year included my humble donation to midwives in Lesotho and the launch of EmONc in my native Nigeria. During this time, WBFA Mamacare classes were birthed, and brought forth the ability to teach advanced clinical and maternal skills using Laerdal anatomical models. The UNFPA are also a great partner in co-signing our SRH efforts. Through it all, the desire to position midwives at the heart of global health policy actions began to grow. In 2016, we worked together to host Nigeria’s First Global Midwifery Conference  – an incredibly proud and full-circle moment for me.

As we marched for more midwives in Toronto in 2017, the Canadian Government announced plans for the reparations of indigenous midwives – a conversation and a figure which sees a deserved increase, right up until today. This served as encouragement that both change, and recognition were on the horizon. Windhoek, Abuja and Suriname were also among the communities we frequented, and every step of the way, we engaged with midwives, policy makers and parliaments reiterating the commission to this great call.

In 2017, we advocated the importance of midwives being qualified to administer safe single-use injectable contraceptives at the FP2020 Family Planning Summit. Within this very same year, the WBFA Alive and Thrive Initiative was in full effect, and midwives were proudly educating women and their families about the importance of MNIYF Care and Nutrition. Through your eyes, I have witnessed the extension of midwifery practices and capacities in Brazil, Mexico, South Africa, India, Japan, and the United Kingdom – all while encapsulating the heart, passion and desires of the ICM Midwives. In doing so, we have successfully and strategically urged governments to invest in midwifery education and mandatory training in a bid to encourage the promotion and facilitation of safer approaches to practice worldwide.

No journey is without regret, and my inability to attend our ICM Congress in Jamaica still weighs heavily on my heart, as I looked forward to frontline observation of midwifery-led birthing centres as a goal to be realised globally.

However, in these inaugural six years together, we’ve beckoned the world to take another long and intentional look, which has in turn, caused me to hone in on the core causes and constructs I so passionately started with – mobilising resources to empower independent midwives, and harnessing the competencies of midwives as the backbone, and heart, of primary and community health.

We have signposted and amplified promising examples of research and policies which will shape the future of midwifery and have proudly recognised and championed some of the most hardworking hands in the realms of global health diplomacy. We have addressed and welcomed alliances with global organisations, the United Nations, African Union, ECOWAS and the WHO World Health Assembly, as well as celebrating remote village-level ward development committees as they continue to challenge stigma, and harmful cultural practices on behalf of the women and families in their care.

Many of us are aware by way of research that women from the black and minority ethnic classification are five times more likely to die from pregnancy and childbirth related complications. Indeed, in a world where racism has become a crisis, I appreciate, respect and applaud the courage of the ICM in choosing me, in 2014, a black African woman, as your first ever Global Ambassador – an organic action that speaks to the egalitarian inclusiveness of the International Confederation of Midwives, and the values of the midwifery profession, globally.

The introduction of the WBFA- JNJ- Liverpool School of Tropical Medicine and Hygiene’s highly specialised BEmONC and EmONC training gaining acceptance across Africa was an incredibly pertinent and refreshing moment for me, as a welcomed and proactive contribution directed at helping mothers to survive, babies to breathe and families around the world to continue celebrating a million more birthdays. WBFA’s new partnership with the Chelsea and Westminster Trust will cascade this innovative learning.

Excitingly, the London School of Hygiene and Tropical Medicine’s WOMAN Trial of tranexamic acid as an early intervention for post-partum haemorrhage was recorded in 2017, and the game changing Ferrings’ heat-stable Carbetocin arrived in this year – both reassuring signs of progress and impact that our ambassadorial advocacy for research-based support and intentional curriculae reaps and delivers results.

Each construct pertaining to health and wellbeing from birth to age and beyond – be it pregnancy and delivery, neonatal and infant feeding or boldly reinforcing the need for adolescents to understand sexual and gender-based violence – all contribute to building a more positive socio-economic road to maintaining our wellbeing. That being said, the entire spectrum of reproductive health has been and must continually remain a primary consideration.

By representing the significant and globally resounding voice of the ICM Midwives, we have recalibrated previously held misconceptions and re-assigned unattributed affiliations. The profession must continue to move forward in order to maintain the recognition it deserves for its contributions in improving sexual and reproductive health beyond just the physiological joining of mother and child. At different points along this momentous journey, midwifery has taken pride of place in reigniting and exemplifying a plethora of best practices for essential frontline Health workers, and has likewise birthed a series of incredibly poignant and monumental experiences within a space I am so truly proud to be advocating for.

Every victory counts, and I have rejoiced as nation-states begin appointing Chief Midwifery Officers. This call to action further reiterates the level of excellence and accountability implored by so many within this incredible profession. Regarding our original goal of Midwifery Education, I was particularly pleased to see the WHO AFRO launch a comprehensive curriculum setting a new standard for the training of midwives back in 2018.

To be crowning six years of ambassadorial achievements with the ICM in this 2020 Year of the Midwife and Nurse, is truly an unprecedented achievement. I remain hopeful that these years have been a catalytic culmination of intentional, educational and strategic efforts that offer a glimpse at centuries of quality advocacy, advancements and assistance. The call to midwifery is patience and perseverance personified. To safely nurture, be the first set of clean hands to touch and guide new life and initiate the first nourishing embrace between a celebratory woman and child is priceless. To do this on rotation, routinely, day in day out is heroic.

We have walked together and achieved the amplification of a vibrant and much-needed platform to celebrate, demonstrate and mobilise the heroic and admirable profession worldwide. The ICM’s leadership in representing, reconfiguring and increasing awareness of Midwifery globally is remarkable and unmatched.

This new decade started with the unique challenge of the Sars-Cov2 virus pandemic that has affected us all, yet pregnancy and childbirth wait for no-one, and front-liners continue to remain ever-ready for battle. The days ahead will require the intensification of resources, courage and commitment. Midwives have proven their mettle in the most daunting of circumstances, and it is time for the world, and the global health community to redeem the centuries of contributions that midwives have made to all our lives, and to community health.

In the vein of supporting the ICM as its midwives continue to stand with women, on the International Day of the Midwife, I joined the WHO, the Global Handwashing Partnership and Hygiene In Health Care Facilities Stakeholders in a resounding new commitment to “Applaud With WASH”.

We will, over this decade, mobilise and reinforce the key resources of water, sanitation and hygiene in health care facilities, to ensure that midwives and nurses clean hands can save more lives. We are confident that an internal approach to education will influence a more widely societal one.

As I bid farewell to the honorary role of Inaugural Global Goodwill Ambassador, I recall that we started our journey to claim the respect, recognition and resources for midwives with an African proverb, of ‘walking together, far and fast’ – in a succession of constant elevations; working authentically to strategize, take action and liberate women and girls from the constraints of family planning, child birth, and the other gender specific limitations they very often face. Our concepts of preparation and delivery have been very much centred around understanding, championing and reiterating the indelible bravery, resilience and selflessness of the millions of midwives who answer the ‘great call’ around the world each day. These particular efforts have been all the more powerful and pertinent because they have been achieved, with honourable dedication, repeatedly, and together.

Together, we have made great strides in authentically hailing a profession which charges each of us to wholeheartedly and strategically contribute to ensuring many more meaningful tomorrows. Our monumental six-year term of collaborative efforts and support for midwives alongside the ICM team has been invaluable. To work in close proximity with likeminded and driven people with an assurance of ‘togetherness’ in this profession as the word is defined, leaves me parting on an empowered, encouraged and excited note.

To all the incredible ICM Leaders, Council, Board and Teams; thank you for facilitating so many memories, key breakthroughs and positive affirmations along the way. Advocacy in itself is an unending journey. I am incredibly proud to be able to say that being the Inaugural Global Goodwill Ambassador for the ICM, will remain an unforgettable part of mine, and I am excited by the thought of new plans, possibilities and partnerships for healthy futures for women, girls and families – all with the midwives’ hands at my heart.

In this most wonderful Year of the Midwife and Nurse, as I appreciate the singular honour of serving the ICM for the last six years as its Inaugural Global Goodwill Ambassador, may I crown our collaborative advocacy efforts with one final African proverb, ‘a friend today is a friend for life.’

I assure the ICM, and every world midwife, that throughout this decade of action and delivery, I have pledged to mobilise resources in parallel to all your goals. At the ICM, you will always have a friend, supporter and partner in me, and in the Wellbeing Foundation Africa. Thank you ICM, and thank you world midwives, again and again, and again.

Curt McDaniel – Chief Legal Officer and Board Secretary – Ferring Pharmaceuticals
” Today we have a very special guest, Her Excellency Mrs. Toyin Saraki. She is Founder-president of The Wellbeing Foundation Africa, a Nigerian philanthropist with two decades of advocacy covering maternal and infant health; ending gender-based discrimination and violence and improving education, socio-economic empowerment and community livelihoods for women and families in Africa. She is also a lawyer and a mother of four.

Please welcome H.E. Mrs Saraki.”

Interview:

Can you tell us about your work to reduce maternal and infant mortality in Africa?

MamaCare: At the Wellbeing Foundation Africa, we place midwives at the centre of our efforts to reduce Maternal and Infant mortality. Over 230,000 women have taken part in our MamaCare programme, Antenatal and Postnatal classes, delivered by a team of 55 midwives to mothers in healthcare facilities across Kwara, Ogun, Osun, Lagos, Kaduna states in Nigeria and the Federal Capital Territory.

Our MamaCare mothers are now achieving the now standard number of antenatal eight visits recommended by the WHO, and we are yet to lose a single one to death in childbirth. Critically midwives are aware of warning signs to both mother and baby’s health during pregnancy and can recognise and intervene when the situation needs to be escalated before it becomes fatal. As well as avoiding immediate tragedy, antenatal education is incredibly effective at promoting positive perinatal outcomes in the long term, as parents acquire knowledge of the physical and psychological factors that affect their health and that of the unborn child.

We know that some of the barriers that increase the risks a mother’s risk can be reduced through a strong and trusting relationship between a mother and midwife. For example, some women perceptive that they are in better control of the delivery process when they are at home and are therefore reluctant to deliver in a hospital. A midwife can act as a strong advocate for facility-based delivery, meaning should a mother or infant experience complications and be inside a hospital they are more to access live saving care in time.

EmONC: But since we first launched MamaCare in 2015 there has been a great deal of organisational learning. We realised that you can only begin to address maternal mortality through the MamaCare approach -educating a mother, providing access to a midwife, and empowering her to deliver in a facility. Ultimately if when she is delivering in that facility, the healthworkers around her are not equipped to deal with a complication, then our work to prevent maternal and infant mortality has failed at the most critical hurdle.

From this understanding, our Emergency Obstetric and Newborn Care EmONC programme, in partnership with the Liverpool School of Tropical Medicine and Johnson and Johnson, was born. Our EmONC training takes place healthcare facilities and equips doctors, nurses and midwives, as a collective team, with the skills and experience needed to overcome obstetric emergencies by using anatomical models. At assessment visit to Kwara, I asked a Doctor how the use of models and the training had affected his outcomes. His response was both illuminating and chilling. Before the use of anatomical models, live births had been a training ground for nurses, midwives and doctors. Unfortunately, in Nigeria our healthworker education all too often does not use cadavers or models, and as a result practitioners do not develop valuable practical experience that cannot be learned through a textbook.

Our team now has trained 600 ‘master trainers’ across a staggering 16 Local Government Associations in Kwara State, establishing ten EmONC Skill Laboratories in ten selected Core-Training Medical Facilities. These 600 master trainers have gone on to train a further 62,800 health workers. The number of up-skilled frontline health workers continues to percolate, as the impact in lives-saved grows. I am hopeful of a Nigeria where this technology and training was available across the nation.

WASH: But even when an mother is educated through antenatal and post-natal classes, has access to a midwife during pregnancy, and trained expert healthworker team on standby during delivery – we still cannot guarantee that preventable maternal and infant deaths will not occur.

There is a World Bank survey on healthcare facilities in Nigeria that really shocked me to the core. 69% of health care facilities said that they could conduct deliveries. But yet only 29% of labour room’s in Nigeria have access to running water. I thought hold up a second, that means that the majority of those healthcare facilities are offering deliveries when they cannot provide the midwives and doctors conducting them with access to safe water. Deliveries are therefore being carried out with hands that have not been sufficiently sterilized. Hands that are not clean. Not because of dirty habits but because these facilities lack running water.

In Nigeria over a woman’s lifetime she has a 1 in 13 risk of maternal death, a staggering reality. Sepsis accounts for 17% of maternal deaths. Strategic approaches to reducing maternal mortality which focus on clinical interventions and strengthening healthcare are critical in addressing the problem of haemorrhage and eclampsia, but neglect sepsis. Which we know is linked to poor WASH.

That is why we launched our WASH programme. I advocate at a parliamentary level for greater resources to be allocated to WASH structures in healthcare facilities. While on the frontline through our Teach Clean programme we train health workers and cleaners on the best hygiene and sanitation practises within facilities. MamaCare has also been integrated a WASH approach, and we go into schools to teach not just personal, social, health and economic education but also WASH skills. Sometimes it as simple as how to wash your hands properly. An incredibly basic but valuable skills that is a wonderfully cost effective way of saving lives.

MamaCare360 Approach: Ultimately all of our Maternal and Infant mortality programmes are governed by our MamaCare 360 approach, the understanding that to protect mothers and babies we need to focus on solutions that holistically tackle all of the causes of preventable death.

We need MamaCare to drive behavioural change to make women an empowered and informed partner in her families’ health, both during, and after pregnancy; we need EmONC to ensure when she gets to the facility she is cared for by safe and skilled pairs of hands; and we need WASH to ensure that those hands that deliver and care for her infant are also clean.

And as you’re here at Ferrings shows, we need to also ensure midwives, nurses, and doctors have access to the medicines and medical tool resources needed to save lives.

Ultimately midwives really drive all our work, they are interlocutors between our Foundation, its aims, child bearing women, other healthworkers and policy makers.

Why is this so close to your heart?

Personal Tragedy of Delivering Twins and Losing a Child.
My personal story of tragedy during childbirth plays out thousands of times a day every day in Nigeria. Close to 200 million people inhabit Nigeria, we are Africa’s most populous country, but we are also where nearly 20% of all global maternal deaths happen.

The year I was born in Nigeria the infant mortality rate was 195 in 1000 births. Meaning that during that year almost one in five babies did not live to celebrate their first birthday. Today infant mortality is 75 per 1000 live births. That less that one in ten babies that do not survive past five. While in my lifetime there has been a change, but this is clearly not enough.

You describe your experience as an unavoidable reality for many women in Nigeria. How did your personal experience motivate you to advocate for women who don’t have a voice?

We have the technology we have the knowledge, we have the medicines, and we now need to deliver the healthcare. The state of the healthcare system in Nigeria means we are failing child bearing women and their infants. In the current environment, these deaths are unavoidable, yet conversely they are completely avoidable, as we know how to prevent complications and treat them when they do arise. What happened to me 27 years ago shouldn’t have happened then, and it is a tragedy that it continues to happen today.

Similar to most developing countries, in Spain women have a 1 in 21,500 lifetime risk of dying during pregnancy, childbirth or post-abortion. In Nigeria that risk is 1 in 21. Nowhere does inequality have stark impacts than healthcare. In my country we women deserve better, our lives and that of our infants are not less valuable than women in Spain.

Gender equality is also a big part of your work at the Foundation. Can you tell us why ending gender-based discrimination is so important to improving maternal health outcomes?

Child Bearing Women: Ultimately social and biological differences mean women and men experience different health risk and have health seeking behaviour, health outcomes and responses from health systems. Of course women are not a homogenous group, however, gender inequity, poverty among women, weak economic capacity, sexual and gender-based violence including female genital mutilation are major impediments that disproportionally affect women their ability to experience optimal health and wellbeing. These impediments become more pronounced in the face of under resourced maternal care services. As a result, we at the Wellbeing Foundation view generating gender equality as a major part we will improve maternal health outcomes. Women carry the burden of childbirth; and it vital that our societies ensure this service labour of love is not fraught with unnecessary dangers.

Nurses and Midwives: Gender based discrimination also impacts the ability of health workers to provide quality maternal care. Nurses and midwives represent half of the professional health workforce and are overwhelming, although not exclusively, women. They play a critical role not only in delivering healthcare to millions of child bearing women, and are key to transforming health policies, disease prevention, and emergency care. In March 2019, the WHO and partners produced a report on the Global Health and Social Workforce, that found that statistically speaking ‘women deliver global health and men lead it’. We now know that women comprise 70% of the global health workforce, but only 25% hold senior roles.

Equally troublingly in a global survey conducted by the ICM and the WHO, 37% of midwives reported that they have experienced harassment at work, whether from colleagues or patients. Gender inequality within the sector is not only unacceptable but it also ultimately weakens the quality of healthcare that we are able to provide. This is why the Wellbeing Foundation, and myself as the International Confederation of Midwives’ Global Goodwill ambassador, assert that respect for both Midwives and their work in maternity care is a non-negotiable necessity and demand that a midwife’s workplace must be free from sexual harassment and gender discrimination. This as an absolute essential element of a functioning, effective decent and dignified health system.

At Ferring, we’re passionate about building families and reducing maternal mortality, particularly through the prevention of post-partum haemorrhage. Can you tell us about the impact of post-partum haemorrhage in Nigeria, and across Africa?

Post-partum haemorrhage is a sudden, terrifying condition, that the approximately 12,000 women who die in my country battle against and lose. This number is so staggeringly large that it is difficult to fully comprehend. But every maternal death is an individual tragedy. Can just ask you to consider the reality for each one those women. You’ve just given birth. You’re filled with emotion, you’re exhausted and elated. You’re relieved and excited holding your baby, who is safe and well. But something’s not quite right. You’re told by your doctor that there’s a, issue. You’re panicking and disorientated and you realise you’re bleeding uncontrollably. It dawns on you and those around you that if you not treated in the short to immediate future, you will certainly die.

Maternal mortality is not only a colossal waste of life but remains a constant, and impenetrable barrier to development. Investing in better maternal health has a ripple effect across families, communities and therefore entire countries. This is why the work you are doing here at Ferrings to provide heat-stable carbetocin to treat post-partum haemorrhage at an affordable to publicly funded healthcare facilities and facilities operating on a social marketing basis in low- and lower-middle income countries.

As the leading cause of maternal mortality, working to treating post-partum haemorrhage has been at the core of my foundation’s mission. Which is why the Wellbeing Foundation Africa participated in the WOMEN trial, an initiative of the London School of Hygiene and Tropical Medicine, which enrolled 20,000 women, to look at the efficiency of using Tranexamic Acid to combat Post-Partum Haemorrhage.

We know that medicines are only part of the solution – together, we need to change healthcare systems. What top three changes need to be made to the system to stop women dying while giving life?

Quality Healthworker Training –While focus was (and should be) on gaps to access, gaps to quality cannot be neglected. Health systems are primarily made up of people, and as a result we must invest in upskilling and training health workers we are to build a universal health coverage which is meaningful

Water, Sanitation, and Hygiene Infrastructure – Without WASH structures in place, a trained midwife, nurse, or doctor, therefore, as a professional dedicated to saving the lives of mothers and infants, is faced with the troubling prospect of having to use water that they cannot be sure is clean and therefore they potentially expose themselves and the mother to deadly infection.

Personal Heath Record Books. Without PHR books a woman may arrive at a hospital she has never been to before with a complication during delivery to be treated by a team she has never met. In these instances, a lack of records can be life threatening. Medical professionals in emergencies need to be able to quickly and accurately ascertain the correct course of intervention. This is why in 2006, shortly after I first started the foundation we developed our Integrated Maternal Newborn and Child Health Personal Healthcare Records (PHR) Books, Nigeria’s Federal Ministry of Health and National Primary Health Care Development Agency’s Midwives Service Scheme.

Do you think that international community can achieve the Sustainable Develop Goals (SDGs) to reduce maternal mortality by 2030?

Although more people around the world are living better lives compared to a decade ago, inequities and inequalities persist as challenges that impede progress. I am aware that we have a long road ahead to 2030 if we are to successfully protect, progress and promote the objectives promised by the sustainable development goals. However, I am impatiently optimistic based on the dedication of people I meet and the pervading sense of urgency that has enveloped each related conversation and event I have been a part of. I believe we will only be able to deliver the SDG 3 – good health and well-being for all with broad sector support. Though it was our political leaders that made these promises, we must all part of efforts, particularly in the private sector, to deliver them. Which is why it is so important that organisation’s like Ferrings are committing to deliver lifesaving medicines to low and middle income countries at an affordable and sustainable cost.

Your story reminds all of us here at Ferring why we come to work every day. What message do you have for Ferring employees?

My message is simple – your work saves lives. I hope this continues to motivate you when the going gets tough to get out of bed each morning and give each and every day your all. As you all know in this room, more than most, child bearing women are not dying because of conditions we cannot prevent or treat. We must do everything in our power to ensure that the quality care is accessible to women everywhere.

Thank you very much for your kind comment and question. I am delighted to be here alongside such brilliant champions for midwives and all frontline health workers, and as the proud Global Goodwill Ambassador for ICM. 

I must begin by commending ICM, in particular Franka and Sally, on their outstanding work and advocacy representing over 600,000 midwives through their 132 midwifery associations in 113 countries. As we discuss making the case for midwifery and promoting midwives as integral to a successful, caring and nurturing health system, ICM is leading the way with smart and powerful initiatives. I was particularly touched by the recent launch of the ‘Midwifery Leaders Showcase’ which tells the stories of midwives all over the world in a series of featured interviews. In doing so, ICM demonstrates the dynamic and diverse roles that midwives play in shaping policy, leading civil society organisations, influencing professional practice and creating a better and brighter future for women, newborns and their families. It also features the Wellbeing Foundation’s own much-missed and dearly departed Felicity Ukoko.

It was in fact ICM’s 50,000 Happy Birthdays campaign that was the key evidence which led the Wellbeing Foundation to partner with Johnson & Johnson and the Liverpool School of Tropical Medicine to bring anatomical skills models-based teaching to midwives and doctors alike. We are now trying to take those same skills to preservice level. 

I feel that the heart of midwifery competencies is directly relevant to your question – although I do advocate for midwives all over the world, I am aware that it is their stories and experiences which are the most powerful. Four years ago WBFA put midwives at the core of our programs to reach women and children across Nigeria and ensure they deliver safely and happily. Even when looking at new programs, I give our WBFA MamaCare midwives the platform to advocate themselves. For instance, alongside the WHO, Global Water 2020 and other partners, we recently launched a global WASH campaign, to improve water, sanitation and hygiene conditions in healthcare facilities, schools and communities. Whilst I am proud to lead the campaign, our best traction came from videos and accounts from our WBFA midwives, who took the materials to their communities and taught in their own inimitable style. In doing so, they make their own case for midwifery very successfully. They come across as they are – as Joy can attest, having visited MamaCare classes herself, WBFA midwives, like their colleagues all over the world, are motivated by a strong sense of duty and compassion. Their good humour and treasure trove of stories are the most persuasive qualities I know. 

So whilst we lead the way for midwives, it is midwives themselves who lead the way so brilliantly. Our role must be to give them the platforms to do so. 

Thank you again for the invitation to join you here today – and thank you most of all ICM for championing midwifery so effectively.