global

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.

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. 

As Founder-President of the Wellbeing Foundation Africa and Special Adviser to the Independent Advisory Group to the World Health Organization Regional Office for Africa, I commend today our partners,  philanthropies, NGOs, faith-based organizations, financial institutions, corporations, and universities as we join together at this historic convening to announce new and wide-ranging commitments to improve water, sanitation and hygiene (WASH) conditions in healthcare facilities. 

Amongst the many commitments made today, the Wellbeing Foundation has outlined its programmatic and advocacy promises to the world:

To disseminate information and advocacy regarding WASH standards through its influential MamaCare midwives and our partnership with Unilever Lifebuoy

To teach about WASH in healthcare facilities and schools

To continue its #WASHWednesday advocacy campaign

To develop our WASH for Healthcare Facilities Proper Cleaning programme.

Having successfully introduced and intensified our WASH for Wellbeing hygiene in health care facilities techniques to health workers and patients in over 570 medical facilities in 5 states of Nigeria, our challenge remains taking those standards to a national scale in Nigeria’s 36 states of the federation – to that end I was encouraged by the speech in November last year given by His Excellency President Muhammadu Buhari declaring a state of emergency in water, sanitation and hygiene in Nigeria and launching the National Plan of Action.

We know that this is a global challenge. 45% of healthcare facilities in ‘Least Developed Countries’ lack basic water services, and 1.5 billion people around the world have to use healthcare facilities without basic sanitation. The impact on infant and maternal mortality, pandemic and infection prevention and control, and antibiotic resistance, is devastating and well-documented.

The commitments made today, however, are truly unprecedented and reflect the impact of advocacy at local, regional and global levels.

In response to the UN Secretary General António Guterres’ Call to Action on World Water Day in March 2018, I retraced the steps of each of the programmes undertaken by the Wellbeing Foundation Africa and launched a new WASH campaign with the World Health Organization in Nigeria.

I committed to work with my partners in the global health and development communities to stop mothers and newborns from dying from preventable and unnecessary complications, simply because the most basic of WASH services are not available, and to ensure that all countries implement the 2017 World Health Assembly Sepsis Resolution. Hand hygiene must be a quality indicator in every facility and a national marker of health care quality, with access to soap and water monitored and assessed.

To that end I conducted high-level meetings at the US State Department, with the World Bank, and with Congress to accelerate progress on WASH – and in many cases reverse worsening trends and indicators.

 At the World Health Assembly last month in Geneva, I spoke in favour of the historic WASH resolution, and was delighted when, for the first time, the 194 WHO Member States joined together to acknowledge this global health crisis and move toward concrete action.

That resolution, combined with the unprecedented commitments made today, represent a leap forward in improving WASH conditions in Nigeria and around the world and have the potential to save millions of lives. Thank you to the frontline healthcare workers who will make that possible, and all of those here today for your vision and endeavour. 

Thank you to the Dutch Government, Bernard van Leer Foundation, the International Confederation of Midwives, and the Dutch Taskforce for Healthcare for hosting us and facilitating this 23rd Board Meeting.

I know that as we sit here in the Hague, all of our discussions are focused upon our shared value and commitment to ensuring that women’s, children’s and adolescents’ health (WCAH) is at the top of national, regional and global agendas. I think it is right, therefore, that the Board Meeting seeks to evaluate and enhance its political engagement at all levels.

At the World Health Assembly this year, alongside Helga Fogstad, PMNCH Executive Director, Dr Tedros Adanhom Ghebreyesus, WHO Director General, and Her Excellency Mrs Emine Erdogan, First Lady of The Republic of Turkey. I commended PMNCH’s Call to Action on Aligning Women’s, Children’s and Adolescents’ Health and Wellbeing in Humanitarian and Fragile Settings.

Given that more than two billion people live under the threat of conflict and emergencies of diverse and complex natures, and that 69 million people have been displaced by humanitarian crises, we need bold steps to enhance coordination and bring together synchronized knowledge, policies and actions for a whole-system approach to achieving health for all, routinely across nations, in order to build the resilience for effective responses in protracted emergencies and in the humanitarian-development nexus. That is why I so strongly support PMNCH’s initiative and call to action, which is best placed to bring us all together – from every sector, region, country and background – to remove the inefficiencies, identify and address gaps of capacity and delivery in every sense.

PMNCH is uniquely positioned to mobilise broader political strategies, and partnerships of all kinds, as it can act as the standard-bearer and interlocutor between the WHO, global institutions, CSOs, governments, the private sector and frontline healthcare workers. This support is invaluable to Governments and healthcare providers, who we can consider to be the duty-bearers. 

At the Wellbeing Foundation Africa, of which I am the Founder-President, we have learned the value which emanates from engagement with PMNCH in Nigeria, as members who supported the ‘Saving One Million Lives’ campaign, the promotion of routine administration of the reinforced ORS-Zinc formula for management of diarrhoea, and the Midwives Service Scheme, a public sector collaborative initiative, designed to mobilize midwives, including newly qualified, unemployed and retired midwives, for deployment to selected primary health care facilities in rural communities.

I must report from Nigeria that whilst there has been an improved focus on surveillance – and a growing acceptance of the fact that suitable civil registration and vital statistics systems will be essential if we are to achieve universal health coverage – I hope that these milestones in accountability also able to catalyse improved services at the frontline. That can only be achieved with expanded investment in primary health.

I strongly support the PMNCH position that we must put women, children and adolescents at the heart of universal health coverage. The relationship between achieving health for all and WCAH must be at the core of our advocacy as the former is simply unachievable without significant improvements to the latter. 

It is of course no coincidence that women, children and adolescents – despite accounting for 60% of the global population – tend to constitute the groups with the least political influence and power, which is why United Nations, WHO and national policies must explicitly highlight and focus on WCAH as part of their UHC strategies. 

Only then can we claim to be truly working towards the principle of “leaving no one behind,” which is central to the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030).

On a final note, as the Global Goodwill Ambassador for the International Confederation of Midwives, one of our co-hosts this week, I must highlight the launch at the World Health Assembly this year, of the report ‘Strengthening quality midwifery education for Universal Health Coverage 2030: A transformative approach to improving quality of care’ produced by ICM, alongside WHO, UNFPA and UNICEF. Women and newborns are the most vulnerable in humanitarian and fragile settings where quality midwifery education saves lives by preparing all midwives to legislate for and respond to emergency health situations. As a critical element in achieving UHC and WCAH, I am sure that we all know that midwives can and do lead the way.

As Nigeria’s first and oldest country member of this esteemed and dedicated alliance, I am honoured by the Wellbeing Foundation Africa’s PMNCH Board Observer Privileges, and delighted to extend a warm welcome to Helen Clark, former Prime Minister of New Zealand, as Chair of PMNCH – who I know will ensure that women’s, children’s and adolescents’ health and wellbeing are reinforced as a global priority. Thank you.

World Intellectual Property Organization (WIPO), AB Building, Salle A, 34, Chemin des Colombettes, CH-1211 Geneva 20, Switzerland

Tuesday, 21 May 2019, 13:00-14:30

Thank you to PMNCH for your timely and powerful call to action. As a Nigerian who has long worked with frontline healthcare workers to empower women, their infants and their communities to stay healthy, safe and to thrive, I know that if we are to achieve universal health coverage, and truly leave no-one behind, we must better align our investments and efforts taking a life-course approach to safeguard women, children and adolescents in humanitarian and fragile settings and uphold their human right to the highest attainable standard of health.

Given that more than two billion people live under the threat of conflict and emergencies of diverse and complex natures, and that 69 million people have been displaced by humanitarian crises, we need bold steps to enhance coordination and bring together synchronized knowledge, policies and actions for a whole-system approach to achieving health for all, especially in protracted emergencies and in the humanitarian-development nexus. That is why I so strongly support this initiative and call to action from PMNCH, which is best placed to bring us all together – from every sector, region, country and background – to remove the inefficiencies, identify and address gaps of capacity and delivery in every sense. 

As the Global Goodwill Ambassador for the International Confederation of Midwives I welcome the launch yesterday of the report ‘Strengthening quality midwifery education for Universal Health Coverage 2030: A transformative approach to improving quality of care.’  produced by ICM, alongside WHO, UNFPA and UNICEF. Women and newborns are the most vulnerable in humanitarian and fragile settings where quality midwifery education saves lives by preparing all midwives to prepare for and respond to emergency health situations. 

It lends significant weight to PMNCH’s initiative, as we seek to provide comprehensive training and support necessary for midwives to provide the full scope of services in situations which are often dangerous and highly prone to change. 

In a year when we have lost midwives, nurses and doctors on the frontline of healthcare, we all know how critical this initiative is. 

PMNCH is best placed to mobilise partnerships of all kinds, and can act as the standard-bearer and interlocutor between the WHO, global institutions, CSOs, governments, the private sector and frontline healthcare workers. This support is invaluable to Governments and healthcare providers as the duty-bearers. At the Wellbeing Foundation Africa we have learned the value which emanates from engagement with PMNCH in Nigeria, as members who supported the ‘Saving One Million Lives’ campaign, the promotion of and ORS formula and zinc for management of diarrhoea, and the Midwives Service Scheme, a public sector collaborative initiative, designed to mobilize midwives, including newly qualified, unemployed and retired midwives, for deployment to selected primary health care facilities in rural communities.  

We know that the road to universal health coverage does not rest upon one single static action, but on the spectrum of interventions and initiatives; from water, sanitation and hygiene standards in healthcare facilities to breastfeeding education and training for healthcare workers. In a country as large as Nigeria, resilience throughout the whole nation’s system is necessary if we are going to be able to tackle critical health emergencies in fragile settings, for example in the north-east. That is why a strengthened primary health care system is imperative as the foundation and bedrock of achieving health for all and should be a focal point for investment. 

I call on all partners and stakeholders to rally behind PMNCH, to support this initiative and most importantly commit to action which will make health for all a reality. Together we can make sure that no-one is left behind. Thank you. 

Fellow speakers: 

• Carl Manlan, Chief Operating Officer of The Ecobank Foundation  
• Dr. Tsitsi Masiyiwa (wife of Strive Masiyiwa, London-based Zimbabwean businessman, founder of Econet Wireless). 

Speaking Notes: 

• Good afternoon. I am delighted to join Carl Manlan, Dr. Tsitsi Masiyiwa and all of you here today for this ‘fireside chat’ as we discuss the progress made by African-led philanthropy on key policy areas. 

• I will share my personal experiences as a philanthropist and the work of the Wellbeing Foundation Africa, of which I am the Founder-President, which has achieved sustainable impact at a grassroots level with cross-sector partnerships embedded in communities. 

• There are inherent strengths which make African-led philanthropy particularly effective. I identify these primarily as the fact that our work is community-led and therefore both more effective and sustainable; and the flexibility which comes from embedded networks leading to the ability to influence policy decisions at a national, regional and global level with data-driven advocacy. 

• I will first turn to the distinct advantage provided by African-led foundations, which is our ability to work with our own communities – not by foisting an external model on them, but by working with them to identify key issues, build up their own champions, and allocate resources, where needed, efficiently and with the buy-in of those who will act as service providers and as service users. 

• At the Wellbeing Foundation Africa, we believe that midwives are best placed to lead the way with quality care and to leverage the trust of a community to improve health outcomes for women and their infants. 

• Our midwives, known as MamaCare midwives, deliver classes in primary healthcare centres, hospitals, and at camps for internally displaced persons, known as IDP camps, which are a frontline for women and their infants. Despite dire mortality rates in Nigeria – where women face around a one in thirteen risk of maternal mortality in their lifetime – we have not lost even one of our over 250,000 MamaCare mothers during childbirth. 

• Our MamaCare midwives have achieved this not only by providing classes to a global standard – and achieving the WHO benchmark recommendation of at least 8 antenatal visits – but also because they act as even more than lifesavers. They provide safe spaces and safe conversations: no subject is taboo or off-limits. They can only do this because they are part of the community that they serve. Too often, global institutions have faced push-back when trying to deliver services – examples that stand out to me include vaccinations and family planning provisions – because they attempt to do so as outsiders, without the trust of a community. 

• Placing midwives at the centre of our work gave us an army of community counsellors which has helped to drive the behavioural change to make women an empowered and informed partner. Midwives are the interlocutors between our Foundation, its aims, and women. 

• That includes family planning, a subject which is not only addressed during their classes but also at the 6-week postnatal home visit. That one-one-one chat covers the continuation of exclusive breastfeeding but also contraception advice and a discussion about spacing. Informally, direct and rather frank conversations are carried out with husbands and partners. In fact, men have started to attend antenatal classes – sat quietly at the back, I should add – in order to learn how best they can support their partner. 

• We have subsequently built on the experience of working with midwives to work as partners in the Alive & Thrive programme, with expertise and assistance from FHI360 and funding from the Bill and Melinda Gates Foundation.

• Alive & Thrive is an initiative to save lives, prevent illness, and ensure healthy growth and development through the promotion and support of optimal maternal nutrition, breastfeeding and complementary feeding practices in rural and urban Lagos and Kaduna States in Nigeria. In Lagos, malnutrition accounts for more than 50% of under-five mortality with a rate of timely breastfeeding initiation at only 28.9%. A mere 19.7% of children 6 months and under in the state are exclusively breastfed and only 10% of children aged 6 – 23 months are fed appropriately. The reality of those statistics is distressing: 47% of children in Lagos under-5 years are stunted, while 34% are under-weight.

• Alive & Thrive works through a four-pronged approach:  policy and advocacy; interpersonal communication and community mobilization; mass communication; and the strategic use of data. The Wellbeing Foundation Africa is the key implementing partner currently working with 500 private health facilities across 10 local government areas in Lagos by providing advocacy, capacity building and health promotion in the area of Infant and Young Child Feeding practices, whilst our partners at Save the Children engage with a number of public health facilities. 

• We are able to be a successful implementing partner precisely because of our proven track record of community-led programmes. 

• • The second key strategic advantage of African-led philanthropy is the ability to be flexible and draw upon existing networks to respond to crises and to inform programmatic work. 
  • Of course, we want to bring the latest innovations in technology, treatment and training to the frontline but sometimes feedback from the grassroots means that we must re-trace our steps. That has been the case with the Wellbeing Foundation, as our midwives were informing us that water, sanitation and hygiene – also known as WASH – indices were not only poor, but were in fact worsening. 
  • This feedback from the frontline was backed up by a World Bank Water report, aptly named ‘Nigeria: A wake-up call,’ which revealed that WASH indices in the country have actually suffered an alarming decline from an already critical condition. Access to piped water on premises in urban areas dropped from 30% in 1990, to less than 10% in 2015.  A lack of investment in WASH is putting the lives of thousands at risk as the spread of Ebola, for example, is made more likely. WASH is at the heart of Infection Prevention and Control (IPC) and the fact that outbreaks of diseases have been so severe in Nigeria recently – with the WHO commenting that the Lassa Fever outbreak last year was unprecedented – is no coincidence.
  • Meanwhile, women and infants are dying needlessly in labour rooms, with maternal sepsis taking a mother’s life at what should be the most joyous time. 
  • It is not just the current situational analysis which is so bleak, but also the systematic failures to bring WASH standards up to an appropriate level for our population.
  • Nigeria is struggling to maintain its current infrastructure, inadequate as it is for the current population and entirely unfit for the years ahead. Government must lead the way, achieving economies of scale in densely populated areas by providing piped water and not forcing individual families or streets to rely on their own sources. As the World Bank rightly highlights, this also allows for the proper regulation of groundwater, essential in the fight against pollution.

• Poor WASH facilities in schools also lowers attendance and educational achievement, with a particular effect on girls. According to UNESCO, one in ten girls in Sub-Saharan Africa do not attend school during their menstrual cycle, and can miss as much as twenty percent of a given school year.

• Having been made keenly aware of the issue from the frontline, we were then able to adapt both our programmes and our advocacy work to take on this challenge. 

• Our MamaCare midwives began to advocate in healthcare facilities for better standards and taught proper handwashing techniques to staff. Their experiences informed our updated Personal, Social, Health and Economic (PSHE) education programme which takes place in schools, teaching staff and students alike the importance of good WASH standards. We already had the framework in place – and the trust of communities – to adapt our programmes to address a significant health risk 

• But in a country of almost 200 million people we knew that we had to reach far beyond that. This is where the key relationship between frontline experience and the ability to improve capacity by achieving effective advocacy comes in. 

• In May 2018, I launched a global WASH campaign in Abuja at a meeting with Dr. Wondi Alemu, who was then the WHO Representative and Head of Mission in Nigeria. We announced that the Foundation would work with partners including Global Water 2020, an initiative based in Washington D.C. which is designed to accelerate progress toward water access and security for all people in developing countries, with a particular focus on increasing the availability of WASH in healthcare facilities.  A key element of that partnership is advocacy for improved WASH standards, both in Nigeria and around the world.
• The following month, I led a delegation to Washington D.C. to take part in multilateral meetings with the US State Department, the World Bank, the Center for Strategic and International Studies, the American Academy of Sciences and members of the United States Congress. The visit was intended as both an information gathering exercise and to engender a new spirit of co-operation on WASH. 

• That visit was followed by a formal submission to the 2018 United Nations High Level Political Forum on Sustainable Development. The intervention was made in relation to the forum event “Partnerships that Deliver for Girls and Women – an interactive dialogue to break down silos and achieve the SDGs” organised by Women Deliver. Following that intervention, Nigeria remedied the lack of priority it was placing on its approved WASH World Bank loan. 

• In September 2018 the WBFA partnered with Unilever Lifebuoy Nigeria and Sightsavers to improve hygiene practices to impact more than 2 million children over the following 12 months. The partnership works on programmes which promote hygiene messages and prevent disease, advancing critical hygiene interventions such as handwashing with soap, addressing the issue of child illnesses and mortality due to preventable diseases.

• On 25th October 2018, I called for a state of emergency to be called in Nigeria on the standards of water, sanitation and hygiene. Two weeks later, President Buhari heeded that call and declared the state of emergency to be in place. 

• We have now been asked by The World Bank to head up its campaign in Nigeria to end open defecation, which stands at a rate of 25% and poses a serious sanitary hazard. 

• That example shows how, within a year, effective advocacy grows the capacity of, in this case, a Foundation, to far beyond the sum of its parts.  

• I will illustrate my point with a further example. Many medical students around the world use cadavers to train with. They practice on the human body so that when the time comes, they know what they are dealing with.

• In Nigeria, however, that is however rarely the case. Future doctors, nurses and midwives are normally constrained to the classroom – with an excellent grasp of the theory, but less experience of the practice. 

• That means that their first ‘practice’ can be on a human being. A midwife bringing a real child into the world. A doctor making an incision on a real mother. For the first time. Through no fault of their own, this is a major contributor to our high maternal and infant mortality rates. 

• At the Wellbeing Foundation Africa, together with our partners Johnson & Johnson and the Liverpool School of Tropical Medicine, we have already introduced life-like anatomical models to 7 local governments in Kwara State, Nigeria. 

• Our partnership currently brings the models, together with the training needed, to health professionals on the job. It has been a gamechanger. 

• I have seen experienced midwives cry with joy as they explain to me that they have only just understood how to evacuate a placenta or implant a contraceptive device.  A young doctor has declared with relief that he now has the confidence to save lives.

• The results have been extraordinary. So far the Emergency Obstetric and Newborn Care Training Programme, or EmONC – has resulted in a 15% improvement in maternal survival and a 38% improvement in the still birth rate in health care facilities where the project is implemented. It will expand to the whole of Kwara to over 600 extra health workers and 62,900 more women and their babies. 

• These results prove, once again, that we have the brain power and excellence in Nigeria to transform our country, to bring our health indices up to global standards. To build capacity we must in part look to these strategic partnerships to help us deliver results to the frontline. 

• Thank you for the invitation to join you today. I will leave you with one final point as we discuss African-led philanthropy. A key issue for our sector is the notion that lower expectations are acceptable, or that dishing out aid is any form of long-term solution. It is not: we should aim for a global standard in all that we do. It has been shown time and time again that we have the capability to achieve on a global level as a nation and as a region once we have the necessary tools, training and infrastructure to do so. Addressing those gaps is part of our challenge in achieving excellence and I believe that partnerships on an equal footing – not aid – are one of the tools we can use to do so. Thank you.