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Good evening and welcome to this Forum on Child Health and Malaria, part of the Access Challenge Universal Health Coverage Conference 2018. 

I am Toyin Ojora Saraki, your moderator for this discussion. As Founder-President of the Wellbeing Foundation Africa, Global Goodwill Ambassador for the International Confederation of Midwives, and Special Adviser to the Independent Advisory Group of the WHO Regional Office for Africa, I am deeply committed to achieving Universal Health Coverage by 2030 and I will bring that experience to bear as we discuss Child Health and Malaria as part of that agenda today. 

We will first focus on input from our experts here on the panel and will then pass over to you – the experts in the audience. Allow me to introduce you to:

Mr. Kevin Watkins – CEO, Save the Children UK

Dr. Kesete Admasu – CEO, RBM Partnership to End Malaria

Dr. Katharina Lichtner – Managing Director of the Family Larsson-Rosenquist Foundation

Ms. Joy Phumaphi – Executive Secretary, African Leaders Malaria Alliance (ALMA 2030)

Dr. Stefan Swartling Peterson – UNICEF, Chief of Health Section

Dr. Henry Mwanyika – PATH, Digital Health Regional Director for Africa

Of course, we all attend many events here at UNGA – all of them no doubt brilliant – but I have to say this format strikes me as the most productive one. Across the four forums – Maternal Health, Child Health and Malaria, NCDs and NTDs in Africa – a shared dialogue will be created, with written input contributing towards a Universal Health Coverage Policy Report, thus creating an essential tool in our joint mission to achieve UHC, with equity at its core. Congratulations to Kate and her team for their work in assembling us all together and for their commitment to UHC. 

As we construct our dialogue today, I would like all of us to have these key goals in mind: 

• Identify the most effective methods of improving diagnosis and prevention of disease in low resource settings
• Highlight the importance of African leadership in driving and directing domestic investment in child health
• Agree the elements of a functioning PHC system in developing countries
• Shape policy objectives that would contribute to the achievement of the UHC 2030 agenda

I know that time is against us, so without further ado let us begin. 

Dr. Katharina Lichtner and Dr. Kesete Admasu:  Partnerships and alliances are key to the UHC agenda. How can we break down silos to better channel investment in the prevention and treatment of diseases affecting children? 

Expected answers: 

1). People working in the global health space should foster cooperation by learning each sectors’ ‘language’

2). At the implementation level this is crucial, particularly in terms of knowledge sharing

3). Changing language can change approaches to partnerships

4). Building partnerships beyond the health sector to promote a multisectoral approach

Mr. Kevin Watkins and Dr. Kesete Admasu – any hope of achieving UHC is predicated on domestic financing and African Leadership. How can domestic funding be better targeted?

Expected answers:

1). Identify how health systems are financed and assess the effectiveness of these financing methods

2). Ensure domestic financing is better targeted by ensuring that the right public financial management and budgetary processes are in place 

Ms. Joy Phumaphi and Dr. Katharina Lichtner, allow me to turn to you and ask: how can we foster confidence between the private sector, charities, and the government?

Expected answers:

1). Foster confidence by making the case to governments using examples of the efficient use of resources

2). Speak the language of governments e.g. referring to GDP. This generates a vested interest for governments and helps to unleash more resources from the investors

3). Assess the most appropriate kind of capital investment for different areas of the research-planning-implementation processes that lie behind financial planning

Dr. Henry Mwanyika and Mr. Kevin Watkins, as we turn to Diagnosis and Prevention, can you speak to how we can integrate the most promising innovations into existing health systems?

Expected answers:

1). By turning away focus from individual pilot projects and focusing on the broad application and mobilization of resources 

2). Following from that, yes: what holds us back is a lack of support mechanisms, and integration requires a focus on infrastructure

Dr. Stefan Swartling Peterson, on a subject very close to my heart, what are the elements of a sustainable Primary Health Care system? How do we ensure equity and quality, moving beyond a focus on access alone? What are the challenges facing service delivery?

Expected answers:

1). Importance of quality services and a system which promotes equity

2). Health systems should react to the high disease burden, and this should be context-specific

3). Community operationalization

TS on challenges facing service delivery and effective primary healthcare systems – equity

You emphasized community engagement, why is this so important?

At 6.00pm: 

Ask the audience about policy recommendations to improve child health and tackle diseases impacting the health of children

End:

Thank you to our panel – Mr. Kevin Watkins – CEO, Save the Children UK, Dr. Kesete Admasu – CEO, RBM Partnership to End Malaria, Dr. Katharina Lichtner – Managing Director of the Family Larsson-Rosenquist Foundation, Ms. Joy Phumaphi – Executive Secretary, African Leaders Malaria Alliance (ALMA 2030), Dr. Stefan Swartling Peterson – UNICEF, Chief of Health Section, and Dr. Henry Mwanyika – PATH, Digital Health Regional Director for Africa, for your insights today. Thank you to the audience for your insightful input which will inform the policy outputs from today. I look forward to analysing all of the forums that have taken place today, learning from them, and becoming a more effective advocate for UHC. I know that for me, equity and quality remain absolutely fundamental. Thank you and congratulations again to Kate and her wonderful team. 

Ladies and Gentlemen, let me begin by saying welcome and thank you for attending this 8th  African Conference on Sexual Health and Rights here in Johannesburg. It is a pleasure to be here in front of you today to share our mutual values, interests and objectives in the field of sexual and reproductive health of women and girls across Africa. 

My name is Toyin Saraki, and I am the Founder and President of the Wellbeing Foundation Africa, an Africa-focused charity that provides services in reproductive and maternal health to those in need. Inspired by my own personal tragedy, the Wellbeing Foundation was created to help other women like myself during the most vulnerable and critical times in their lives. 

In carrying out that mission, the highly commendable leadership of Dr Natalia Kanem, Executive Director of UNFPA, and the work carried out by Dr Keita, as Resident Representative of UNFPA in Nigeria, and her team has been an inspiration. 

South Africa, much like my native Nigeria, has made huge advancements in sexual and reproductive health over the past decade, a trend that resonates widely across our beloved continent. Maternal mortality has been slashed, thanks to improved technology, medicine and a renewed commitment to tackling this burden that unnecessarily inflicts individuals, communities and societies. Yet there is still much work to be done, and despite vast improvements, Africa continues to have the worst maternal health outcomes of any continent. Nigeria alone accounts for 13% of maternal deaths globally. It is for this reason that events like this remain absolutely critical, to keep the issue alive and to force people to listen and to act. 

Sexual and reproductive health means more than just slashing maternal mortality. It means liberating women and girls from the constraints of family planning, child birth, and the other gender specific burdens that women face globally. Constraints that so often marginalise women and their individual struggles, and consolidate the gender divide that we are working so tirelessly to close. Sexual and reproductive health is about education, awareness, and choice: the choice to have children in clean and safe conditions. The choice to space children, so that resources can be distributed to maximise the opportunities of each child. The choice to be properly informed and empowered in the decision-making process that surrounds these issues is important for the young, for prevention of catastrophe is better than cure. 

My organisation, the Wellbeing Foundation Africa, recognises the importance of sexual and reproductive health, and to be around such likeminded people as I am today gives me great assurance that together we can tackle and overcome the deficits in the area of healthcare that is prevalent across the continent. The WBFA runs a range of programmes across Nigeria that serve women in areas of sexual and reproductive health. Our Mamacare classes educate expectant mothers on child care, nutrition, and the birthing process, reducing the risk of complications and providing support to mothers who lack support elsewhere. The WBFA is also involved in training midwives – who form an essential part of any safe birth, as well as providing basic perinatal care – across the country. Our trained midwives have in turn have gone on the serve hundreds of thousands of women. The WBFA is also driving universal health coverage, funding health insurance for 5,000 Nigerians annually. Universal health coverage is the cornerstone to better reproductive and sexual healthcare, and deserves greater prioritisation at national, regional and global levels. It is my belief and hope that it can be achieved in a matter of years around the world, and we must make this happen. 

Looking at the programme for the days ahead of us, I can see that this conference will undoubtedly be informative and conducive to a better future for women and girls across the continent. Alongside the aforementioned representation from UNFPA, I am delighted that Phumzile Mlamdo Ngcuka, from UN Women, is attending – UN Women and UNFPA are both critical organisations in the pursuit of reproductive and sexual rights for women around the world, and I support their endeavours wholeheartedly. 

Over the course of the next few days I hope to learn, and to share ideas and thoughts on how to progress the agenda of improved sexual and reproductive health, and it is my firm belief that together we will challenge and overcome sexual health deficits in Africa, once and for all. 

Thank you.

Good evening and welcome

Thank you for you all for being here tonight. My name is Toyin Saraki and I am the Founder Director of the Wellbeing Foundation Africa and Global Goodwill Ambassador for the International Confederation of Midwives.  My Foundation works across Africa to improve health and social outcomes for women and their children, a cause I have dedicated much of my life to.

Tonight, I would like to thank the team at London School of Hygiene and Tropical Medicine for hosting the event and for their dedication to the trial.  Without your expertise and hard work we would not be gathered here today to celebrate the transformational trial findings.

I would also like to welcome everyone here tonight who has in one way or another contributed to improving the maternal health outcomes of women around the world; the maternal health researchers, health and advocacy organisations, students, health professionals, funders and other stakeholders. Your tireless work and dedication to the cause of maternal health is vital to the livelihood of mothers and their children, and to families across the world.

The issue of maternal and newborn mortality is one close to my heart.  I tragically lost one of my twin babies during childbirth, and then had to fight for the survival of the other. In fact, I am an example of both the success of modern medicine and of what can go wrong when there is a delay. Even though I was an educated and informed woman, I was unable to save the life of my second twin daughter due to the infrastructural deficiencies in Nigeria’s healthcare system at the time. I had to wait to find an anesthetist for an emergency C-section – a delay that cost me my daughter’s life. It is thanks to modern medicine however that I was lucky to survive with one healthy child. The mission to improving maternal health is what brought me here today and is why I am so passionate about finding interventions, such as tranexamic acid, which can save the lives of mothers.

In the developed world, death during childbirth is rare – in fact the average maternal mortality ratio in OECD countries is just 11 deaths per every 100,000 births. Sadly, this is not the case everywhere. Although in Europe, maternal mortality is a near-negligible figure, in Sub-Saharan Africa, the risk of maternal mortality remains painstakingly high. In Nigeria, for example, the country of my birth, a woman incurs a 1 in 23 risk of dying during child birth in her lifetime. In Chad, with the highest maternal mortality ratios in the world, this figure is closer to 1 in 17. It is countries such as these that can benefit the most from tranexamic acid.

Tranexamic acid works by clotting a woman’s blood, reducing the risk of death by postpartum haemorrhage (PPH) by a third. A drug as cheap and effective as tranexamic acid therefore provides a rare opportunity for continental divides to converge – by preventing a third of PPH deaths worldwide (of which a shocking 99% are from Sub-Saharan Africa), we are a significant step closer to fair and equal maternal care around the world. The results speak for themselves. Over 20,000 women were enrolled in the trial, which took place in 21 diverse geographical settings, including countries with some of the highest mortality rates and absolute numbers of maternal deaths globally. I thank the trial organisers for including such a diverse cross section of countries. As I mentioned before, maternal mortality affects those in developing countries the most and to have the trial focused in countries such as my own is incredibly important.

The administration of the drug can mark the difference between life and death; as we have heard this evening, when administered to women experiencing PPH (which affects around 6% of births)  the drug can lower the amount of blood lost by mothers, and was shown to reduce maternal deaths from PPH by a 30%. What’s more, the drug is already readily available, and costs just $3 per injection.

Clearly, if administered across Africa, the health outcomes would be immense and would lead to lives of thousands of women across Africa being saved.

But this will not be easily achieved and we can expect challenges along the way.

Firstly, funding. The drug has been shown to be inexpensive and excellent value for money. However given the competitive health funding agenda in Nigeria and across Africa it is becoming increasingly difficult to secure funds for interventions, especially where Ministries of Health have funding constraints and other health demands.  To combat this, we need to look elsewhere and to form strategic partnerships to secure funding sources.

We also need to consider how women access the drug and how it is administered. In my country Nigeria, many women give birth at home or in poorly equipped and under resourced medical facilities. Investigators acknowledge that most maternal deaths occur in low-resource settings, either at home or in poorly resourced health facilities where intravenous administration may not be available. I believe that by commissioning further study into the administration of this drug we can investigate whether there are viable alternatives that can be used in rural and remote settings. Another option is strengthening healthcare facilities in these communities. I have seen first-hand the impact of strengthening these facilities, allowing women who would often have to travel for miles to access maternal healthcare to give birth.

These are challenges which cannot be addressed without a coordinated response involving global organisations, country governments, the academic community and those on the ground. We need to issue a call to action, urging on those responsible to fund the drug and distribute it to those who need it most..

Finally, education for expectant and new mothers and midwifes. We need to ensure that all midwives are educated to a high standard, are aware of warning signs during pregnancy and can recognise when the situation needs to be escalated. Education is the first vital step in this process. My foundation, the Wellbeing Foundation Africa, provides ante- and post-natal education programmes to help prepare mothers for birth, give them confidence to go through labour, and to care for their babies. The programme provides a range of information and topics including; preparation for birth, labour, coping with pain, care of the newborn, and breastfeeding.

We also need to train midwives and upskill health workers. My foundation has introduced an Emergency Obstetrics and Newborn Care Skills and Drills programme. Objectives of the project include improving the quality of emergency obstetric newborn care and supporting pre-service midwifery institutions to improve components of the curriculum.  Scaling up initiatives like these has the potential to make a massive impact in terms of competency and delivery of vital maternal care. Similarly, we have also focused on education for expectant mothers with the introduction of Mamacare classes, providing antenatal classes covering a range of topics and issues.

It is vital that we coordinate the responses of actors – NGOs, health academics and researchers must synchronise their efforts for maximum effect. By putting pressure on governments, we can work towards collaboration with global organisations to put together a coordinated case for funding the drug. We then need to work together to ensure the drug is distributed to those who most need it. I am especially heartened to see the recently released WHO recommendations, which call for early use of the drug within three hours of both and administration of the drug being considered as start of the standard PPH treatment package. Such high-level recommendations add to the strength of our argument for the use of the drug and we must utilise these findings.

Conclusion:

Immediate and widespread distribution of tranexamic acid is undoubtedly a step in the right direction but this needs to be met with a greater commitment from governments to boosting maternal health outcomes. Just $3 can save the life of a woman – a mother. We are also bound by a global commitment to reducing maternal mortality; outlined in SDG 3, the goal is to reduce maternal mortality rates to 70 per 100,000 live births by 2030. Maternal deaths not only signify a waste of life, but serve to massively and negatively impact the lives of their infants and communities, and remain a constant, and impenetrable barrier to development. Investing in better maternal health therefore serves as both a means and an end, to be prioritised accordingly.

When I established my foundation over 25 years ago, the outlook for maternal care in Nigeria, and beyond, looked bleak. Since then, Nigeria’s maternal mortality ratio has nearly halved. Although this achievement is commendable, it can only go so far in addressing the inadequacies in maternal care in Nigeria and in Africa. Progress has been made, but there remains much work to be done.

It is my hope that the ground-breaking tranexamic acid will mark a new era in maternal care around the globe, and that its positive impact can be matched, through heightened investment and commitment to the cause. The drug provides hope to thousands of women and their families – now we must follow through.

Thank You

WOMAN Trial panel event and Blood Clock launch

I believe that we have reached a crossroads, where gender equality in many parts of the world is still not accelerating and advancing sufficiently enough for the Sustainable Development Goals to be met by 2030.  As a global health advocate, I believe to meet these goals, we must understand that : Health equality is gender equality. If a mother in rural Nigeria is not receiving the same health treatment as another in the urban areas, then there is no true progress in gender equality until these differences are diminished. 

One of the vital steps in reaching health equality will be to strengthen the national Primary Healthcare Systems across the continent. As Chair of the Primary Healthcare Revitalisation Support Group, I truly believe that every woman, every child deserves the same universal access to healthcare, and this needs to happen firstly through a fair budget allocation and implementation on our health systems, especially Primary Healthcare.  With this first step, we can ensure every woman, every child, from birth to age, has access to healthcare throughout their lives.

At the Wellbeing Foundation Africa, we have been delivering antenatal and postnatal classes to expectant mothers across Nigeria through our MamaCare programme for nearly 2 years. We have delivered our classes to over 300,000 expectant mothers now. This programme is uniquely led by midwives and delivered to mothers of all creed and socioeconomic backgrounds. The midwives give the expectant mothers continuum of care and counsel free of charge. Giving equal access to pregnant women to a highly qualified medical professional and services is a vital step in gender equality and human equity. As gender equality advocates, we must ensure the most natural thing, childbirth, does not harm,  kill and destroy the lives of millions of women, which is doing now. We must ensure that every mother has access to a midwife, no matter her position in society or what part of the country she is from.

We must ensure that increased women in leadership and participation will improve the lives of all women. This includes women who have been marginalised in society such as incarcerated women.  My Foundation will be giving antenatal and postnatal classes to incarcerated women in Nigeria in the coming months. I truly believe every woman and every child deserve rights to healthcare.

Female leadership is key. If we do not have female leaders now, our daughters will not have role models, their dreams may remain as just dreams. They need role models to emulate, they need us to pave the way for them. For this, we must ensure that we restructure and fix our societies representation of the woman. More of us need to stand for political office, and all of us should support each female political candidate from beginning to end. Our daughters need to see and believe, that yes, the woman is the mother, the daughter and colleague, but she is also the Chief Executive, the President, The Parliamentarian and The Board Member.

As a member of the African Women’s Leaders Forum, I am committed to championing its values and recent call to action. I believe that we should all remain steadfast in encouraging and mentoring young women to enter leadership, to supporting women leaders and also spreading our message of gender equality for all women.  

As I mentioned, these components, universal health rights and access, political participation, legislation, and the future of our girls, are part of the same puzzle in transforming Nigeria into a more equal society for women and girls. I truly believe that one component being missed, is an incomplete puzzle, so we must all ensure that every part of the puzzle is treated as equal, so we can build a fairer and more equal society.