global

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. 

Good afternoon, I am delighted to join you here today. I have been asked to convey the apologies of Mrs Toyin Ojora Saraki, the Founder-President of the Wellbeing Foundation Africa, who is unfortunately unable to be with us. It is my privilege to represent Mrs Saraki here today: my name is Jack Tunmore and I lead Global Communications and Policy for the Wellbeing Foundation, also known as the WBFA. 

I will give a very brief overview of the work of the WBFA and then offer more insight into the two of our programmes which I think are the most relevant for our discussion here today. This session focuses on building partnerships with NGOs, communities, and academia. We bring the perspective of an NGO which works with global partners, academic institutions and Governments, both local and national. 

The Wellbeing Foundation Africa was founded in 2004 by Her Excellency Mrs Toyin Ojora Saraki, with the primary aim of improving health outcomes for women, infants and children. We combine our programmes with advocacy work in Nigeria and around the world: in fact our frontline health programmes inform that global advocacy. 

We have offices in Lagos, Abuja and Ilorin – and a global office in London, which is where I am based. I am fortunate to regularly spend time with our teams in Nigeria, including taking global partners on assessment visits, and when in London I am equally fortunate to be kept closely, and frankly, informed of frontline activities by the WBFA midwives, known as MamaCare midwives, via WhatsApp and Skype. 

Over 200,000 women have taken part in our flagship ‘MamaCare’ classes in Nigeria; antenatal and postnatal classes delivered by our qualified midwives. Despite dire national maternal mortality rates, we have not yet lost a single MamaCare mother. Our WBFA midwives transform the lives of mothers, their children and communities. No topic is off-limits in their classes – trust me, I know – and their results speak for themselves. Our online #MaternalMonday campaign was conceived as a platform for mothers and our WBFA midwives to share their knowledge, experiences & best practice. The aim of that sharing exercise is to raise awareness for the improvement of reproductive, maternal, newborn, child & adolescent health.  We harness the power of story-telling on social media each Monday to share accurate information on maternal health 

Now I will turn to the two programmes which I think are most relevant to our discussion here today. 

The first is the Emergency Obstetric and Newborn Care (EmONC) programme which  is run in partnership with the Centre for Maternal and Newborn Health (CMNH) at the Liverpool School of Tropical Medicine, the oldest and most established school of tropical medicine in the world, and Johnson & Johnson, one of the largest global health companies. The model therefore brings together an esteemed higher-education institution, the private sector and a civil society organisation – which is of course us. 

Our EmONC training takes place in-house and equips doctors, nurses and midwives, as a collective team, with the skills needed to overcome obstetric emergencies.

Funding from the Johnson & Johnson Corporate Citizenship Trust allows for a three-pronged model from LSTM and the WBFA: (a) direct, skills-and-drills based method of teaching Emergency Obstetrics and Newborn Care, including newborn resuscitation; (b) Data Management training; and (c) Quality Improvement (QI) training. WBFA’s model is based on community mobilisation, advocacy, and strategic policy advisory. 

The partnership began in February 2015, with the two first phases being active in 7 of the 16 Local Government areas in Kwara State. In February I joined representatives from Johnson & Johnson and the Liverpool School of Tropical Medicine to carry out a ground assessment of the training. The demonstrations witnessed by the team in Kwara were wide-ranging and innovative – we were particularly impressed with the simple inexpensive use of a condom catheter balloon filled with saline to control postpartum haemorrhage, the excessive bleeding after birth which is the leading cause of maternal mortality. As we know, 80% of all maternal deaths result from five complications which can be readily treated by qualified and trained health professionals: haemorrhage, sepsis, eclampsia, complications of abortion and obstructed labour. 

So far, the EmONC training programme has resulted in a 15% reduction in maternal case fatality rate and a 38% reduction in the still birth rate in health care facilities where the project is implemented. 

Since that visit, we can as partners proudly report that we have moved to the next stage of the programme, as from August 2018 to August 2020 our EmONC training is set to expand across the whole of Kwara State. 

Between 2018-2020, EmONC training will be delivered to an additional 27 healthcare facilities in the remaining 9 LGAs. Over 600 healthcare providers will be directly trained and over the 30-month project, an estimated 62,900 women and their newborns will benefit from the interventions implemented.

We have taken a quite different approach to our partnerships which seek to improve water, sanitation and hygiene – or ‘WASH’ conditions in healthcare facilities, schools, and communities in Nigeria. 

Poor WASH facilities in schools 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. Meanwhile, poor WASH conditions in healthcare facilities lead to high rates of maternal and infant mortality. The WHO found that in Nigeria 29% of HCFs do not have access to safe water and toilets and 16% of HCFs do not have handwashing facilities with soap.

In May our Founder-President Mrs  Saraki launched a global WASH campaign in Abuja at a meeting with Dr. Wondi Alemu, WHO Representative and Head of Mission in Nigeria, working 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. A key element of that partnership is advocacy for improved WASH standards, both in Nigeria and around the world. 

In June we carried out a fact-finding and advocacy mission to Washington D.C. to take part in multilateral meetings with the US State Department, the World Bank, and members of the United States Congress. In August, as the United Nations marked International Youth Day, the WBFA took its pioneering PSHE and water, sanitation and hygiene (WASH) education programme to schoolchildren in Ogun State, Nigeria. 

The WBFA’s programme is based on its Adolescent Skills and Drills, Personal Social and Health Education Curriculum, the first locally-developed PSHE curriculum, which is formed of three core pillars – Your Rights and Your Body, Health Relationships, and Planning Your Future. Within those main areas an extensive range of topics pertinent to the health and wellbeing of young people are covered, with a focus on WASH.

The cohort of children, aged between 8 and 17 years old, were taught the WHO standard of hand washing techniques in addition to further break-out sessions, in line with the commitment of the WBFA to support the attainment of UN Sustainable Development Goal 6: Ensure availability and sustainable management of water and sanitation for all. This pilot, which took place over two days, educated 237 children at the Ogun State Summer Camp, before an anticipated roll-out across the state and throughout Nigeria. 

Last month we 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 will work 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.

Thank you for your attention and I look forward to hearing how we can be a great frontline health partner for you all. 

Good evening. I am delighted to join so many friends here to celebrate midwives and the work of ICM. 

Indeed, we often meet at times of celebration. Last time I joined you at a public event, at the World Health Assembly in Geneva, the atmosphere was joyful as we celebrated midwives leading the way for quality care around the world. I know that we will share some of that spirit tonight. 

Events last week, however, will be weighing heavily on all of our minds, and prompting difficult questions about the safety of midwives and our role as champions and advocates for midwives. 

In March, a 25-year-old midwife named Saifura Hussaini Ahmed Khorsa was kidnapped by militants alongside two other International Committee of the Red Cross aid workers. Saifura, a young mother herself, had moved to Rann in north-eastern Nigeria to selflessly help those in need. 

Saifura’s murder last week is a tragedy for Nigeria and for the global community of midwives. As a mother, as a Nigerian, and as a champion for midwives, I am devastated that we have lost one of our own.  We pray and work for the release and rescue of Hauwa Mohammed Liman and Alice Loksha as we come to terms with this stark reminder of the threat to life and liberty faced by midwives, nurses and health-care workers who selflessly work for the health and wellbeing of others. 

Saifura had specifically been working in a facility for Internally Displaced Persons – where women are of course particularly vulnerable. Two days after the terrible news broke, our MamaCare midwife Rita was herself conducting an antenatal class in an IDP camp, albeit in an area with a quite different security situation. There can be no greater reminder of the need to support ICM’s advocacy and aims than the news last week and the work carried out by midwives like Saifura and Rita, with no fanfare, day after day, in some of the most challenging conditions imaginable. 

I have just come from the ICM stakeholders meeting, where we discussed ICM’s three-year strategy and had a very honest discussion about all of our strengths and weaknesses. There is no truer friend than a critical friend. One point that I must however bring to this forum which I made in that meeting is that ICM punches far above its weight. ICM’s reach is of course huge, representing over 500,000 midwives from 132 Member Associations in 113 countries across 6 regions of the world.  Many of you here this evening would probably be surprised at the number of staff given their remarkable output. I congratulate ICM, in particular Franka and Sally of course, on their outstanding work not only in forging the way ahead for ICM but for leading the way in advocacy and vision. 

I have now been ICM’s Global Goodwill Ambassador for quite some time – four and a half years and counting, in fact. I am fortunate in this role to have my work informed by the Wellbeing Foundation Africa MamaCare midwives, by the team at ICM, and by friends – many of them here – who share our vision and commitment. Like all of you, however, I strive to find new and effective ways to champion the cause of midwives, both as a public advocate and in private. Making the right case to the right people, at any level, is something I know we can share our wisdom on – please never refrain from letting me know how I can be a better champion. 

Thank you to everyone here today for being friends to ICM and champions for midwives. Above all, thank you to ICM for all that you do. 

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