global

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

Please welcome H.E. Mrs Saraki.”

Interview:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why is this so close to your heart?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.