Her Excellency Mrs Toyin Ojora Saraki

Wife of the Senate President of the Federal Republic of Nigeria

Founder-President, Wellbeing Foundation Africa (WBFA)

Inaugural Global Goodwill Ambassador, International Confederation of Midwives (ICM)

Panel Discussion: Incentivising Investment in the Health Care Sector in Nigeria

24th Nigerian Economic Summit – “Poverty to Prosperity: Making Governance and Institutions Work”

Date: October 23th 2018 Time:  2:00pm

Location: Transcorp Hilton Hotel, Abuja

Panel:

H.E. Mrs Toyin Ojora Saraki – Founder-President, Wellbeing Foundation Africa

Professor Isaac Adewole, Honourable Minister for Health

Mr Uche Orji – CEO, Nigeria Sovereign Investments Authority 

Dr. Olumide Okunola – Senior Health Specialist, International Finance Corporation 

Moderator: Mr James McIntyre Brown, Health Practice Director, Global Health, DAI

Timings:

Opening – 5 minutes

Presentation – 15 minutes

Panel Discussion – 40 minutes

Audience Participation – 30 minutes

Wrap-up/Next Steps – 25 minutes 

Closing – 5 minutes 

Speaking Notes:

• Thank you to the Nigerian Economic Summit Group and to DAI for the invitation to join you here today and for co-hosting this roundtable. It is important that we are able to have a productive and frank conversation about the existing barriers to investment; how that investment should be fostered, and the benefits for business, Government and the people of Nigeria. 

• • We are fortunate that Professor Isaac Adewole, Honourable Minister for Health, is here to give the perspective of the Government, along with experts from the private sector. It should be clear to all of us here that promoting investment in healthcare in Nigeria must be a combined effort if we are ever to achieve Universal Health Coverage and the resulting demographic dividend.

  • I hope today to bring a combined perspective – from the experience of an NGO operating on the frontlines of health care training and delivery, as Founder-President of the Wellbeing Foundation Africa; from a legislative viewpoint as Chair of the Forum of Senators’ Wives; and from a technical basis as Special Adviser to the Independent Advisory Group of the World Health Organization Regional Office for Africa. 

  • I must begin by sounding a note of alarm. In 2015, world leaders agreed to 17 goals for a better world by 2030. These Global Goals for sustainable development are intended to end poverty, fight inequality and stop climate change, guiding governments, businesses, civil society and the general public to work together to build a better future for everyone. 

  • At the World Health Summit in Berlin last week, Dr. Tedros, Director-General of the WHO,  warned that we are not on target to meet those goals. We will miss the targets on maternal, child and neonatal mortality; we will miss the targets on HIV, TB and malaria; and we will miss the targets on family planning, child stunting and universal health coverage.

• Here in Nigeria, even the direction of travel should cause serious concern. Some indicators, for instance in water, sanitation and hygiene – known as WASH – have in fact regressed. According to the World Bank, Nigeria’s spending on WASH must at least triple if we are to have any hope of achieving the clean water and sanitation goals. These essential factors must be addressed to foster the kind of investment and confidence Nigeria needs. Investors will ask the same questions as all of us. Are we making sufficient progress towards achieving the WASH Sustainable Development Goals? Is a lack of investment in WASH putting the lives of thousands at risk as the spread of Ebola is made more likely? Are women and infants dying needlessly in labour rooms, with maternal sepsis taking a mother’s life at what should be the most joyous time?

• When we ask these questions of Nigeria, the answers are deeply troubling. 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.

• Last year the World Bank published its appropriately-named report “A Wake up Call – Nigeria Water Supply, Sanitation, and Hygiene Poverty Diagnostic.”  I met with the water team at the World Bank this summer to discuss and analyse its conclusions, which were devastating. Only 29% of Nigerians have access to improved sanitation, and poor children are about four times more likely to get diarrheal disease than rich children due to poor access to WASH. Is this dire situation being effectively addressed? Well, 15% of completed works on public water infrastructure are considered to be of unsatisfactory quality, and nearly 30% of water points and water schemes fail within their first year of operation. Access to piped water on premises in urban areas has decreased substantially, from a level which was already critical. Across most water-utility indicators, Nigeria underperforms in comparison to African and global averages and needs to invest at least three times more than it does today to achieve the WASH sustainable development goals.

• Nigerians, who have to put up with the daily dangers of poor WASH standards, can therefore have little confidence that future generations will be safer than they are. Can they really expect that their children and grandchildren will be able to bring their own children into the world safely, in a clean labour room? That their communities will not be ripped apart by diseases which could have been prevented with decent WASH conditions? 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 this year was unprecedented – is no coincidence.

• In truth, 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 report rightly highlights, this also allows for the proper regulation of groundwater, essential in the fight against pollution. For all of Nigeria, the tripling of current WASH spending is an absolute imperative.

• There have been very recent encouraging signs from the Ministry of Water Resources in Nigeria, but I would like to take this opportunity to ask us all to acknowledge that water, sanitation and hygiene conditions in Nigeria represent a national emergency – and should be treated as such. 

• The issue of security is one that we can also not shy away from. The on-the-ground reality of frontline healthworkers in Nigeria is now known all around the world. Last week International Committee of the Red Cross aid worker Hauwa Leman was murdered, having been kidnapped in March this year along with two other medical workers in Rann, Borne State. Last month another of those workers, a 25-year-old midwife named Saifura Hussaini Ahmed Khorsa, was also killed – a matter of critical and crucial health worker security which I raised for urgent attention, accountability and action at the United Nations General Assembly. 
• It is not the case that Nigeria is entirely unsafe for investment – of course, Nigeria represents a huge opportunity. But we owe it to healthcare workers and investors to create a Nigeria that is safe. Until that is achieved, universal health coverage will always elude us. 
• We must also recognise the importance of a well-designed civil registration and vital statistics (CRVS) system in order to collect and produce accurate data – and thereby ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies in Nigeria. 

• At the WBFA we designed the Personal Health Record (PHR), a book in which the medical records of each mother and child are recorded and stored for future reference and analysis. The PHR evolved from a child immunisation and growth record to a comprehensive CRVS tool. Without a centralised health database for many families to rely upon to keep them informed of the necessary health processes in a child’s first thousand days of life, the PHR came as an innovation that placed this knowledge directly into the mother’s hands, and empowered her to provide, analyze and follow-up on her own data. A comprehensive CRVS system in Nigeria will enable us to deliver health for all as a measurable demographic dividend, and provide an attractive basis for investment. 
• I have thus far focused on the challenges we face, which are sizable – of that there is no doubt. My experiences of public-private health partnerships in Nigeria have however been hugely positive. 
• Allow me to give one example: the Emergency Obstetric and Newborn Care (EmONC) programme which the Wellbeing Foundation Africa runs 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 took 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.
• I use the example of this partnership to demonstrate that the will is there on the side of the Nigerian people – for training, improved healthcare and partnering to improve health outcomes for all of us. Once the correct conditions are in place, the opportunity to achieve remarkable results is there for us all. 
• Primary healthcare is both a critical challenge and a huge opportunity in Nigeria. I have a vision to strengthen primary healthcare centres to the standards of medical referral centres, to deliver costed, insured, and funded community health to a high quality for all. An ambitious goal but one which I believe is attainable, and certainly crucial if we are to achieve universal health coverage.  DAI will, I trust, be part of making that goal a reality. 

• Inextricably linked to that success will be investment in strengthening health insurance systems – in Nigeria and around the world, too many people are pushed into poverty by health emergencies that they or their families experience.

• There has been some progress in Nigeria towards achieving Universal Health Coverage and fostering the investment we need to provide quality, affordable healthcare – I would for instance point to the Consolidate Revenue Fund and health commitments. However, as we meet today here in Abuja, I would point out that only two countries in Africa have met the Abuja Declaration pledge to devote 15% of their government budgets to health. Nigeria is not one of those two countries – which are, incidentally, Rwanda and South Africa. 
• Let us work together to create the conditions for health investment in Nigeria, provide the resulting boost for the economy, and create a safer, healthier and happier country. The national emergency of water, sanitation and hygiene conditions must be addressed. It can – and must – be done. Thank you. 

Good morning and Happy Handwashing Day!

Before we get down to the very important business of the day, I would like to thank a number of people. Firstly, thank you to our partners at Unilever Lifebuoy, with whom we are committed to reaching 2 million children over the next year, teaching them proper hand hygiene techniques. It is a special partnership, one which is founded on a passion for saving lives through improved water, sanitation and hygiene. Your work all over the world has been an inspiration and I am delighted that you are now here in Nigeria. Together I know that we can not only educate but advocate for the drastic improvements in WASH standards that we know are necessary. Thank you also to Omawumi. Unilever Lifebuoy and this partnership are so very lucky to have you as the brand ambassador. For you to use your star status to get the key messages across to a wider audience is wonderful. You truly are a ‘Wonder Woman’ – thank you. 

Thank you to the staff here at Command Primary School for hosting us today. By doing so you are providing a great service to your students and your community. Handwashing with soap is a highly effective way to prevent the spread of disease and save lives. It will keep your students healthy and make sure that they don’t miss any lessons! 

Most of all I say thank you to the students. Not for being here today: I am a realist and I am quite sure that your teachers have instructed you to attend! However, I would still like to thank you for what I hope that you will do after today. If you pay close attention today, you too can be ambassadors for good handwashing. 

You are about to be taught a very important skill. It may seem a simple one: but it is life-saving. It is a skill you should share with your friends, your parents and your whole family, because it will keep them and you healthy. There are some things that are very dangerous that we cannot see. Washing those things away means that we don’t pass them on to other people or make ourselves sick. I have been told that you are all excellent students so I am confident that I can count on you to all be brilliant handwashing ambassadors – to tell everyone you know how to do it properly, when the key occasions to wash your hands are, and to tell off anyone who does not do it! Am I right?
I certainly hope so. Thank you again and let’s do some handwashing! 

Honorable Minister; Esteemed dignitaries; Ladies and Gentlemen; on behalf of Her Excellency Mrs Toyin Ojora Saraki; Wife of the Senate President of the Federal Republic of Nigeria, Special Advisor to the World Health Organization Africa Regional Office (WHO AFRO), Goodwill Ambassador for the International Confederation of Midwives (ICM) and Founder-President of the Wellbeing Foundation Africa (WBFA), I extend Her Excellency’s sincere thanks for the invitation to join you here today and her apologies for being unable to attend in person. I am Amy Oyekunle, CEO of the Wellbeing Foundation Africa, and it is my privilege to deliver the following Goodwill Message from Her Excellency today. 

We salute the leadership of the Federal Ministry of Health for hosting this event to discuss progress made on promoting breastfeeding in Nigeria. We are gathered here today, during World Breastfeeding Week, which commemorates the Innocenti Declaration signed in August 1990 by governments, the World Health Organization, UNICEF and other organizations, to protect, promote and support breastfeeding. All of us assembled here today will know that breastfeeding is the best way to provide infants with the nutrients they need. The WHO recommends the commencement of exclusive breastfeeding within one hour after birth, and until a baby is 6 months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to 2 years or beyond. 

The campaign focus for the WHO during this year’s World Breastfeeding Week is the importance of helping mothers breastfeed their babies with the first hour of life. That crucial first hour is one which all mothers and healthcare professionals must hold to be of the utmost importance. The so-called ‘first vaccine’ of a baby is the goal: the first skin-to-skin contact along with suckling at the breast stimulates the production of breastmilk, including colostrum, which provides a rich dose of nutrients and antibodies. 

In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition which specified six global nutrition targets for 2025 – including increasing the rate of exclusive breastfeeding in the first 6 months up to at least 50%.  For Nigeria to move towards such a rate, we must heed the Ten Steps to Successful Breastfeeding, but also adopt a multi-sectoral, partnerships-based approach.

The Wellbeing Foundation Africa, of which I am the Founder-President, is a proud partner of Alive and Thrive, an initiative funded by the Bill & Melinda Gates Foundation and managed by FHI360. Alive & Thrive saves lives, prevents illness and ensures healthy growth and development through improved breastfeeding and complementary feeding practices, through a four-pronged approach:  policy and advocacy; interpersonal communication and community mobilization; mass communication; and strategic use of data.

Alongside McCann Global Health, the Wellbeing Foundation is leading on the development and scale-up of a private sector model for breastfeeding support and is part of a consortium working on comprehensive social and behavior change communication (SBCC) strategies, especially the adaptation of the Nigeria national SBCC Strategy of the Federal Ministry of Health, to Kaduna and Lagos States, and detailing a mass media plan at the national level.

Our mandate is to improve Behaviour Change Communication practices in private health facilities in ten Local Government areas in Lagos State with a target reach of 27,942 pregnant women and 9,471 pregnant women in four LGAs in Kaduna. Our next phase is a substantial scale up to approximately 691 facilities in Lagos and 54 facilities in Kaduna by November 2018. An important part of our work has been the assessment and evaluation of practices that are already being undertaken, as without a thorough grasp of existing practices, population and facility practices, we will be unable to achieve any of our ambitious targets.

I would like to end this Goodwill Message by highlighting the importance of midwives in promoting breastfeeding. At the Wellbeing Foundation Africa, our MamaCare midwives are able to instil the importance of exclusive breastfeeding in all the expectant mothers who attend our antenatal care classes, and during postpartum classes and home visits to check up on progress. Any successful strategy to promote breastfeeding in Nigeria must include a commitment to improving the effective deployment of qualified midwives.

Thank you again for the opportunity to celebrate World Breastfeeding Week with you all, and I look forward to working together with all partners to save lives and improve health outcomes in Nigeria through the effective promotion and support of breastfeeding.

Your Excellencies; Distinguished Guests; esteemed organisers of the African Women in Leadership Organisation; Ladies and Gentlemen; thank you for the kind invitation and gracious bestowment of an award today. I am delighted to address this Goodwill Message to the premier organisation for female leaders of African descent and I salute your goal of changing the narrative and unlocking the potential for women to achieve the best for them and our sisters. 

It is my very great pleasure to accept the AWLO 2018 Phenomenal Woman of the Year Award. I do so not for myself, but for my sisters – the Wellbeing Foundation’s midwives, women in Government positions, those in global roles – who inspire me every day to lead for better outcomes for women and for all of society.

I would also like to take this opportunity to commend AWLO for its 1Mother1Child initiative, which recognises the role of motherhood as key to the nurture and future success of our children. You are right to support those crucial stages of development – which is exactly what the Wellbeing Foundation Africa, of which I am the Founder-President – achieves through its pioneering ‘MamaCare Classes’ led by our qualified midwives. Some of those classes, like 1Mother1Child, also take place in IDP camps, a frontline for women and their infants. Despite dire mortality rates here 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 200,000 MamaCare mothers during childbirth. Our MamaCare midwives have achieved this not only by providing classes to a global standard – and achieving the new 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. To unlock the potential for women and girls, our first obligation is to ensure that they are safe and healthy. 

The Wellbeing Foundation Africa was founded with health for mothers and infants as its key objective. Its scope has expanded however, as I soon realised that we cannot confine our actions to our supposed speciality; legislative change, gender equality, maternal health, education and health security are so closely interconnected. To make a sustainable impact and truly open up opportunities for women in Africa, we must reach across borders, knowledge-bases and cultures.

Given that the challenges for women cut across every aspect of their life, our solutions must be universal. As a global advocate for Universal Health Coverage, in Nigeria and across Africa, I know that it not only improves health, but also reduces poverty, creates jobs, drives economic growth, promotes gender equality and protects populations against epidemics. Africa faces the burden of weak health systems and both communicable and non-communicable diseases in a population estimated to reach 2.5 billion by 2050. If we want to transform opportunities for women, we must treat their health and wellbeing as a security threat. That must translate into appropriate levels of funding. The WHO estimates that 85% of the costs of meeting the SDG health targets – including UHC – can be met through domestic resources. But resources must be maximised and utilised effectively. In Nigeria, for every 1 Naira spent on health, 2.5 Naira is spent on defence. It is time that Governments across Africa responded to healthcare deficits as swiftly and aggressively as they respond to military threats.

Indeed, whilst investment in releasing the potential of women is a moral obligation, we must not shy away from making the hard-headed business case for it. Women are key to achieving the demographic dividend that comes with an interplay of reduced total fertility rate, an expanded base of working-age population, and improved educational, infrastructural and healthcare investments. Success for women, both professionally and personally, is success for the whole of society. The UN estimates that gender inequality costs sub-Saharan Africa on average $US95 billion a year. Our countries have both a moral and economic imperative to transform the equality agenda.

The fight for gender equality must also be reflected in the institutions which seek to work in Africa to expand opportunities for women. The release earlier this year of the Global Health 50/50 report demonstrated that organizations from the United Nations system; bilateral and multilateral development institutions; philanthropic organizations and funders; civil society and nongovernmental organizations; public-private partnerships; and the private sector still have a long way to go to reflect the values they are trying to themselves instill. Of course I salute our male allies – when the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, became the first African to succeed to that role, he established a senior leadership team which consists of more than 60% women, declaring that “We need top talent, gender equity and a geographically diverse set of perspectives to fulfil our mission to keep the world safe.” António Guterres, Secretary-General of the United Nations, recently tweeted that he had kept his personal commitment to women’s empowerment and gender parity at the UN by creating a “50-50 Senior Management Group.” We must however use our influence to empower African women to take on leadership roles and ensure that global institutions practice what they preach.

Thank you once more for the kind invitation to join you today and to receive an award. I will follow your conversations during this conference closely and vow to work closely with all partners to help African women achieve their potential. Thank you and God Bless. 

Good morning and thank you for inviting me to speak today about ‘the Role of Technology in Improving Mother and Child Healthcare in Nigeria’.  

My name is Toyin Saraki and I am the Founder-President of the Wellbeing Foundation Africa and Global Goodwill Ambassador for the International Confederation of Midwives, and a special adviser to the Africa Regional Office of the WHO, with a committed purpose to transforming health in Africa towards realising universal health coverage for all.

Within all my roles and from years of frontline engagement with the challenges faced across Nigeria, and some successes, I have seen how digital technology can, at its best, ensure that quality and standards of care are improved and maintained – the ability to track, trigger actions and provide accountability empowers midwives and other health workers to lead the way with quality care, adapting to their own situational awareness. 

I am also particularly delighted to join you today because I see this event as an opportunity. Of course, I am eager to share with you how technology facilitates the work of midwives and the Foundation, but the condition of mother and child healthcare in Nigeria means that I must consider this as an opportunity. In this room are technological experts, leaders in the corporate field and young entrepreneurs. So, I hope that today you will tell me what you can do, and what we can do, together, to improve mother and child healthcare. Let’s talk, let’s partner, let’s save and change lives.

Before we do so, however, I would like for us to take stock of mother and child healthcare in Nigeria and sub-Saharan Africa. For us to be able to apply technological solutions we must first understand the challenges currently faced and the impending factors which will further exacerbate the dangers for women and infants. 

Around 20,000 babies will be born in Nigeria today – each one of them a blessing. Today, however, we will also lose about 2,300 under-five year olds and 145 women of child-bearing age. UNICEF rightly points out that although the rate of newborn deaths has improved, to 37 per 1000 births, this national average hides the differences between our 36 states and the slow progress in some of them. Whilst these figures are already startling and should constitute a national emergency, Nigeria’s growth rate of 3.2 percent annually means that our nation will, according to USAID, reach a population of 440 million people by 2040. As a nation which is currently unable to keep its mothers and children safe and healthy, we must urgently seek solutions to the scale of the challenge we are about to face. 

It is these very statistics, and the absence of crucial detail within the raw statistics, that led me to establish the Wellbeing Foundation Africa in 2004, pioneering two key copyrighted and trademarked tools at its core: the patient custody IMNCH and now RMNCAH Personal Health Records, and the Mamakit Clean Delivery Solution.  

A well-designed civil registration and vital statistics (CRVS) system is an essential component of a successful health system which delivers for mothers and children, and to inform Government policy on where projects must be implemented. Only with the collection and dissemination of accurate data can we hope to ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies. 

My approach in 2004 was not revolutionary or entirely new, as in the late 1950s, Professor David Morley had developed the ‘Road to Health’ chart here in Nigeria for monitoring the growth of infants and young children. This home-based chart was originally designed to monitor growth in resource-poor countries, but developed into a record of a child’s growth and development, kept by parents – it was revolutionary in its time. At the WBFA we took that concept and designed the Personal Health Record (PHR), a book in which the medical records of each mother and child are recorded and stored for future reference and analysis. The PHR evolved from a child immunisation and growth record to a comprehensive CRVS tool. So, what is the value of a statistical life? Without a centralised health database for many families to rely upon and keep them informed of the necessary health processes in a child’s first thousand days of life, the PHR came as an innovation that placed this knowledge directly into the mothers’ hands, and empowered her to provide, analyse and follow-up on her own data – to be in control of her own situational analysis. The digitisation of the PHR to inform similar nationwide efforts by qualified midwives would place Nigeria at the forefront of improving maternal and infant health outcomes. It would be fitting to imagine the impact of scaling and achieving comprehensive coverage of data for health here in Nigeria, where the idea for a home-based record was developed and has since been successfully deployed in countries like the UK and Japan.

The importance of registering births and linking birth registration to vaccinations cannot be overemphasised, as Nigeria is currently battling with a situation where only 1 in 4 children, of our population of 198 million citizens, is immunised against preventable disease, a crisis in the making, and right at the primary health frontline, where the battle to save lives, and deliver demographic dividend will be won, or won. 

The second component I mentioned alongside the PHR – our Mamakits – provide the essential tools to take a safe delivery, and indeed ensure clean births and healthy infants. The impact on clean births without Sepsis was immediate and huge, leading, through its deployment by the NPHCDA’s Midwives Service Scheme, to a sharp drop of mortality rates by 40% between its adoption in 2010, and 2015.

However, we found that the instant popularity of these kits, designed to equip public health medical teams, which were adopted into government policy and replicated across the nation, had an unexpected responsibility shift, as when health agencies chose to distribute directly to mothers, these resulted in medical facilities growing irresponsibility in shirking the provision and budgetary Appropriations of the most basic of essential medical supplies in reliance of a mother to bring her own kit, without the healthcare facility providing their own materials on-site. We have therefore now restricted our distributions to licensed birth attendants,  hospitals, IDP camps and humanitarian dignity situations. 

Technology should be present at every stage of the life cycle of every child – which begins of course with pregnancy. From pregnancy to partograph and beyond, technology such as Philips’ Mobile Obstetrics Monitoring service – or ‘Mom’ for short’ – transforms health outcomes, allows for real-time situational awareness and provides accountability within the health sector. MOM, which features two mobile phone apps, in addition to training and education applications, allows midwives to collect vital measurement data such as weight, blood pressure and temperature, and sync it to the MOM web portal.  This data is tracked and the condition of a woman’s pregnancy is reviewed – while specialists at regional primary care centres can also monitor and assess high-risk pregnancies via a dashboard interface. At the Wellbeing Foundation our midwives also have experience of InStrat Global Health’s CliniPAK Mobile Electronic Health Records, a tablet computer-based data capture and decision support tool which allows health workers to capture patient health information and share the data to remote servers via mobile networks. That system also allows for an immediate alert for at-risk patients and swift onward referrals, as well as up-to-date and accurate health data

We must however also get the basics right. More than 80 per cent of new-born deaths are due to prematurity, asphyxia, complications during birth or infections such as pneumonia and sepsis. These deaths can be prevented with access to well-trained midwives during antenatal and postnatal visits as well as delivery at a health facility, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact, proper cord care, and good nutrition. A shortage of well-trained health workers and midwives means that many Nigerians do not receive the life-saving support they need to survive. Whenever I talk about our MamaCare midwives and the work they do, I always consider how difficult it is to properly convey the level of their care and their innovative use of technology. The results are clear to see – over 200,000 women have taken part in our MamaCare classes, achieving the now standard number of eight visits recommended by the WHO, and we are yet to lose a single one to death in childbirth. Long may that continue. Furthermore, our midwives prove that even relatively simple technology can transform maternal and child health outcomes over a huge area. The Wellbeing Foundation WhatsApp groups have, for example, proven to be hugely popular with expectant and new mothers. Questions and worries are aired within that community 24 hours a day – and handled expertly by our qualified midwives. Of course, whilst our MamaCare classes do not yet operate throughout Nigeria, friends and family of those already in the group from all over the country are added, giving a huge scope to the community – which is constantly changing, as mothers leave to make space for newly expectant mothers. It also allows MamaCare midwives to attend to emergencies swiftly and discreetly. 

The potential of using mobile phones to reach mothers with key information has of course been recognised for some time. The WBFA was a proud partner and supporter of the Mobile Alliance for Maternal Action – or MAMA – which remains an excellent example of a successful public-private partnership between USAID, Johnson & Johnson, the UN Foundation and BabyCenter. With a core set of messages timed and targeted to pregnant women and mothers, MAMA shared vital information exactly when it is most needed and successfully reached millions of women and families with free and modifiable messages. They were also able to demonstrate the knock-on effect of the scheme, with improved health behaviours from MAMA country program subscribers, including higher rates of exclusive breastfeeding, delivery in clinics or with skilled birth attendants, adherence to recommended pre- and post-natal care visits, and recommended vaccinations for mother and child. Importantly – and I believe we will hear from Nigeria’s Honourable Minister of State for Health, Dr Osagie Ehanire, later today – these technological innovations can be adopted and implemented nationwide by Government. 

Whilst we are here to discuss the role of technology in the future of health, we cannot ignore the role of Government – not only in creating the right environment to encourage and adopt successful technology, but in ensuring that Nigerians can access it. Whilst internet access has increased, again the statistics are skewed by certain regions, whilst others lag behind in infrastructure. According to Nigeria’s Communications Commission, over 200 communities which are home to about 40 million people lack access to basic telephones and internet access. Our challenge is not therefore solely in producing technology to save lives but in ensuring that it can be used where it is most needed. 

Technology informs the care of a mother and her infant and can benefit the training of health workers themselves. Last week I visited Gwagalada School of Nursing and Midwifery in Abuja to assess the use of another InStrat Global Health initiative deployed by the WBFA – video training, or VTR. VTR is available both as a mobile app and on the web. Whilst our focus is on midwifery and nursing students, its application also extends to teachers. The cost of upskilling teachers by sending them to a training centre is prohibitive or impossible for many institutions, an issue significantly reduced by VTR. As you can see from the slide, the students at Gwagalada very much enjoy the multi-media training content, which includes text, audio and video – with quizzes and tests, of course. Two students were unable to show me the programme from the beginning, because they had already progressed so far. The goal is not of course simply convenience or to operate within economic constraints, but to produce excellence – training health workers to a global standard so that they can save lives and empower powers and infants. A 2015 Human Resources for Health study of the use of an mHealth tutorial application to improve the knowledge and attitude of frontline health workers to the Ebola virus found an 11% improvement in average knowledge levels, and significantly improved knowledge retention. The connection between data, training and health policy is an exciting one – and one we must make the most of to improve maternal and child health. 

As we examine the broad applications of technology to transforming health outcomes, I still believe that there is no substitute for hands-on experience. I would therefore like to briefly mention the Foundation’s hugely impactful experience of technology and training -driven public-private partnerships. 

Since 2014, the WBFA has joined forces with 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. Together we implemented the Emergency Obstetrics and Newborn Care (EmONC) training programme in Kwara State. This is a unique partnership model, bringing together an esteemed higher-education institution, the private sector and a civil society organisation. I mentioned earlier that the majority of infant deaths are preventable; so too are maternal deaths. 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. Our EmONC training takes place in-house and equips doctors, nurses and midwives, as a collective team, with the skills needed to overcome these obstetric emergencies. At a recent impact assessment visit to Kwara, I asked a Doctor how the use of models and the training had affected his outcomes. His reply was both instructive and chilling. Before the use of this technology, live births had been the training ground for nurses, midwives and doctors. The demonstrations I witnessed in Kwara were wide-ranging and innovative – I was particularly impressed with the simple inexpensive and innovative 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 and affects up to 5% of women. Together with Liverpool School of Tropical Medicine and Johnson & Johnson has trained 600 ‘master trainers’ in nine local Government Areas 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. Imagine a Nigeria where this technology and training was available across the nation. 

“My vision is to combine the strengths of each virtual and physical technology experience and create a fully inter-connected PHC chain. The WBFA has produced a business plan to achieve exactly that – to bring global standards of training, referral, care and accountability to communities across Nigeria.”

I would like to finish today by addressing one of the most serious challenges to maternal and child health outcomes in Nigeria – water, sanitation and health, or ‘WASH,’ in healthcare centres. Here in Nigeria, the WHO found that 29% of healthcare facilities do not have access to safe water and toilets, whilst a WaterAid survey revealed that half of primary health facilities do not have handwashing facilities in delivery rooms. Pregnant women and new-borns are thereby placed in huge danger and at risk of sepsis, which is a leading cause of death in hospitals. Rita’s quote on the slide here is quite right: midwives cannot save lives if the conditions they work in are not sanitary. When it comes to patients, among the most vulnerable are pregnant women and newborns, both at great risk of sepsis — a leading cause of death in hospitals. I have launched a new, global WASH campaign, initiated by the Wellbeing Foundation Africa in partnership with the World Health Organization, Global Water 2020 and others, which aims to transform water, sanitation and hygiene in healthcare centres and schools around the world. I call on all of you here today to work on making existing technologies available to Nigerian healthcare centres and developing new ways of making giving birth safe. Thank you once again for inviting me to address you here today. The scale of our challenge is significant but not insurmountable, and technology will play a key role in Nigeria’s future success story.  I look forward to your questions, your ideas and your innovations, as I imagine the impact in Nigeria, and imagine the impact of innovation, at scale.

Thank you.

Thank you to the National Association of Nigerian Nurses and Midwives for inviting me to address you today. It is an honour to be here following International Day of the Midwife, as we celebrate the work of frontline health workers in Nigeria and around the world. Thank you to all those of you here today whose life work it is to save lives and enable our fellow citizens to thrive.

As the Global Goodwill Ambassador for the International Confederation of Midwives, I consider my role to be twofold. Firstly, I advocate for health workers in every setting – from calling for more investment and support for nurses and midwives from the Federal Government, to championing the Midwifery Services Framework as the core of a successful Universal Health Coverage system. Secondly, I believe that it is my responsibility to provide a platform for health workers to share their own experiences and to use their knowledge to impact policy and global health debates.

Those two roles are inextricably interlinked – and mutually dependent. For example, last Friday, along with the World Health Organization, Global Water 2020 and other partners, I launched a new, global WASH campaign. Our goal is to transform water, sanitation and hygiene in healthcare centres and schools around the world. Everyone here today will understand the challenging WASH conditions which put lives at risk every day in Nigeria, with infants and mothers most at risk. That campaign was informed by the experiences of WBFA midwives, who identified WASH as a key priority – and it will be led by them and other health workers. I hope that you will join our campaign and add your voices to those calling for change. 

I believe that the same is true of all health policy – it is not sufficient to simply celebrate health workers, although that recognition is of course important. We must empower those who have frontline knowledge to shape policy and debate. In doing so, we can also share best practices to raise standards everywhere. I know that our Wellbeing Foundation Africa MamaCare midwives go above and beyond the call of duty; and manage to use developments in technology and inter-connectedness to do so. The WBFA WhatsApp group, for example, gives WBFA midwives the platform to answer questions from concerned mothers 24 hours a day, dispelling fears and reacting to emergencies. They have become counsellors and friends, advising on topics from FGM to gender-based violence. I also know that on more than one occasion they have sternly informed a husband of the importance of an expectant mother of attending an antenatal class. Every nurse and midwife will have similar examples of innovation and extraordinary care – but it is crucial that they are shared by those in decision-making positions. 

The holistic role of midwives and nurses makes their experiences uniquely important, but must be part of wider investment in healthcare standards and infrastructure. The publication of the UNICEF report “Every Child Alive” earlier this year provided a stark reminder of the progress that must be made. It found that five newborn babies die every minute across the world – meaning 2.6 million tragedies every year. A shocking 80% of these deaths can be prevented by access to skilled midwives, clean water, breastfeeding within the first hour and good nutrition. In Nigeria, the WHO found that 29% of healthcare facilities do not have access to safe water and toilets, whilst a WaterAid survey revealed that half of primary health facilities do not have handwashing facilities in delivery rooms. Pregnant women and newborns are thereby placed in huge danger and at risk of sepsis, which is a leading cause of death in hospitals. Without adequate WASH facilities, health workers all over the world are unable to safely carry out their crucial work.

Only with Universal Health Coverage can a nation make the most of its health workers and enable them to fulfil their potential to save lives. As a global UHC advocate, I believe that investment in high-quality and accessible healthcare will transform nations. The benefits go far beyond health – it allows young people to reach their potential, protects against epidemics, reduces inequality and stimulates the economy. The announcement last week from my husband the Senate President of Nigeria that one per cent of the Consolidated Revenue Fund (CRF) is set aside in the 2018 budget to boost the provision of basic primary healthcare services across the country is a welcome step in the right direction. We must build on that progress and ensure that health workers are able to provide their input into the future of health in Nigeria. Only then will it prove to be a success. 

Thank you again for the invitation to address you today, and thank you most of all for your life-saving work. I commit myself to always championing your voices and your priorities – and making sure that your experiences and knowledge are at the forefront as we create a better and safer health care system.