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Her Excellency Toyin Ojora Saraki, Founder-President of the Wellbeing Foundation Africa, addressed the World Health Assembly yesterday on ‘Why water, sanitation and hygiene must be a priority for quality healthcare.’

The high-level intervention came at a symposium organised by the Governments of Zambia, Tanzania, Sweden, Japan, Germany and Eswatini; the World Health Organization and WaterAid. 

Mrs Saraki expanded on the campaign she launched last year to dramatically improve water, sanitation and hygiene (WASH) conditions in healthcare facilities in Nigeria and around the world, calling for a whole-system approach to tackling systemic failures.

Following her intervention, Mrs Saraki commented:

“I was honoured to speak to the representatives of Governments from around the world and global institutions at the World Health Assembly to advocate for a transformation of WASH standards.”

“According to UNICEF, 7,000 newborn babies died every day in 2017, mostly from preventable and treatable conditions including infections like sepsis, directly linked to poor WASH conditions. One in four health care facilities around the world lacks basic water services, impacting over 2 billion people.”

 “Last year I called on all Governments to adopt the WHO’s resolutions on WASH and sepsis, and I agree with Dr Tedros’ warning that we must “go back to basics” – medicine has achieved so much, yet without universal access to safe water, sanitation and hygiene we will never achieve universal health coverage.”

“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.”  

“WASH conditions in healthcare facilities are our first line of defence as infection prevention and control. Dangerous conditions put not only patients in danger, but also workers on the frontlines of healthcare.”

“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. As the Founder-President of the WBFA, I work with our midwives through our frontline healthcare programmes to ensure that mother and baby are safe from birth through to age. Without adequate WASH facilities, however, midwives all over the world are unable to safely carry out their crucial work – and to lead the way with quality care.”

World Health Assembly delegates were also addressed by Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization; Hon. Senator Lizzie Nkhosi, Minister of Health, Eswatini; Professor Dr. Nila Faustine Ndugulile, Deputy Minister of Health, United Republic of Tanzania; Dr Abel Kabalo, Director, Ministry of Health, Zambia; Dr Naoko Yamamoto, WHO Assistant Director General of Antimicrobial Resistance at the World Health Organization; Professor Wendy Graham, Chief Scientific Adviser, Soapbox Collaborative and Professor at the London School of Hygiene and Tropical Medicine; Kaveri Mayra, a midwife representing the International Confederation of Midwives; Lucy Singh from the University of Aberdeen; Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health; Tim Wainwright, Chief Executive, WaterAid UK, Dr Kirana Pritasari, Director of the Ministry of Health of Indonesia; and Anders Tegnell from Public Health Sweden. 

Toyin Saraki, Founder-President of The Wellbeing Foundation Africa (WBFA) and Special Adviser to the Independent Advisory Group of the WHO Regional Office for Africa, yesterday addressed a high-level meeting at the World Health Assembly on how to better align solutions to Women’s, Children’s and Adolescents’ Health and Well-being in Humanitarian and Fragile Settings.

The symposium and call to action organized by the Partnership for Maternal, Newborn and Child Health (PMNCH) and the World Bank, was also addressed by Dr Tedros Adanhom Ghebreyesus, WHO Director General, Helga Fogstad, PMNCH Executive Director and Her Excellency Mrs Emine Erdogan, First Lady of The Republic of Turkey.

In her remarks, Mrs Saraki commented:

“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”.

The symposium was also addressed by Anshu Banerjee, Director, Maternal, Newborn, Child and Adolescent Health, WHO, Manuel Carballo, Executive Director, International Centre for Migration, Health and Development, Rashid Khalikov, Assistant Secretary General for Humanitarian Partnership in Middle East and Asia, Joy Phumaphi, Executive Secretary, ALMA 2030; EWEC Independent Accountability Panel Co-Chair; and Member of the SUN Movement Lead Group, Tim Evans, Senior Director of Health, Nutrition and Population, The World Bank. 

The Wellbeing Foundation Africa (WBFA), led by its Founder-President Toyin Ojora Saraki, is this week attending multilateral meetings at the 72nd World Health Assembly in Geneva, Switzerland.

The World Health Assembly is the decision-making body of the World Health Organization (WHO); determining the policies of the WHO, supervising financial policies, and reviewing and approving its programmatic budgets.

Toyin Saraki, who also serves as Special Adviser to the Independent Advisory Group of the WHO Regional Office for Africa, will speak at high-level events throughout the week, including alongside WHO Director-General Dr Tedros Adhanom Ghebreyesus and H.E. Mrs Emine Erdogan, First Lady of The Republic of Turkey, focusing on aligning women’s, children’s and adolescents’ health and wellbeing in humanitarian and fragile settings and frontline healthcare workers.

Speaking upon arrival at the World Health Assembly, Toyin Saraki commented:

“It is auspicious that my first engagement at the World Health Assembly this year is to celebrate ‘heroines of health’ alongside Women in Global Health, Johnson & Johnson and Medtronic Foundation. Women make up 70% of the global health workforce but are underrepresented in positions of leadership. If we are to achieve universal health coverage and leave no-one behind by 2030, we must drive change for gender equity and strengthen healthcare workers.”

“I support Dr Tedros’ call to action to address the predicted shortfall of 18 million health workers and, as Global Goodwill Ambassador for the International Confederation of Midwives, welcome the launch of the report conducted by WHO, ICM, UNFPA and UNICEF: ‘Strengthening quality midwifery education for Universal Health Coverage 2030: A transformative approach to improving quality of care.’”

“Women and newborns are the most vulnerable in humanitarian and fragile settings. Quality midwifery education saves lives by preparing healthcare workers emergency health situations. Investing in the health and social workforce is critical to the attainment of the health Sustainable Development Goals and I look forward to working with the WHO, global partners and frontline healthcare workers to make that a reality”.

The Wellbeing Foundation Africa has announced a major expansion of its MamaCare Antenatal and Postnatal Education program in the Federal Capital Territory Abuja. The ‘MamaCare + Nutrition program’ will now reach four more local government associations and a further twenty-eight healthcare facilities.

The Foundation has strengthened its midwifery workforce, who will help the program to reach an additional 11,000 mothers and newborns annually with respectful inter-personal maternity care, communications, education and counsel.

This expansion, which will improve the nutrition component of the MamaCare program, is being supported by the United Nations Population Fund (UNFPA), the lead UN agency for delivering a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.

Toyin Saraki, Founder-President of the Wellbeing Foundation, praised the partnership expansion, commenting:

“As events to mark International Day of the Midwife draw to a close, I am delighted that with the support of the United Nations Population Fund, we will be enabling so many more mothers to access quality antenatal and postnatal health with our life-saving Mamacare programme.”

“It is also crucial that we have been able to adapt the program to lend a greater focus to nutrition. The first 1,000 days of a child’s life offer a critical window of opportunity for preventing undernutrition and its consequences as part of the reproductive health care continuum, and will be vital if Nigeria is to meet its commitments under the 2030 Agenda for Sustainable Development.”

“According to UNICEF, malnutrition is a direct or underlying cause of 45 percent of all deaths of children under the age of five. Nigeria has the second highest burden of stunted children in the world, with a national prevalence rate of 43 percent of children under five – translating into 16.5 million children.”

Mrs Amy Oyekunle, CEO of the Wellbeing Foundation Africa, commented:

“Our research reveals a clear link between anaemia and sub-optimal maternal nutrition, and a mother’s success in establishing the essential lactation and breastfeeding to give her newborn the best start in life.  The Foundation delivers on the eight antenatal care visits recommended by the World Health Organization, and follows up with new mothers to ensure that breastfeeding is being undertaken – for the good of mother and baby.”

“Thank you to our Mamacare midwives, who are at the heart and frontline of our work.”

The intended outcome of the partnership is to ensure that Nigerians enjoy improved well-being through sustainable, equitable and quality basic social and protection services which fulfil their human rights and contribute to greater social cohesion and economic development. 

Toyin Saraki and the Wellbeing Foundation Africa, of which she is the Founder-President, today held a multi-lateral event with key stakeholders to mark the International Day of the Midwife. The conference, held jointly with the ACT Foundation and Access Bank, was attended by representatives of the National Association of Nigerian Nurses and Midwives; the Ministry of Health, FHI360, the Luth School of Midwifery, and other strategic partners in the space of global health.

Thanking partners for their advocacy and engagement, Toyin Saraki went on to deliver her keynote speech, commenting:

“We are joined here today with a common vision and passion, and I am sincerely heartened by your presence and ongoing enterprise.”

“I stand before you today as the Global Goodwill Ambassador for the International Confederation of Midwives, commonly known as ‘ICM’, which represents 500,000 midwives, in 132 associations across 113 countries. Within that huge scope there are of course significant differences in the environments and conditions in which midwives operate. Wherever they work, however, midwives are the community leaders and interlocutors who are best placed to foster safe environments including, but also beyond, pregnancy, birth and breastfeeding”.

“As allies of midwives, it is incumbent upon us to advocate for the whole-system support to enable and elevate midwives as the key defenders of women’s rights – in Nigeria and around the world. Today I would like to alight on the critical elements of that whole-system support, with a particular focus on the role of women’s rights in light of the theme of this year’s International Day of the Midwife. I will also explain why I do not believe it is a coincidence that it is a day shared with ‘World Hand Hygiene Day,’ as water, sanitation and hygiene, or ‘WASH,’ is a critical factor in systemic progress for and with midwives.”

“Midwives are champions of women’s rights; but can only be effective if their rights are also secure. This includes the right for every midwife—and all health workers—to decent work and a safe and dignified workplace. Saving lives does not mean a midwife should risk her own. Sadly, as we all know, in the past year we have lost selfless Nigerian midwives. Too often midwives also suffer ‘burnout’ – from long hours carrying out a complex role, combined with the lack of basic infrastructure or professional support to deliver high-quality care. Many rural midwives represent the sole point of access to health care in remote and under-served areas. It is our first duty to keep the care-givers safe.”

“Whole-system support means providing midwives with the adequate tools, equipment, and medicine to provide the full scope of timely, high-quality care, and the capacity to carry out the WHO-recommended 8 antenatal visits. That can only be achieved through effective supply chain management and procurement, overcoming challenges related to drug selection, registration, quantification, procurement, storage and distribution, quality assurance, and information systems.”

“If 13 essential reproductive and maternal health-related commodities were more widely available, it is estimated that the lives of over 6 million women and children could be saved. Those commodities are as follows:

Oxytocin – for post-partum haemorrhage (PPH)

Misoprostol – also for postpartum haemorrhage

Magnesium sulfate – for eclampsia and severe preeclampsia

Injectable antibiotics – to combat newborn sepsis

Antenatal corticosteroids (ANCs) – for preterm respiratory distress syndrome

Chlorhexidine – for newborn cord care

Resuscitation devices

Amoxicillin – for

Oral rehydration salts (ORS) – to treat diarrhoea

Zinc – also for diarrhoea

Female condoms

Contraceptive implants

Emergency contraception – family planning/ contraception”

“Each of these commodities form part of the toolkit with which we need to equip midwives. But they also need to be equipped with a career trajectory and security to benefit them and the communities that they serve. Health system managers, supervisors and policymakers need to better support midwives throughout their careers: from planning, for example for a midwife’s recruitment and deployment to a post, to providing supportive supervision and clinical mentoring and amplifying midwives’ leadership roles.”

“Where midwives’ human resources metrics are not tracked, they cannot be managed. Thus, more data on midwives is needed: from midwifery schools on graduate profiles; from professional associations or councils on licensure, registration, and continuing professional development; and routine, robust, and up-to-date human resource information systems.  In addition, midwife-generated data streams can provide valuable feedback on how services are delivered and promote service improvements.  A comprehensive civil registration and vital statistics system must form the basis of health services and personnel decision making. That will, I have no doubt, provide the evidence needed to understand how midwives’ enhanced leadership roles can optimize health systems.”

“I recently chaired a technical working group at SwitchPoint Conference in North Carolina, organised by IntraHealth International. Our focus was on gender equality and the workforce. Despite my many years of working with frontline health workers, I was shocked by some of the accounts of gender violence. As an absolute essential element of a functioning, decent and dignified health system, a midwife’s workplace must be free from sexual harassment and gender discrimination. According to a global survey conducted by the International Confederation of Midwives and the WHO,  37% of midwives reported that they have experienced harassment at work, whether from colleagues or patients. Effective interprofessional collaboration is important to keeping midwives’ workplaces safe”.

“The theme of last year’s International Day of the Midwife was “Midwives Lead The Way”, and indeed, safe workplaces also mean safe conditions of water, sanitation and hygiene: WASH. Thus, in 2018 I was  delighted when Dr Tedros, Director-General of the World Health Organization, matched World Hand Hygiene Day with International Day of the Midwife. Midwives of course need clean water to facilitate a safe and healthy delivery and support families’ sanitation and hygiene needs across their lives. Everyone here today knows of healthcare facilities where midwives must pull buckets of water up from wells themselves; purchase their own examination gloves; chase livestock out of the health centre compound for lack of a proper fence; or dig makeshift pits to dispose of medical waste”.

“At the Wellbeing Foundation Africa, we launched a water, sanitation and hygiene campaign in May 2018, at the World Health Organization offices, in Abuja. We did so precisely because of the overwhelming evidence coming back to us from our frontline healthcare programmes that we had to retrace our steps – that WASH indices in Nigeria were not only poor; but were worsening in many instances. Poor WASH conditions endanger Infection Prevention and Control systems and put health workers and service users at risk. 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”.

“Our MamaCare midwives began to advocate in the over 570 healthcare facilities where we work, for better standards and taught proper handwashing techniques to staff. Their experiences informed our updated child and adolescent Personal, Social, Health and Economic (PSHE) education programmes which takes place at 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, thanks to midwives”.

“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”.

“As we launched the campaign in May 2018, we announced that the Foundation would advocate to key development partners and policymakers including World Bank Water, USAID, the State Department of the United States Government,  and the United States Congress, allying our human development effort with the 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 and schools, and ending Open Defecation.  A key element of that partnership is advocacy for improved WASH standards, both in Nigeria and around the world. As Special Adviser to the WHO Africa Regional Office, I strongly advocate for the WHO Sepsis Resolution to be adopted and implemented by all governments. In October 2018 the WHO introduced new and pioneering guidelines for WASH in conjunction with neglected tropical diseases”.

“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 issues of trachoma and diarrhoea to reduce child illnesses and mortality due to preventable diseases”.

“This program will soon extend to midwives, the health facilities they work in, and the mothers they serve as the first eyes to see, and first hands to hold, our newborns, for clearly, clean hands save lives”.

“In many West African countries, data provided by UNICEF indicates that between 15 to 20% of newborn deaths in their first month of life are due to sepsis. According to the World Health Organization, improved access to WASH and improved handwashing for all health workers could help prevent infections, and the risk of sepsis in health facilities. We know what works for WASH standards: we must provide those standards and training for midwives who once again have led the way to strengthen health policies nationally, as I welcome the announcement this week of a new WASH program by the National Centre for Disease Control, termed “Turn Nigeria Orange” encouraging health workers to wash their hands with soap and water.”

“As we are joined by our partners here today, I must also mention and commend them for our joint work on the Alive and Thrive programme.  I am delighted by the nucleus of critical host community support from the Lagos State Government and thank our Alive & Thrive programme partners, FHI360 for their technical support and oversight, the Association of General and Private Medical Practitioners of Nigeria, the Wellbeing Foundation Africa Team and all those involved in the organization of this conference. Thank you for your efforts as Nigeria unites to ‘Start Strong!’ for infant and child nutrition as part of a global movement.”

“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 as well as Kaduna.  Good nutrition in the first 1,000 days from conception to two years of age is critical to enable all children to lead healthier and more productive lives. Alive & Thrive works through a four-pronged approach:  policy and advocacy; interpersonal communication and community mobilization; mass communication; and the strategic use of data. Our midwives are crucial to each part of that approach and I cannot conclude my remarks here today without paying tribute to them for their work on this programme”.

“With the Wellbeing Foundation’s access to the latest global and home-grown midwifery-led research on the benefits of mother’s own milk in neonatal intensive care units for sick and premature infants, I again look forward to bringing these key findings to the frontline of care in Nigeria, through advocating for the administration of buccal colostrum to fragile neonates who need special care, another example of Midwifery leadership enabling and elevating whole health system strengthening, to nurture and nourish the most fragile infants for a stronger start from premature birth, to survive, alive, and thrive, to age.”

“I must also pay a special tribute to our MamaCare midwives. They deliver classes in primary healthcare centres, hospitals, and at IDP camps, which are a peace and security frontline for displaced, vulnerable and traumatised 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 – orienting health-seeking behavior and improving Nigeria’s progress towards the WHO benchmark recommendation of at least 8 antenatal visits which the Wellbeing Foundation Africa’s Reproductive Health Lifeprint achieves – 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 professional 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”.

“They should however become the interlocutors between every government and global institution and the communities that they serve.

To achieve this, we must enable and elevate midwives with whole-system support – as ‘Defenders of Women’s Rights.’ Thank you”.

Toyin Saraki is the Founder-President of the Wellbeing Foundation Africa, the Global Goodwill Ambassador for the International Confederation of Midwives, and the Special Advisor to the Independent Advisory Group of the World Health Organization Regional Office for Africa.

This year’s theme for the International Day of the Midwife, commemorated on May 5, is “Midwives: Defenders of Women’s Rights.” This includes the right for every midwife—and all health workers—to decent work and a safe and dignified workplace. Saving lives does not mean a midwife should risk her own. We hear stories of too many midwives burnt out, from not just the long hours guiding families through their complex and unpredictable travails, but from the lack of basic infrastructure or professional support to deliver high-quality care. Behind every miraculous and unique birth, every interaction between a midwife and her clients, the midwife’s “whole system” must be strong and supportive.

Let us support a midwife to reach her fullest potential by supporting her “whole system”:

Access to water, sanitation and hygiene (WASH): Midwives need clean water to facilitate a safe and healthy delivery and support families’ sanitation and hygiene needs across their lives. Whether in Nigeria or Timor-Leste, we have witnessed midwives who must pull buckets of water up from wells themselves; purchase their own examination gloves; chase livestock out of the health center compound for lack of a proper fence; or dig makeshift pits to dispose of medical waste.

In the words of midwife Rita Momoh, “it is not possible for us to do our jobs as midwives without access to water, sanitation, and handwashing stations.”

Progress in reducing neonatal mortality is slower than in mortality among children aged 1–59 months. In many West African countries, data provided by UNICEF indicates that between 15 to 20% of newborn deaths in their first month of life are due to sepsis. According to the World Health Organization, improved access to WASH and improved handwashing for all health workers could help prevent infections, and the risk of sepsis in health facilities.  

Adequate tools, equipment, and medicine:  All midwives should have the supplies and commodities needed to provide timely, high-quality care. Effective supply chain management and procurement is needed so she can access life-saving medicines. Challenges are related to drug selection, registration, quantification, procurement, storage and distribution, quality assurance, and information systems.  

If 13 essential reproductive and maternal health-related commodities were more widely available, it is estimated that the lives of over 6 million women and children could be saved.

A positive and safe social environment: For many rural midwives, they represent the sole point of access to health care in remote and underserved areas. When communities are engaged with midwives to develop a strong and trusting relationship, to provide feedback about their perceptions of the care she delivers, and even to encourage and support her by providing living quarters, clean water, or planting her a vegetable garden, they demonstrate their understanding and appreciation of her contributions.

A midwife’s workplace should also be free from sexual harassment and gender discrimination. According to a global survey conducted by the International Confederation of Midwives and the WHO,  37% of midwives reported that they have experienced harassment at work, whether from colleagues or patients. Effective interprofessional collaboration is also important to keeping midwives’ workplaces safe.

Professional careers guided by data-driven human resources management: Health system managers, supervisors, and policymakers need to better support midwives throughout their careers: from planning (e.g., a midwife’s recruitment and deployment to a post), to providing supportive supervision and clinical mentoring and amplifying midwives’ leadership roles.

Where midwives’ human resources metrics are not tracked, they cannot be managed. Thus, more data on midwives is needed: from midwifery schools on graduate profiles; from professional associations or councils on licensure, registration, and continuing professional development; and routine, robust, and up-to-date human resource information systems.  In addition, midwife-generated data streams can provide valuable feedback on how services are delivered and promote service improvements.  

Vertical segregation, where female health workers do not advance to higher leadership and remuneration as their male counterparts, remains a challenge within primary health care and health systems. More evidence is needed to understand how midwives’ enhanced leadership role can optimize health systems.

This International Day of the Midwife, let us support midwives’ “whole system” so they can be the change agents that our world needs.

By H.E. Mrs Toyin Saraki / Wellbeing Foundation Africa/ Rachel Deussom / HRH2030 Program, Chemonics International