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.