Good morning, my name is Toyin Saraki and I am the Founder, President, of the Wellbeing Foundation Africa and Inaugural Global Health Ambassador for the WHO Foundation. My Foundation works across Africa to improve health and social outcomes for women and their children, a cause I have dedicated much of my life to.
I am delighted to join you all here today, to celebrate the launch and mark of the Smiles for Mothers Program First Use of Heat-Stable Carbetocin in Nigeria and Sub-Saharan Africa. Today is a life changing moment for women around the world, and the global health community as we will actively witness in real-time the vital impact of heat-stable carbetocin, a new formula which does not need refrigeration or cold-chain transportation, challenges we have faced time and time again in Nigeria.
I personally have been awaiting this major maternal health milestone since the publication of the CHAMPION (Carbetocin hemorrhage PreventION) trial results in 2018 – a study led by the World Health Organization (WHO) as part of a collaboration with MSD for Mothers and Ferring Pharmaceuticals. That data then contributed to heat-stable carbetocin being added to the WHO Model List of Essential Medicines (EML), as well as an update in the WHO’s recommendations on uterotonics for the prevention of excessive bleeding after birth.
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality, morbidity and long term disability related to pregnancy and childbirth in not just low-resource countries, but globally, accounting for nearly one quarter of maternal deaths worldwide. In Nigeria, low use of antenatal care (ANC) and delivery services contribute to PPH, with PPH observed to be the most frequently diagnosed obstetric hemorrhage complication, and majority of women who experience PPH complications have no identifiable clinical or historical risk factors prior to.
While improving overall quality of healthcare is crucial to addressing the high maternal deaths, the use of Heat-Stable Carbetocin will be revolutionary. Maternal health, with thriving mothers and children, is the first and most vital component of healthy societies, economies and nations. Healthy mothers lead to healthy families and strong health systems. It has a direct impact on the welfare of society especially in many developing countries, as a mother’s death is much more than an emotional crisis, it often leads to long-term social and economic breakdown, both for her immediate family and the wider community.
Throughout my years advocating for improved maternal health in Nigeria, one thing has always been clear – effective interventions to prevent and treat PPH do exist and can largely reduce the burden of this life-threatening condition.
I personally have addressed the challenges associated with a lack of access to PPH medication and training, and adequate timely maternal health care ,by developing and then implementing programming through my Wellbeing Foundation Africa to improve access to skilled birth attendance, particularly better quality primary health care at a grassroot community level.
The WBFA, in partnership with the Liverpool School of Tropical Medicine and Johnson and Johnson has successfully introduced, implemented and championed Emergency Obstetric and Newborn Care (EmONC) Skills and Drills training in Nigeria which takes place in-house and equips doctors, nurses and midwives, as a collective team, with the skills needed to overcome obstetric emergencies. The training uses lifelike anatomical models and simulation case scenarios to enable health workers to develop expert first-hand experience – which is often not common in the developing world. At implementing facilities, there’s been a 15% reduction in maternal fatality & 38% reduction in the stillbirth rates – validating our push to scale these lifesaving innovative capacitation to the pre-service curriculum with the denomination of the Kwara State School of Nursing and Midwifery as Nigeria’s First National Centre of Excellence.
As the Inaugural and Emeritus Global Goodwill Ambassador to the International Confederation of Midwives, since 2014, the WBFA has recognised the role of midwives as primary educators and health carers for chilbearing women in our frontline programmes towards safer births and healthy futures through our flagship Mamacare360 Antenatal and Postnatal programme, which covers the mother’s nutritional status, mental wellbeing, and lifestyle choices, before, during and after pregnancy; profoundly affecting the future health and wellbeing of the mother and child. Antenatal education forms part of the early intervention and promotes positive perinatal outcomes and should be viewed as part of a life-long journey. My Foundation promotes respectful care and the involvement of pregnant women and their families by making the mother a premium partner in her own outcome, through education and awareness in birth preparedness.
The quest for real and practical solutions to improve PPH outcomes in Nigeria has seen us walk the daily path from research bench to hospital bedsides and birthing stools in huts over decades, from a simple mat placed under the mother to measure the flow of blood as a practical signal in 2008, and the oxytocin shot for life, to misoprostol with DFID PATHS2 in 2010, to fighting alongside with Flight For Every Mother for hands-on training across Africa in 2013, to our 6-Year WBFA-LSTM-JNJ Program To Improve The Availability and Quality Of Maternal And Neonatal Health Care In Nigeria through the EmONC Skills and Drills Program pioneered from 2015 to 2021 throughout Kwara State, to the London School of Tropical Medicine’s WOMAN Trial of tranexamic acid in 2018, to advocating to the Global Board of Ferrings in January of 2020, and an ongoing working partnership with Laerdal Global Health to improve community midwives access to modern tools and training in the 670 community HCF we have engaged with across Lagos, Kwara, Osun, Cross River, Kaduna, Kano, Sokoto and the FCT Abuja.
Now, with accessible treatment of PPH through heat-stable carbetocin, we will be much closer to reaching the Sustainable Development Goal 3, with our healthcare workers given timely access to appropriate medications and support in procedures relevant to the management of PPH, and our mothers being aware and knowledgeable on advocating for heat-stable carbetocin.
The fact remains that despite significant statistical improvements, becoming pregnant is still one of the most dangerous things a woman can do in her lifetime in Nigeria where there is a 20-fold higher risk of death than in better resourced regions of the world – but today, with the entry of heat-stable carbetocin into the arsenal, we are a quantum leap closer to tackling and ending PPH, demonstrating first-hand how work across both the public and private sectors can help achieve development goals in global health.
It is my hope that the ground-breaking progress we have made today will also mark a new era in strengthening the Essential Medicines Supply Chain and Drug Revolving Fund Management at the Primary Health Care frontline where this matters most, and to transforming maternal care around the globe with positive impact that will be implemented and accessible everywhere through heightened investment and commitment to the cause. When we save the lives of mothers, we are also saving families and communities from tragic emotional, mental and socio-economic costs of irreplaceable losses, but also realizing and potentiating an enormous opportunity for human development and a healthy future for all.