It has been a huge honour and an incredibly valued privilege to serve the International Confederation of Midwives as its Inaugural Goodwill Ambassador since the first of June 2014.

On that day in Prague, as I addressed world midwives on the theme, ‘Education: the bridge to midwifery and women’s autonomy’, I looked at the faces of the midwives, and I pledged to walk focused, fearlessly and fervently with you all. My commitment was to actualise a rightful yearning for recognition, remuneration and much-deserved respect in a line of duty that so palpably personified care, continuity and courage. I was all too aware that it would be a daunting task, but I knew also, that it would be a fulfilling one.

The journey had actually begun in May 2011 when I attended the launch of Monique and the Mango Rains – a multi-layered tale of midwives’ realities which amplified the heroic voices of a Malian midwife and a Peace Corps volunteer. This midwife had so tenaciously mobilised resources while vividly demonstrating the numerous responsibilities that are so often synonymous with midwives and echoing their primary charge too; standing with women right up until the point of their life’s most anticipated introduction. That particular story immediately caused me to recall the names of the midwives who had laboured with me as I welcomed my own children into the world. As a result, I instantly became a convert-interlocutor, on a mission determined to amplify the ethos of recognition, rights and a much-needed redemption of respect for the ancient and modern profession that was, and still is Midwifery.

I embraced the global call to action in 2014, to increase respect for midwifery education, in order to join the ICM as it stands with hundreds of millions of women who had and would labour and deliver new life – and as I walked with the world midwives of the ICM, so did my Wellbeing Foundation Africa, by intentionally and immediately placing midwives at the heart of our unique institutional actions.

It is of utmost importance to me that all healthcare professionals are given opportunities to upskill, progress and demonstrate the highest level of competency, repeatedly.

Midwifery in particular, is a daily-charge, an exercise of accountability and a lifelong commitment directed towards holistically practicing what I as an advocate, and midwives as front-line professionals, work so intentionally hard to preach. So together with the ICM Midwives, and armed with the goals of the Midwifery Services Framework, I have travelled far and wide proudly bearing the responsibility of being the first Global Goodwill Ambassador.

2014 saw us address American Midwives in Washington DC, and the following year included my humble donation to midwives in Lesotho and the launch of EmONc in my native Nigeria. During this time, WBFA Mamacare classes were birthed, and brought forth the ability to teach advanced clinical and maternal skills using Laerdal anatomical models. The UNFPA are also a great partner in co-signing our SRH efforts. Through it all, the desire to position midwives at the heart of global health policy actions began to grow. In 2016, we worked together to host Nigeria’s First Global Midwifery Conference  – an incredibly proud and full-circle moment for me.

As we marched for more midwives in Toronto in 2017, the Canadian Government announced plans for the reparations of indigenous midwives – a conversation and a figure which sees a deserved increase, right up until today. This served as encouragement that both change, and recognition were on the horizon. Windhoek, Abuja and Suriname were also among the communities we frequented, and every step of the way, we engaged with midwives, policy makers and parliaments reiterating the commission to this great call.

In 2017, we advocated the importance of midwives being qualified to administer safe single-use injectable contraceptives at the FP2020 Family Planning Summit. Within this very same year, the WBFA Alive and Thrive Initiative was in full effect, and midwives were proudly educating women and their families about the importance of MNIYF Care and Nutrition. Through your eyes, I have witnessed the extension of midwifery practices and capacities in Brazil, Mexico, South Africa, India, Japan, and the United Kingdom – all while encapsulating the heart, passion and desires of the ICM Midwives. In doing so, we have successfully and strategically urged governments to invest in midwifery education and mandatory training in a bid to encourage the promotion and facilitation of safer approaches to practice worldwide.

No journey is without regret, and my inability to attend our ICM Congress in Jamaica still weighs heavily on my heart, as I looked forward to frontline observation of midwifery-led birthing centres as a goal to be realised globally.

However, in these inaugural six years together, we’ve beckoned the world to take another long and intentional look, which has in turn, caused me to hone in on the core causes and constructs I so passionately started with – mobilising resources to empower independent midwives, and harnessing the competencies of midwives as the backbone, and heart, of primary and community health.

We have signposted and amplified promising examples of research and policies which will shape the future of midwifery and have proudly recognised and championed some of the most hardworking hands in the realms of global health diplomacy. We have addressed and welcomed alliances with global organisations, the United Nations, African Union, ECOWAS and the WHO World Health Assembly, as well as celebrating remote village-level ward development committees as they continue to challenge stigma, and harmful cultural practices on behalf of the women and families in their care.

Many of us are aware by way of research that women from the black and minority ethnic classification are five times more likely to die from pregnancy and childbirth related complications. Indeed, in a world where racism has become a crisis, I appreciate, respect and applaud the courage of the ICM in choosing me, in 2014, a black African woman, as your first ever Global Ambassador – an organic action that speaks to the egalitarian inclusiveness of the International Confederation of Midwives, and the values of the midwifery profession, globally.

The introduction of the WBFA- JNJ- Liverpool School of Tropical Medicine and Hygiene’s highly specialised BEmONC and EmONC training gaining acceptance across Africa was an incredibly pertinent and refreshing moment for me, as a welcomed and proactive contribution directed at helping mothers to survive, babies to breathe and families around the world to continue celebrating a million more birthdays. WBFA’s new partnership with the Chelsea and Westminster Trust will cascade this innovative learning.

Excitingly, the London School of Hygiene and Tropical Medicine’s WOMAN Trial of tranexamic acid as an early intervention for post-partum haemorrhage was recorded in 2017, and the game changing Ferrings’ heat-stable Carbetocin arrived in this year – both reassuring signs of progress and impact that our ambassadorial advocacy for research-based support and intentional curriculae reaps and delivers results.

Each construct pertaining to health and wellbeing from birth to age and beyond – be it pregnancy and delivery, neonatal and infant feeding or boldly reinforcing the need for adolescents to understand sexual and gender-based violence – all contribute to building a more positive socio-economic road to maintaining our wellbeing. That being said, the entire spectrum of reproductive health has been and must continually remain a primary consideration.

By representing the significant and globally resounding voice of the ICM Midwives, we have recalibrated previously held misconceptions and re-assigned unattributed affiliations. The profession must continue to move forward in order to maintain the recognition it deserves for its contributions in improving sexual and reproductive health beyond just the physiological joining of mother and child. At different points along this momentous journey, midwifery has taken pride of place in reigniting and exemplifying a plethora of best practices for essential frontline Health workers, and has likewise birthed a series of incredibly poignant and monumental experiences within a space I am so truly proud to be advocating for.

Every victory counts, and I have rejoiced as nation-states begin appointing Chief Midwifery Officers. This call to action further reiterates the level of excellence and accountability implored by so many within this incredible profession. Regarding our original goal of Midwifery Education, I was particularly pleased to see the WHO AFRO launch a comprehensive curriculum setting a new standard for the training of midwives back in 2018.

To be crowning six years of ambassadorial achievements with the ICM in this 2020 Year of the Midwife and Nurse, is truly an unprecedented achievement. I remain hopeful that these years have been a catalytic culmination of intentional, educational and strategic efforts that offer a glimpse at centuries of quality advocacy, advancements and assistance. The call to midwifery is patience and perseverance personified. To safely nurture, be the first set of clean hands to touch and guide new life and initiate the first nourishing embrace between a celebratory woman and child is priceless. To do this on rotation, routinely, day in day out is heroic.

We have walked together and achieved the amplification of a vibrant and much-needed platform to celebrate, demonstrate and mobilise the heroic and admirable profession worldwide. The ICM’s leadership in representing, reconfiguring and increasing awareness of Midwifery globally is remarkable and unmatched.

This new decade started with the unique challenge of the Sars-Cov2 virus pandemic that has affected us all, yet pregnancy and childbirth wait for no-one, and front-liners continue to remain ever-ready for battle. The days ahead will require the intensification of resources, courage and commitment. Midwives have proven their mettle in the most daunting of circumstances, and it is time for the world, and the global health community to redeem the centuries of contributions that midwives have made to all our lives, and to community health.

In the vein of supporting the ICM as its midwives continue to stand with women, on the International Day of the Midwife, I joined the WHO, the Global Handwashing Partnership and Hygiene In Health Care Facilities Stakeholders in a resounding new commitment to “Applaud With WASH”.

We will, over this decade, mobilise and reinforce the key resources of water, sanitation and hygiene in health care facilities, to ensure that midwives and nurses clean hands can save more lives. We are confident that an internal approach to education will influence a more widely societal one.

As I bid farewell to the honorary role of Inaugural Global Goodwill Ambassador, I recall that we started our journey to claim the respect, recognition and resources for midwives with an African proverb, of ‘walking together, far and fast’ – in a succession of constant elevations; working authentically to strategize, take action and liberate women and girls from the constraints of family planning, child birth, and the other gender specific limitations they very often face. Our concepts of preparation and delivery have been very much centred around understanding, championing and reiterating the indelible bravery, resilience and selflessness of the millions of midwives who answer the ‘great call’ around the world each day. These particular efforts have been all the more powerful and pertinent because they have been achieved, with honourable dedication, repeatedly, and together.

Together, we have made great strides in authentically hailing a profession which charges each of us to wholeheartedly and strategically contribute to ensuring many more meaningful tomorrows. Our monumental six-year term of collaborative efforts and support for midwives alongside the ICM team has been invaluable. To work in close proximity with likeminded and driven people with an assurance of ‘togetherness’ in this profession as the word is defined, leaves me parting on an empowered, encouraged and excited note.

To all the incredible ICM Leaders, Council, Board and Teams; thank you for facilitating so many memories, key breakthroughs and positive affirmations along the way. Advocacy in itself is an unending journey. I am incredibly proud to be able to say that being the Inaugural Global Goodwill Ambassador for the ICM, will remain an unforgettable part of mine, and I am excited by the thought of new plans, possibilities and partnerships for healthy futures for women, girls and families – all with the midwives’ hands at my heart.

In this most wonderful Year of the Midwife and Nurse, as I appreciate the singular honour of serving the ICM for the last six years as its Inaugural Global Goodwill Ambassador, may I crown our collaborative advocacy efforts with one final African proverb, ‘a friend today is a friend for life.’

I assure the ICM, and every world midwife, that throughout this decade of action and delivery, I have pledged to mobilise resources in parallel to all your goals. At the ICM, you will always have a friend, supporter and partner in me, and in the Wellbeing Foundation Africa. Thank you ICM, and thank you world midwives, again and again, and again.

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

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

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

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

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

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

As Founder-President of the Wellbeing Foundation Africa and Special Adviser to the Independent Advisory Group to the World Health Organization Regional Office for Africa, I commend today our partners,  philanthropies, NGOs, faith-based organizations, financial institutions, corporations, and universities as we join together at this historic convening to announce new and wide-ranging commitments to improve water, sanitation and hygiene (WASH) conditions in healthcare facilities. 

Amongst the many commitments made today, the Wellbeing Foundation has outlined its programmatic and advocacy promises to the world:

To disseminate information and advocacy regarding WASH standards through its influential MamaCare midwives and our partnership with Unilever Lifebuoy

To teach about WASH in healthcare facilities and schools

To continue its #WASHWednesday advocacy campaign

To develop our WASH for Healthcare Facilities Proper Cleaning programme.

Having successfully introduced and intensified our WASH for Wellbeing hygiene in health care facilities techniques to health workers and patients in over 570 medical facilities in 5 states of Nigeria, our challenge remains taking those standards to a national scale in Nigeria’s 36 states of the federation – to that end I was encouraged by the speech in November last year given by His Excellency President Muhammadu Buhari declaring a state of emergency in water, sanitation and hygiene in Nigeria and launching the National Plan of Action.

We know that this is a global challenge. 45% of healthcare facilities in ‘Least Developed Countries’ lack basic water services, and 1.5 billion people around the world have to use healthcare facilities without basic sanitation. The impact on infant and maternal mortality, pandemic and infection prevention and control, and antibiotic resistance, is devastating and well-documented.

The commitments made today, however, are truly unprecedented and reflect the impact of advocacy at local, regional and global levels.

In response to the UN Secretary General António Guterres’ Call to Action on World Water Day in March 2018, I retraced the steps of each of the programmes undertaken by the Wellbeing Foundation Africa and launched a new WASH campaign with the World Health Organization in Nigeria.

I committed to work with my partners in the global health and development communities to stop mothers and newborns from dying from preventable and unnecessary complications, simply because the most basic of WASH services are not available, and to ensure that all countries implement the 2017 World Health Assembly Sepsis Resolution. Hand hygiene must be a quality indicator in every facility and a national marker of health care quality, with access to soap and water monitored and assessed.

To that end I conducted high-level meetings at the US State Department, with the World Bank, and with Congress to accelerate progress on WASH – and in many cases reverse worsening trends and indicators.

 At the World Health Assembly last month in Geneva, I spoke in favour of the historic WASH resolution, and was delighted when, for the first time, the 194 WHO Member States joined together to acknowledge this global health crisis and move toward concrete action.

That resolution, combined with the unprecedented commitments made today, represent a leap forward in improving WASH conditions in Nigeria and around the world and have the potential to save millions of lives. Thank you to the frontline healthcare workers who will make that possible, and all of those here today for your vision and endeavour. 

Thank you to the Independent Midwives Association of Namibia and the ICM Board Members for the Africa region, who as our hosts have accorded us the warmest welcome here in Namibia.

I am delighted to offer my own welcome to you all, as ICM’s inaugural Global Goodwill Ambassador, to the Africa Regional Conference of the International Confederation of Midwives (ICM).

I would like to pay tribute to the work done by my dear friends Sally and Franka, at the leadership of level of ICM, who along with their team, work tirelessly with and for midwives all around the world.

In fact, the numbers increase every time I give a speech for ICM. I believe that ICM now supports and represents an incredible 140 Members Associations, representing 121 countries. Thank you for all that you do, and for bringing us here together, with the support of generous partners and sponsors.

Most of all, of course, welcome and thank you to our midwives. It is a real pleasure to see many familiar faces here today, and I look forward to meeting more of you over the duration of this conference.

The theme here today, ‘midwives leading the way for quality and equity in Africa,’ is striking in its simplicity and accuracy. As we share our experiences and knowledge here in Namibia,
I know that we will focus on how midwives already lead the way across Africa in so many different respects. I look forward to strategizing how we overcome barriers that prevent midwives from providing the very best of care to women, newborns, families and communities wherever they may be – from a small village in Namibia to the bustling streets of Lagos.

I have always operated according to the central belief that a women-centred, midwife-led model of care – one that follows normal physiologic labour and childbirth with no unnecessary or excessive interventions – saves lives and allows women and their infants to stay alive and thrive. That is, of course, essential. But midwife-led care is also transformative beyond the labour room.

At the World Health Assembly in Geneva earlier this year, I welcomed the launch 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.

Wherever they work, midwives are the community leaders and interlocutors who are best placed to advocate for and ensure safe environments including, but also beyond, pregnancy, birth and breastfeeding. In many instances rural midwives represent the sole point of access to health care in remote and under-served areas. When midwives are safe and able to carry out their full range of services, we will have a real opportunity to drive forward Universal Health Coverage.

That means providing whole-system support for midwives, including 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. By that I mean we must overcome challenges related to drug selection, registration, quantification, procurement, storage and distribution, quality assurance, and information systems.

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; to professional associations on licensure, registration, and continuing professional development. We need routine, robust, and up-to-date human resource information systems.

Midwife-generated data streams can provide valuable feedback on how services are delivered. With accurate information we can advocate for service improvements. A comprehensive civil registration and vital statistics system must form the foundation of health services and personnel decision making. Metrics provide the evidence needed to understand and advocate for how midwives’ enhanced leadership roles can optimize health systems.

We also know, and demand that a midwife’s workplace must be free from sexual harassment and gender discrimination. This as an absolute essential element of a functioning, decent and dignified health system. According to a global survey conducted by the ICM and the WHO, 37% of midwives reported that they have experienced harassment at work, whether from colleagues or patients. Effective interprofessional collaboration is important to keeping midwives’ workplaces safe. Midwifery must have its own ‘MeToo’ moment – and the harassment must end. Respect for both Midwives and their work in maternity care is a non-negotiable necessity.

At the Wellbeing Foundation Africa, of which I am the Founder-President, I have seen the remarkable effect that midwifery-led care has on equity in relationships and communities. Our ‘MamaCare’ midwives deliver their antenatal classes to women, but are also counsellors on issues as diverse as domestic violence and financial access. Men may attend some classes, and I have seen them sit quietly at the back of the room taking notes. Quite right too. I know that this is an experience mirrored by midwives across Africa, who act as strong role models and champions for women.

I am delighted to be here with you all in Namibia and I look forward to our shared learning and growth. Next year the Year of the Nurse and Midwife will be upon us. The Africa Regional Conference is going to be an important event for midwifery, it is an opportunity for us to lay the groundwork to drive progress forward. It is a space that allows us not only to share the latest developments in midwifery knowledge but also to build new partnerships that strengthen our networks within the region. A space we can exchange learning experiences and professional realities, and work together on solutions to the challenges we must overcome.
Thank you.

The Honourable Minister of Health, Prof. Isaac Adewole;

The Executive Director of the UNFPA, Dr Natalia Kanem;

The Executive Director, FP2020, Beth Schlachter;

President of Global Development at The Bill & Melinda Gates Foundation, Dr Chris Elias;

Distinguished Colleagues and Partners;

Ladies and Gentlemen.

It is an honour and a privilege to welcome you all, especially our visitors, to Nigeria, on this occasion of the Family Planning 2020 Reference Group (FP2020 RG) meeting sessions in Nigeria. The FP2020 is a global movement that we all are very proud of – a catalyst of contributions, innovations, advocacy, policy action, equity, and wellbeing. We salute your individual and collective participation, for the ideals of improved human welfare and economic empowerment, through greater access to the high-quality contraceptive choices for the women and families who desire such, and in line with the Sustainable Development Goals (SDGs).

This year, the global health community lost my dear brother, Babatunde Osotimehin. Professor Osotimehin was an indefatigable ally in his role as Executive Director of UNFPA, especially in our shared goal of improving the conditions and outcomes of pregnant mothers, newborns, children, adolescents, and their communities. He also served tirelessly, of course, as a co-chair of the FP2020 Reference Group. Our thoughts and prayers have been with his family, friends and colleagues since we heard the terrible news in June. The new Executive Director of UNFPA and FP2020 Reference Group Co-Chair Dr. Natalia Kanem, is the right person to carry on the legacy of Professor Osotimehin and, alongside Dr. Chris Elias of The Bill & Melinda Gates Foundation, she is superbly placed to help realise our vision for a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.

We are all united by the principle on which FP2020 was created in London, back in 2012 – that all women, no matter where they live, should have access to life-saving contraceptives. I founded the Wellbeing Foundation Africa (WBFA) in 2004 to improve the reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) indices of Nigeria, as well as much of sub-Saharan Africa; and to eliminate all forms of gender-based discrimination, neglect, abuse and violence. Despite being rich in human and natural resources, estimates from 2013 stated that Nigeria accounted for almost 13% of global maternal deaths, with close to 40,000 women dying due to pregnancy- and birth-related complications, every year. The evidence of the life-saving effects of family planning for mothers and children is irrefutable, including potentially averting 32% of all maternal deaths and nearly 10% of childhood deaths, if it were available to all those who wanted it.

If we are to achieve the FP2020 goal, and ensure universal access to sexual and reproductive health services and rights by 2030, as laid out in Sustainable Development Goals 3 and 5, the work of the Performance Monitoring & Evidence Working Group will be absolutely crucial. I am a strong believer in promoting the use of data and investments in proven tools such as the WBFA client-held Personal Health Records (PHRs), a family planning health information delivery platform for women, as well as an accountability tool that can identify gaps in their reproductive care. The move towards the Expert Advisory Community expanding its role to become a two-way channel between the Secretariat and the family planning community of experts is welcome for the same reason – not only to better share information but also to hear back from those who have the evidence from the frontline. The emphasis on supporting and reinforcing country-level activities is one that the WBFA is fully in support of, so that we can play our part in increasing access to information, services and family planning supplies. 

At the Family Planning Summit in London this July, the WBFA team and I were encouraged to learn the results of the scaled deployment and accessibility of the innovative Sayana Press Uniject injectable contraceptive device, for which I led the advocacy for, from its acceptance into Nigeria’s National Council on Health’s approval for the Task-Shifting and Task-Sharing Policy in 2012, to its scaled implementation as an affordable solution in diverse humanitarian settings from crisis, to development in the Ouagadogou Partnership, the Sahel Women’s Empowerment and Demographic Dividend Project, and within the developing strategy for Nigeria’s Lake Chad Basin.  

I call on all global and national leaders to honor their FP2020 commitments to improve family planning funding and services; partner with donors and other NGOs to increase financial backing for family planning at all levels; and join with the relevant agencies to build the capacities of healthcare providers. Such leaders and other stakeholders (as in the private sector) must also strengthen primary health care facilities to provide family planning counselling and services for increased access and better coverage, while improving their forecasting capacities.

Good morning. It is a pleasure to join you to present the Goodwill Message of Mrs Toyin Ojora Saraki, Founder-President of the Wellbeing Foundation Africa (WBFA), Global Goodwill Ambassador for the International Confederation of Midwives (ICM) and Special Adviser to the Independent Advisory Group to the World Health Organization Regional Office for Africa.

Thank you to Dr Tunde Segun, Country Director for MamaYe! Evidence for Action, for the kind invitation to join you today on this 7th MamaYe Day, to discuss such an elemental and yet crucial aspect of health care service deliver: accountability. 

According to the Global Strategy For Women and Children’s Health, the tracked indicators in Nigeria are some of the worst in Africa, with one of the fastest growing populations globally: our population is likely to reach 440 million people by 2050. We know the key issues Nigeria faces: from having the second largest number of people living with HIV, the highest burden of malaria globally – which remains the top cause of child illness and death – to having the second highest burden of stunted and malnourished children in the world. 

To achieve accountability in health service delivery, we must be able to accurately assess the demographic need for health: which necessitates a well-designed civil registration and vital statistics (CRVS) system. 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. 

In the late 1950s, Professor David Morley developed the ‘Road to Health’ chart 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 Wellbeing Foundation Africa, 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. 

This forms part of what I call 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. Home-based records have since been successfully deployed in countries like the UK and Japan.

Registering births and linking birth registration to vaccinations is an important part of CRVS and social accountability. Nigeria is currently battling with a situation where only 1 in 4 children, of our population of 198 million citizens, is immunised against preventable diseases. The Global Alliance for Vaccine and Immunisation 
(GAVI) has revealed that despite considerable investment – of about $700 million – we only have total immunization coverage of around 30%. CRVS would allow us to hold Governments accountable for their policy, spending and distribution decisions – including in cases such as this. 

At the United Nations General Assembly in New York last September I attended the launch of the IAP report ‘Private Sector: Who is Accountable.’ That report rightly called on governments, parliaments, private sector partners and multilateral agencies to establish effective accountability systems. As I noted at the time, only two countries in Africa have met the Abuja declaration to pledge 15% of their government budgets to health. Meanwhile, tuberculosis kills more than 4,000 people every single day. This can be avoided – and there are five key interventions which would take us far closer to delivering the 2030 Agenda and achieving universal health coverage:

1. Civil registration and vital statistics systems must be implemented and strengthened to allow Governments to prepare for epidemics and allocate investment where it is needed the most. CRVS is the only way to ensure that we leave no-one behind. 

1. Investment in family, community and primary healthcare – along with hospitals where needed – to bolster healthcare wherever people need it; in rural areas and urban, cities and villages.
2. Government investment in strengthening health insurance systems is also paramount to achieving Universal Health Coverage – in Nigeria and around the world, too many people are plunged into poverty by health emergencies that they or their families experience.

1. Non-communicable diseases kill over 41 million people every year. The Director-General of the WHO, Dr. Tedros, has rightly highlighted the NCD crisis and it must be a core focus of all Government programmes. Strengthening the primary health tier is key to prevention, detection and treatment of NCDs.

1. Finally, and most importantly, the murder of young midwife and mother Saifura Hussaini Ahmed Khorsa in Nigeria last year must spur Governments and global institutions on to strengthen security provisions for frontline health workers, in particular those who work in fragile humanitarian settings. 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. 

We know that the road to universal health coverage does not rest upon singular interventions, but rather on a plethora of interconnected  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. 

Thank you once again for the kind invitation to join you today, and I look forward to working with all of you for stronger, more accountable, and safer health systems.