Conference on Maternal, Newborn and Child Survival

Plenary 1730-1830

Co-speaker with Thomas Hurley, Director, Human Development Department, African Development Bank

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Roger (Williamson – Wilton Park), David (Mepham – Save the Children), ladies and gentlemen, my thanks for this invitation to join you today.

I am joined by my colleague Ernest Massiah, Head of the Health Division within the Commonwealth Secretariat, and I see that in turn we are joined – both as official supporters of the conference and as conference attendees – by representatives of Government, business and civil society from both the developed and the developing world.

Reducing maternal, child and infant mortality is a moral imperative.

It is also a litmus test of development.

For too long, too many women have died as a result of complications of pregnancy and childbirth, dying painful deaths that could have been averted with access to health services.

For too long, too many children in developing countries have died before their fifth birthday, many of these within the first month of life.

This is unacceptable in the 21^st Century.

Medical science has developed the procedures to reduce the risk of maternal and child death.

So why do we still see so much of it?

These deaths are preventable, unacceptable, and they may be more accurate indicators of the true state of our ‘development’ than the economic ones that we so often use.

The collective efforts of our shared humanity and responsibility – what I call our mindset of ‘globalism’, as opposed to our role as an inevitable part of ‘globalisation’ – are required to address this problem.

That is why you will hear the word ‘partnership’ many times over the next few days.

I warmly commend you for convening this event, and it is for people like me to be unequivocal as to why it is being held.

What we are really talking about here at Wilton Park are deaths by ignorance, discrimination, omission, negligence, and more.

We are talking about eminently preventable deaths.

It has helped me, in thinking about this event, to reflect further on what our theme means.

Before the onslaught of technical terms and statistics, priorities and policies which are inevitably - and rightly - the stuff of events such as these, it pays to transport ourselves to other worlds to experience the reality of what we are talking about.

That is why I refer first to two Commonwealth Secretariat resources on maternal mortality: a short film ‘My Sister, Myself: Women of the Commonwealth speak to Women of the World’ from 2004; and then a series of documentary films from 2005, which we made alongside the WHO and the UNFPA.

Two African stories stick out.

First, there was the 15 year-old girl who was in labour for five days, before spending three days travelling by camel to a health centre, where both she and her baby died.

Second, the young woman who lost her baby because her village chief wouldn’t risk his bullock cart to take her across the bush in the dark.

I also recall a discussion with a colleague who had been in an Asian hospital, where she heard the medical staff constantly talking about the ‘DoA’.

She asked what this meant, and was horrified to find that the staff were discussing the sheer number of women reaching the hospital ‘dead on arrival’.

Indeed, in many countries, because people delay seeking medical help, women with complications in labour or pregnancy, and their babies, die unnecessarily.

Their lives would have been saved if the decision to take them to hospital had been made earlier.

But in this social context, it’s often only a male relative who can decide that a mother in childbirth should be taken to hospital, and a male relative may also be needed to act as escort.

Women alone often don’t have the power to make those decisions.

These examples remind us again of the root of some of our problems: the inaccessibility of quality health services including skilled birth attendants; the unavailability of reproductive and sexual health services; women’s lack of decision-making power; and the lack of good transport and referral systems.

And they take us back to the year 2000, when the global community pledged itself to achieving the Millennium Development Goals.

Eight years later, we should and we do debate these Goals.

I did so myself in a powerful Ditchley Park debate earlier this year about the growth in population rates, which is making the Goals even less likely to be achieved.

But we do not argue over the fact that the Goals were the first truly global acknowledgement of governments’ responsibilities to their citizens and to each other: a policy and programming framework for developed and developing countries alike.

They gave us shared goals towards which national policies, civil society, bilateral assistance, regional and global institutions could all strive.

But, let us be ruthlessly honest also: MDGs 4 and 5 are floundering.

We will scrutinise them here at Wilton Park; but this afternoon I will just use the headline figures.

And they are these: that one woman dies every minute from complications related to pregnancy, while 20 children under 5 years old die every minute.

Take a deep breath and reflect on that for a minute.

And this is a Commonwealth concern because no less than two-thirds of these deaths are in our countries.

Further, there is still a huge disparity in maternal, newborn and child mortality between the rich and the poor, with just 1% of these deaths happening in developed countries.

So in addressing this conference today, it seems clear that we are asking ourselves why – if the technical solutions to maternal and child mortality are perfectly well known – they haven’t been applied.

As I look across the Commonwealth, I see four issues that I would like to bring to our discussion here today.

First, it is the Commonwealth belief that there are two inherently inter-twined and mutually enforcing pillars to successful societies: Democracy and Development, two sides of the same coin.

It must be patently obvious that this debate is about far more than the availability of sufficient and trained doctors and nurses, and sufficient, effective and affordable medicines and medical equipment.

It is about political culture and the values of governance.

Good governance helps health.

Strong and enlightened leadership is vital to provide a vision for developing health systems, for management of support systems, for facilitating partnership and developing the collective responsibility for health.

Good governance can reduce inequality and inefficiency and help save lives.

Good governance sees human development as freedom.

On this latter point I am indebted to my respected friend and fellow countryman, Amartya Sen.

In his pre-conference notes, David Mepham asked us to look at the political blockages to the delivery of healthcare: those problems which lie outside the health sector itself.

War and conflict are the most obvious of these; but the democratic culture is at the heart of it.

This came home to me just two nights ago, when – hours after issuing a statement on Zimbabwe which at heart was about human rights and democratic culture – I was watching the news and seeing young children miraculously rescued from cholera, just in time.

The Commonwealth’s ‘brand’ is democratic governance: our greatest efforts are spent working with the engines of public administration, advancing efficiency, transparency, accountability, fairness.

And it is equity issues that can best be addressed within a functioning democracy.

As we look at the MDGs, the disturbing picture that emerges is the lack of progress and achievement by the poor.

This reflects badly not on the poor themselves, but on the systems that do not focus resources and services on those who need them most.

Second, as we look at maternal mortality, we cannot avoid a discussion on the status of women, surely the single strongest indicator of the health, literal and figurative, of any society.

There have been many advances over the last 100 years – and, especially within the last 20, we have seen changes in the economic and political status of women.

But we must ask ourselves why, in 2008, do we allow so many women to die in childbirth?

Why have these statistics not spurred social and political disquiet, and more immediate and drastic action?

Are women’s lives being valued?

Why is access to family planning not more widely available, when it is known that the more children she has, the greater the risks to a mother’s life?

Contraceptive prevalence is still low in many of the countries with the highest levels of maternal mortality.

And can we achieve widespread and rapid reductions in maternal mortality without improvements in girls’ education?

Honouring women and the ‘girl-child’ in our communities, both in spirit and deed, is at the heart of this universal challenge.

Third, we need more health workers.

The global health community is ready with a new phrase: ‘health system strengthening’.

It is often difficult for lay folk to get a clear definition of what this does not constitute.

I am not qualified to enter that debate, other than by referring to some of the ways that we in the Commonwealth contribute – whether by running our midwifery courses in Southern Africa; or, on the bigger stage, by debating the potential of e-health, which was the subject of our Commonwealth Health Ministers Meeting in Geneva this year, on the eve of the WHO meeting.

E-health is partly about efficiency – and it’s partly about access and equity.

But, I am concerned about one element that ‘health system strengthening’ does constitute: that of health workers.

There are insufficient numbers of workers, too few workers where needed, too many workers leaving their countries, too many health professionals working in their countries in other fields, too many health workers preferring to work on the well-funded ‘vertical’ disease programmes, and too many health workers working in under-resourced, under-staffed, under-remunerated jobs.

The solution to the health worker crisis requires widespread changes in the organisation of health services.

We know what needs to be done.

Most of these are within the purview of Ministries of Health and Education.

But, health workers make rational choices given the political and economic contexts within which they live, and they make choices based on their aspirations for their families and their well-being.

Political instability, economic mismanagement, and conflict will continue to reduce the impact of our ‘technical solutions’.

The 2004 Commonwealth Code of Practice for the International Recruitment of Health Workers, was one of the first of its kind, designed to protect migrant health workers’ rights when they go abroad and, more important, to better their lot in their own countries, thereby stemming the flow of migrants, and also plugging the gaps left by migrants.

While our code has informed other such international codes, these codes - all voluntary - face serious threats.

First, the competitiveness of the global market for health workers shows no sign of abatement.

Second, the debate on compensation to countries that are exporters of health workers remains highly contentious.

Third, in most Commonwealth countries the dialogue between the public and private health sectors is fragmented, ad hoc and under-developed.

Fourthly, advocacy.

David challenged us, as to how we can bring maternal, newborn and child health into the very centre of the development debate.

There is perhaps a simple framework: we must, in our advocacy efforts, clearly establish the gravity of the problem.

Clearly our existing efforts have not succeeded as we would like.

For a start, we need more data, since many of our countries do not have the systems to record properly the extent of the problem.

This deficiency must be addressed.

We cannot have data on half of the problem, which is why we in the Secretariat have been working to improve the quality of maternal death reviews in a number of our member countries.

Beyond the raw data, the impact of the problem needs to be clearly established. What does a maternal death imply for the family, the household, and the state?

We need to bring the debate to the non-health sectors.

Here, I know that the Commonwealth Secretariat can help.

We convene, on a regular basis, Ministers of law, women’s affairs, labour, sports, youth, for example, all of whom have very clear sectoral responsibilities.

We also convene Heads of State and Ministers of Finance. They are critical partners in this dialogue.

The changes needed are not sectoral, but all-embracing.

Our advocacy strategies need to become more sophisticated, cleverer, and much more consistent.

Politicians have a short life span in many countries: there is always a new minister, or a new government.

We need to reach them, remind them, and convince them in all environments of governance.

Advocacy has to be built on firm foundations.

If we see good governance as a sine qua non for development, then, our funding must be allied with our principles.

We have lived through an era where increased resources were seen to be the answer: countries needed more money to produce more development.

The fallacy of that approach is becoming more evident. Inefficient administrations, opaque accountability and restricted transparency reduce the effectiveness of resources.

But it cannot be done without resources either.

The partnership has to reflect the spirit of the Monterrey Consensus, in which I myself was very closely associated.

The global partnership and solidarity has to embrace both the value of governance and the flow of resources through all possible means, whether development assistance, debt relief, or trade promotion.

We cannot afford not to acknowledge these connections, and to draw conclusions.

So let me end with a renewed call for partnership – and for what I began by calling the ‘globalist’ view in the globalised world.

I understand that the session before this one looked at the successful ‘child survival revolution’ launched by UNICEF in 1982, which concentrated on just a few primary healthcare solutions, in areas like growth monitoring, oral rehydration, breast-feeding and immunisation.

The good results were not in dispute.

But it was partnership which made it happen, between national, international, bilateral, and non-governmental bodies.

And it is a second, even more powerful revolution in partnership which needs to be launched now if we are to meet the MDGs on women and children.

We need strong international and national partnerships to work towards this change.

I wonder if you have heard this line recently: “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.”

The world has heard the Obama slogan: ‘Yes, we can!’

But here, now, in December – and in the months ahead in the WHO, in our governments, our NGOs, the media, wherever – we will see if we can embody the change in the commitment to improving maternal, newborn and child survival.

Thank you.

ENDS