Thank you to all of you for being here. Thank you to the Bill and Melinda Gates Foundation for the tremendous support that has made this possible. Thank you to the South African government for co-hosting us. Thank you to everybody at Align MNH Secretariat, the committee that made it all possible.
But thank you also to Treasure. Because we need to understand the experience one by one. And she brings home a key lesson about the challenges we’re up against.
When the last meeting happened, the wind was at our backs. The Millennium Development Goals were coming to their targets. And we had remarkable progress: Three percent annual reductions in maternal mortality rates, steady improvements in newborn survival.
Treasure’s story tells us about the places where we’ve plateaued. The places where we’ve even fallen back.
Even before the pandemic, progress was slowing. But the pandemic has had a devastating impact. It disrupted and diverted resources from essential services. Those same services that Treasure was relying on when she came to that emergency room and it wasn’t there for her. When her own room where she could be cared for was taken away. When the people who can be there and attentive had to be pulled to the lives of so many others who were being lost.
Last week, the World Health Organization’s Pulse Survey came out. It has happened four times during the pandemic—looking at what happened to our health services—and it described some signs of improvement. But ongoing disruption of essential services, including critical services, for maternal care and for newborns.
Eighty-four percent of countries reported continued service disruptions in key child and maternal services. We’ve come through the pandemic with 67 million children who have not been vaccinated completely. We’ve lost years—years of progress. And the ongoing economic damage has been slashing our health care budgets, especially for health workers.
What Treasure experienced was a gap of support. [According to a recent report by Care, it is estimated that] what we see globally is a gap that was 18 million health workers before the pandemic, and now, it’s a shortage of 26 million health workers. Because health workers salaries have been cut, physicians have disappeared, or they’ve been pushed out by the pandemic itself.
We’ve experienced the first global reduction in life expectancy since World War II. A story of decades of progress has been put into reverse.
Last week, after three years, the WHO—Dr. Tedros—called an end to the emergency. Can we have a round of applause and celebration for that? We have the end of the emergency, but it is only the start of recovery. It is only the start.
At USAID, we have recognized that our strategy for preventing child and maternal deaths has to change because of what we’ve experienced in the pandemic. We’ve had a primary focus on access to goods and services across our global strategy to keep driving towards the SDGs.
But now we understand that this has to include a focus on quality of services in the face of disruptions and devastating setbacks—and on recovering equity. Because the places that have sacrificed first are the ones that needed help most, and that is not the way it should be.
Treasure’s case brings home—her story brings home—the challenge.
In our global work that we’ve been doing at USAID, we have helped more than 44 million women give birth at health facilities, almost a 60 percent increase. We expanded access to skilled care for 33 million newborn babies, trained 14 million health workers in skills for pregnant women and young children.
But if the team can’t come together to be there for people—if those workers are so overwhelmed that they can’t provide the simple information that would have helped Treasure understand what the danger signs are, that she needs to come in for—who is supposed to be there for the help?
She has to be able to be known in the system, by somebody who understands this woman does not complain easily. She is not someone who is likely coming into that emergency facility. She is someone who needs to be taken very seriously. Without that focus on quality, we are lost.
To save lives, we must strengthen the quality of care—not just by investing in individuals and their skills and in commodities. But by also investing in the teams who deliver care and the systems in which they deliver it.
We’ve come out of the pandemic taking very seriously—as we should—the need for pandemic preparedness.
But we have not reignited that demand that it is time we recover. We just talked about the SDG 2030 goals. We continue to talk about the SDG 2030 goals. And yet, we’ve gone backwards. It is time to recover our pre-pandemic levels of survival—and better—by 2025.
We have not even begun to get immunization rates back to where they were. We have the entire spectrum to work on.
A critical element of this strategy for us is a focus on an initiative we’ve called Primary Impact, in which we are joining with WHO and the World Bank’s Global Finance Facility for Women, Children, and Adolescents and others in driving a radical reorientation of health systems toward primary health care.
And we’re starting with seven primary impact focus countries that have chosen to join in this prioritization of primary health workers and their needs for successful delivery care. Those countries are Côte d'Ivoire, Ghana, Indonesia, Kenya, Malawi, Nigeria and the Philippines.
What they all recognize is that the evidence is overwhelming that equity in reducing preventable deaths requires the scaffolding of strong community-based primary health care teams. When communities have paid and well-trained health care workers providing outreach and health services to every household, and when those workers are integrated into primary health clinics equipped to address the majority of people’s health needs—survival rates rise dramatically.
But too often, those primary health workers are the last to receive investments and the first to get cut when budgets are tight.
Earlier this year, I was in Indonesia on a visit to the Kupang district on the island of Timor, and I met Adriana Bety, a midwife who is the head of the puskesmas, the primary health center for nine villages with a population of 20,000.
Indonesia has had a far higher maternal mortality rate than countries of its income should have. And the island of Timor has a far higher maternal mortality rate than within Indonesia. Indonesia—despite having resources—has focused its health investments on hospitals and secondary care. The Minister of Health said that just ten percent of the health budget was going to primary care when he took office.
But under his leadership, they increased the percentage point of primary health care to 25 percent. And he had committed to raising that level to 50 percent by 2025 with the support of domestic investments, the World Bank and the Global Finance Facility. And our USAID team could therefore work to ensure that those investments could produce quality. And at Adriana Bety’s primary health center, I could see the difference.
She’d been able to ensure that critical supplies were in stock, that faulty equipment had been upgraded, and make sure their staff were enough that they can ensure an extra set of hands were always available to support deliveries, and make sure no one fell through the cracks for their prenatal care and postnatal care.
And then our USAID team worked to help her harness those investments, and previous ones that have been made, to steadily improve their quality of care. The leadership and staff, for instance, adopted the WHO Safe Childbirth Checklist and used it to strengthen and practice their work as a team. They were able to even reach the point that they were offering family planning advice immediately after birth, so that family planning and contraception offers could be made. They were giving instructions for the life-saving signs of danger both before birth and after birth.
And the result is in their community—for the last nine years—they have not had a single maternal death. Not a single one. (I’m going to do that American thing and knock on wood because I don’t want to jinx them.)
You heard what we said earlier, this is not just a moment. This is a movement. And it is vital that we reinvigorate this movement. This conference is an opportunity to do just that, to identify our successes and what the evidence is showing us; to facilitate collaboration and learning; to address where we are not succeeding; and to prioritize the actions that support and enable these frontline workers to recover our loss ground and reclaim progress toward our SDG goals. Thank you all for joining in this vital work. Thank you for supporting the message that Treasure is bringing here today.