Improving Healthcare in Africa

Published on 20th March 2018

In October last year, Malumfashi General Hospital in Katsina State, Nigeria, helped Gaje Zubairu bring the blessing of quadruplets into the world. The initial widespread jubilation at such wonderful news soon, however, gave way to sorrow. One of the babies passed away and was tragically followed four days later by Gaje herself. The case attracted such widespread attention not only because of its inherent tragedy but also because of the fundamental issues which led to the loss of the mother and baby. Doctors who attended to Gaje stated that she did not survive because she was malnourished and had not attended antenatal care (ANC).

Gaje's husband reportedly explained that his wives never attended ANC because the classes are given too far away.

This is a story that is all too familiar in Nigeria, where limited access to - and knowledge of - ANC, limited health spending and a widespread failure to deal with postpartum haemorrhage makes pregnancy a fatal journey for so many women and their babies.

I will discuss how we cannot confine our actions to our supposed speciality; as legislative change, gender equality, maternal health, education and health security are so closely interconnected. To make a sustainable impact and truly open up opportunities for women in Africa, we must reach across borders, knowledge-bases and cultures.

As the Founder-President of the Wellbeing Foundation Africa, I set up MamaCare to help women and their infants stay alive, and thrive. Our professional midwives deliver respectful maternity care and counselling throughout the antenatal, intrapartum and postnatal period.

Last month's UNICEF report "Every Child Alive" analysed newborn deaths worldwide. It found that five newborn babies die every minute across the world - 2.6 million tragedies every year. Of the ten highest-risk countries, eight are in sub-Saharan Africa. The key statistic, already widely known, is that 80% of these deaths are easily preventable.

Despite dire mortality rates in my native 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 200,000 MamaCare mothers during childbirth. Our MamaCare midwives have achieved this not only by providing classes to a global standard - and achieving the new 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.

Midwives become instrumental in the empowerment and health of women and their children. I know of circumstances where a husband - like Gaje's in Katsina State - has tried to keep his wife from coming to a class and our MamaCare midwives have politely, but firmly, explained to him that he is putting his wife and his unborn child in danger.

Gaje's story also demonstrates however why our midwives cannot be fully effective in isolation. Whilst they are embedded in their communities - providing antenatal classes in the local language, visiting mothers late at night and answering questions at all hours on WhatsApp threads - infrastructural, educational and cultural challenges limit their impressive ability to empower women. I realised that whilst midwives could lead a healthcare revolution, we need legislative support.

It is that context which led me to become an advocate for Universal Health Coverage, in Nigeria and across Africa. UHC systems not only improve health, but also reduce poverty, create jobs, drive economic growth, promote gender equality and protect populations against epidemics. Africa faces the burden of weak health systems and both communicable and non-communicable diseases in a population estimated to reach 2.5 billion by 2050. If we want to transform opportunities for women, we must treat their health and wellbeing as a security threat.

That must translate into appropriate levels of funding. The WHO estimates that 85% of the costs of meeting the SDG health targets - including UHC - can be met through domestic resources. But resources must be maximised and utilised effectively. In Nigeria, for every 1 Naira spent on health, 2.5 Naira is spent on defence. It is time that Governments across Africa responded to healthcare deficits as swiftly and aggressively as they respond to military threats.

A key step towards UHC is a well-designed civil registration and vital statistics (CRVS) system in order to collect and produce accurate data - and thereby ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies in Nigeria. At the WBFA we 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. Without a centralised health database for many families to rely upon to 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, analyze and follow-up on her own data. The rate of immunization in Nigeria should be treated as a national emergency. The Global Alliance for Vaccine and Immunisation

(GAVI) has revealed that despite considerable investment - of about $700 million - we only have immunization coverage of around 30%. That is absolutely shocking. I cannot overstate the risk of not immunizing our children. A comprehensive CRVS system in a nation enables us to deliver health for all as a measurable demographic dividend - but we must also begin to stand on our own feet to finance immunization.

We must be prepared to make the case that investment in women's health and opportunity will be transformative for communities across Africa. Women are key to achieving the demographic dividend that comes with an interplay of reduced total fertility rate, an expanded base of working-age population, and improved educational, infrastructural and healthcare investments. To take the example of contraception, for every $1 spent on family planning, benefits worth $120 are reaped. That is such an astute investment because it helps to empower women to make their own choices at the right time for them - and women's success, both professionally and personally, is success for the whole of society. The UN estimates that gender inequality costs sub-Saharan Africa on average $US95 billion a year. Our countries have both a moral and economic imperative to transform the equality agenda.

The fight for gender equality must also be reflected in the institutions which seek to work in Africa to expand opportunities for women. The release in London of the Global Health 50/50 report demonstrated that organizations from the United Nations system; bilateral and multilateral development institutions; philanthropic organizations and funders; civil society and nongovernmental organizations; public-private partnerships; and the private sector still have a long way to go to reflect the values they are trying to themselves instil. Of course I salute our male allies - when the new Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, became the first African to succeed to that role, he established a senior leadership team which consists of more than 60% women, declaring that "We need top talent, gender equity and a geographically diverse set of perspectives to fulfil our mission to keep the world safe."

Last month António Guterres, Secretary-General of the United Nations, tweeted that he had kept his personal commitment to women's empowerment and gender parity at the UN by creating a "50-50 Senior Management Group." We must however use our influence to empower African women to take on leadership roles and ensure that global institutions practice what they preach.

I will end by briefly addressing the issue of global funding - President Trump's so-called 'Global Gag Rule' forms only part of the challenge facing organizations working with women in Africa. There are certainly causes for optimism in this regard, despite widespread gloom. The Overseas Private Investment Corporation officially announced 2X, its new women's initiative, which will see OPIC will invest $350 million in projects that support women ranging from increasing financing to women-owned businesses to improving access to water. The goal is for that investment to bring in an additional $1 billion in investment from the private sector. The Secretary of State at DFID here in the UK, Rt Hon Penny Mordaunt MP, has also taken a lead with the department's new Strategic Vision for Gender Equality.

Her stated commitment to "doing more to increase women and girls' political participation so their voices are heard, and they're able to influence decisions that affect their lives, whether that's at home or in government" is particularly welcome.

I would add to those examples our hugely positive experience of public-private partnerships. The WBFA joined forces with the Liverpool School of Tropical Medicine, the oldest and most established school of tropical medicine in the world, and Johnson & Johnson, one of the largest global health companies. Together we implemented the Emergency Obstetrics and Newborn Care (EmONC) training programme in Kwara State.

This is a unique partnership model, bringing together an esteemed higher-education institution, the private sector and a civil society organisation. Our EmONC programme with the Liverpool School of Tropical Medicine and Johnson & Johnson has trained 600 'master trainers' in nine local Government Areas in Kwara State, establishing ten EmONC Skill Laboratories in ten selected Core-Training Medical Facilities. These 600 master trainers have gone on to train a further 62,800 healthworkers. The number of up-skilled frontline healthworkers continues to percolate, as the impact in lives-saved escalates. I use the example of our EmONC programme to demonstrate my opening point here today: that it is only by pooling our resources - finances, knowledge, connections - that we can be truly successful.

By Her Excellency Mrs Toyin Ojora Saraki

Wife of the Senate President of the Federal Republic of Nigeria; Founder-President, Wellbeing Foundation Africa (WBFA); Inaugural Global Goodwill Ambassador, International Confederation of Midwives (ICM).

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