With less than 1000 days remaining until 2015, our continued joint effort is needed more than ever to meet the UN Millennium Development Goals (MDGs). Over the last few years, we have seen promising global and national mobilisation for the MDGs that were lagging furthest behind: reducing child mortality and improving maternal health. Investing in life-saving commodities and family planning is value for money for every nation, and for its women, children and families. The Global Business Coalition Health, the World Health Assembly and the Women Deliver Conference are important arenas for key actors who are putting life-saving medicines and commodities on the agenda.
In recent years we have seen gratifying progress towards MDGs 4 and 5 (reduce child mortality and improve maternal health, respectively). The number of child deaths is down from about 12 million in 1990 to about seven million in 2011, and maternal deaths are down from an estimated 500,000 in 1990 to under 300,000 in 2010.
Nevertheless, we are not accelerating fast enough to reach our goals of reducing child deaths by 67 percent and maternal deaths by 75 percent by 2015. However, recent initiatives promise to further accelerate progress towards these goals. 2010 was a landmark year, with the United Nations Secretary- General launching the Every Woman Every Child initiative and the G8, under Canadian leadership, placing maternal and child health at the top of its agenda. The African Union’s July 2010 Summit on Maternal and Child Health raised the profile of this important issue across Africa.
We are pleased that in 2012 the global community built on this momentum by launching initiatives to ensure further progress towards MDGs 4 and 5. These initiatives included: the Committing to Child Survival — A Promise Renewed in Washington DC in June; the London Summit on Family Planning in July; the Saving Mothers, Giving Life partnership meeting at the Global Health Conference in Oslo in June; the launch of Nigeria's Saving One Million Lives initiative in Abuja in October; and the launch of the Open Health Initiative in December, which called for the mobilisation of further sub-regional action in East Africa for women’s and children’s health.Most importantly, in recent years we have seen strong national leadership in many countries, including Ethiopia, Nepal, and Rwanda. There have been initiatives such as the National Rural Health Mission in India and the President’s Initiative on Maternal Health and Safe Motherhood in Malawi, endorsed at the highest political level. Such leadership has greatly facilitated the integration of international initiatives and partner contributions into national action, based on each partner’s comparative advantage. This gives value for money and makes the return on investments higher.
In 2012, Nigeria and Norway had the honour of co-chairing the UN Commission on Life-Saving Commodities for Women and Children. This Commission contributes to the UN Secretary-General’s Global Strategy and Every Woman, Every Child initiative. It followed on from the Commission on Information and Accountability for Women’s and Children’s Health, which developed and launched a strong accountability framework in 2011.
The Commission estimated that an ambitious scaling up of 13 life-saving and essential commodities, which have until recently been overlooked and underused, would over the next five years save more than six million lives.
This would include averting 230,000 maternal deaths through increased access to family planning. Achieving these goals would further reduce estimated child deaths to 5.3 million and maternal deaths to around 200,000 per year. The estimated costs per life saved are low and represent excellent value for money. For example, more than 1.5 million children could be saved in the next five years with two effective treatments: oral rehydration solution and zinc, costing less than USD 0.50 per treatment.
In September 2012, we delivered the Commission’s report to the Deputy Secretary-General, Jan Eliasson, at the United Nations General Assembly. We recommended ten time-bound actions to dramatically improve access to the commodities. These included ensuring that quality-certified products are available, providing incentives for health-care professionals to follow the latest national guidance for care, and promoting, at regional and national levels, the manufacture and supply of appropriate commodities.
We are pleased to report that these recommendations have been enthusiastically received, and that significant implementation efforts have already begun in the short time since the launch of the report. Specifically, eight countries—the Democratic Republic of the Congo, Ethiopia, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, and Uganda—have made a commitment to implementing the Commission’s recommendations, as adjusted for local needs and priorities through the Abuja Declaration. In addition, global implementation plans have been developed, financed, and launched. The Reproductive, Maternal, Newborn and Child Health Trust Fund (RMNCH Trust Fund) has been established to facilitate implementation of the Commission’s recommendations and country-level implementation of RMNCH-related activities under national leadership.
An excellent example of country-led implementation of the relevant recommendations is Nigeria’s Saving One Million Lives initiative, which aims to save one million lives by 2015 through an ambitious and comprehensive scaling up of access to essential primary health services and commodities for women and children. This initiative is the result of careful analysis of Nigeria’s needs and priorities and a nationally designed plan, supported by international and national partners.
The long-term financing of national health systems is important for ensuring access to health services. The International Development Association (IDA), the World Bank’s soft loans for the poorest countries, leads to a long-term perspective in programs. The development and financing of evidence-based models for health finance adapted to local conditions are crucial for developing more sustainable health services in all countries. Results-based financing is an example of an innovative approach to improving the supply and quality of services, and it has expanded rapidly in Africa. Together with the UK, Norway supports the Health Results Innovation Trust Fund under the World Bank, which supports activities to test, evaluate, develop models and support scaling up of results-based financing in relation to both supply and demand, with an emphasis on access to and use of services for women, children and vulnerable groups. At the present time, the Trust Fund is supporting programmes in more than 20 countries. Nigeria is currently piloting results-based financing in Adamawa State, and remarkable results have been achieved in a very short time. One health centre increased the number of births at its facility from 10 % of births in its sub-district population to 100 % in the course of one year.
It is important to capitalise on the synergies between these new global and national developments to ensure effective collaboration and tangible, timely results. We therefore published a new report of the Global Campaign for the Health Millennium Development Goals, which we presented in Oslo and in the margins of the World Economic Forum in Davos. The report highlights recent developments as well as new commitments and approaches by national and global leaders. These commitments have been made by a wide range of stakeholders, including governments, multilateral organisations, non-governmental organisations, the private sector and academic institutions. In September 2012, for example, Norway, together with the Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation, the Clinton Health Access Initiative, USAID, the UK, and Sweden announced a volume guarantee for the contraceptive implant Jadelle, in cooperation with its manufacturer, Bayer HealthCare, which halved the price of the popular family planning method. The engagement and partnership that characterised the price reduction initiative for the Jadelle contraceptive implant has already resulted in increased collaboration and problem-solving with regard to forecasting and ordering, which has in turn resulted in the expected increase in orders.
If we can ensure that there is effective collaboration between the various efforts to promote maternal and child health, combined with innovative national leadership, we are convinced we will together achieve a dramatically accelerated reduction in maternal and child deaths. We hope that we can look back on 2013 as the tipping point when the vast majority of the Every Women Every Child countries achieved accelerated progress towards MDGs 4 and 5.
