Remarks by Administrator Rajiv Shah on Saving Mothers, Giving Life

Thursday, January 9, 2014

[Remarks as delivered]

Good morning. Thank you to Janet for that kind introduction and for reminding me that I’ve now been in this role for four years. I’d like to thank Stephen Morrison and CSIS for hosting us today in your beautiful new building. We’re so pleased to be here today celebrating in this new facility. We are celebrating and learning from a great partnership, and I’d like to recognize Tom Frieden who will be here later, Tore Godal from Norway and I hope that Norway will continue their leadership in the global health sphere. I am also pleased that Dr. Phirie from Zambia is here, and that Dr. Acheng is here from Uganda; we value your partnership and are very much celebrating today the results of your work, so thank you. And I want to take a moment to recognize that there are so many wonderful USAID colleagues here, but in particular Claudia Morrissey and Robert Clay who carry the torch forward for this important initiative.

It is hard to believe that it was just over a year ago when Secretary Clinton joined our friends in Norway to launch this ambitious partnership. She brought together not only the whole of the U.S. Government and the commitment of our colleagues in Norway, Uganda, and Zambia—but also a genuine partnership in combining the expertise of the private and public sectors: Merck for Mothers, Every Mother Counts, Project CURE, and the American College of Obstetricians and Gynecologists who have all lent their expertise and their unique capabilities to achieving the extraordinary results will be discussing today.

The reality that we know today is unacceptable and heartbreaking—that nearly 300,000 mothers and 3 million newborns continue to die each year from causes we know how to prevent. Without access to a skilled birth attendant who provides life-saving care in rural settings, a mother’s risk of dying at what should be the most joyous moment of her life is 120 times higher than here in the United States.

That is why Saving Mothers was specifically designed to target the three big delays that put the lives of women and newborns at risk every day: the delays in seeking, reaching, and receiving good care. In many cases, something as simple as knowing the danger signs during pregnancy or arranging for transportation to a clinic ahead of time is all it takes to save a mother’s life.

In Uganda and Zambia, for instance, we focused on the challenge of getting women the help they needed in an emergency. We used geospatial technology to map travel time to clinics, helped form district committees to coordinate transportation for mothers, and provided travel vouchers to pay for it. In Uganda, in one year alone, nearly 30,000 transportation vouchers were redeemed.

In Zambia, where distances are vast and roads sometimes perilous, motorcycle ambulances now connect women to facilities that can provide emergency services in the 2-hour window around birth when the risk to women and their newborns is greatest.

Now, a year after we launched this pioneering effort, we have begun to see real evidence of progress, and the results are inspiring.

In just one year, maternal mortality declined by roughly a third in the districts we worked in, in Zambia and Uganda. The number of women who delivered in healthcare facilities shot up by 62 percent in Uganda. And the number of women who received the care they needed to protect their children from being born with HIV rose by 28 percent in Uganda and 18 percent in Zambia.

These are extraordinary results, achieved in just one year of real change and effort; they are remarkable, and we know that they can be scaled to larger levels.

We know this because in order to even gather the data to make these claims, we had to help build robust measurement systems to document our progress. In Uganda, officials carried out a Reproductive Age Mortality Study to identify the baseline and track results. In Zambia, where information was too sparse to measure maternal mortality by district, we reviewed the medical records in each facility independently.

As a result, we now have a strong foundation for continued monitoring and reporting, and we are confident we will see similar results as we take Saving Mothers to scale nationwide in Zambia and Uganda.

But we’re not stopping here—not with these promising results. In the next five years, we plan to bring Saving Mothers to at least three more countries, because we know just what a difference this approach can make on the ground.

When you save the life of a mother, you create ripples of change that echo outwards—transforming not only the health of her family and the strength of her community, but also the stability of her society.

A mother’s survival resonates across borders and through the generations.

“Every life we save,” Secretary Clinton said when she first launched Saving Mothers, Giving Life, “is step toward the more peaceful, prosperous planet.”

Today, we know exactly just how big a step forward it represents. For centuries, birth rates across the world remained stubbornly high—a dangerous hedge against the awful reality that many children die young, often right at the moment of birth. But as countries began investing in family planning, child survival, neonatal health, and education, something surprising happened: their economies took off.

Armed with data from the World Bank and UN and visualization software that became the envy of technology companies like Google, the world-renowned analyst Hans Rosling has traveled the world to demonstrate the close connection between healthy children and prosperous economies.

As they trace across the decades, his animated graphs show how the distribution and rate of child mortality in numerous countries has changed—and the conclusion is quite clear: child survival underpins strong economic growth.

Take Thailand as just one example. Fifty years ago, the average citizen made under a dollar a day and the average family had over six children. But with our support and partnership, the country expanded access to voluntary family planning, immunized children, fought malaria, and made educating girls a priority. Birth rates fell quickly. The average family now has fewer than two children, and retrospective economic analysis showed that a major part of Thailand’s economic rise was the demographic dividend they experienced from the changing structure of their population in the early 90s.

This phenomenon is far from unique. In fact, this is the rule and not the exception. In country after country, we have seen population growth slow as families choose to have fewer children when they know each will have a chance to survive and thrive. And that serves as the underpinning for what the World Bank has identified as a two percent demographic dividend that supports accelerated economic growth in those countries for the past two decades.

The truth is that maternal and child mortality are not only a stain on our conscience, but an anchor on our global prosperity. Hans Rosling says it best: “The moral obligation of providing health services hides the fact that healthy children are also one of the best economic investments you can make.”

That’s why—nearly two years ago—we joined UNICEF and the governments of Ethiopia and India in hosting a global Call to Action here in Washington, D.C. It was a powerful moment—and I see many of you here today who were with us then—as more than 176 countries and more than 450 civil society and faith organizations from around the world stepped forward to join the call.

Together, we committed to a new approach to global health that is not about excluding the poorest populations or deprioritizing diseases.

In fact, it’s the opposite.

By setting a single, comprehensive goal—that we can end preventable child death within two decades—we focused on the core interventions, the core target populations, and the core health commodities that need to be delivered at much larger scale in order to achieve the desired result.

With a greater emphasis on science, business, and innovation, as you’ve demonstrated through this partnership, we are seeing new solutions emerge that can help us achieve the deadlines we’ve set for ourselves.

By partnering with the private sector, Saving Mothers, Giving Life is getting affordable new maternal health technologies into the hands of community health workers. With Merck for Mothers in the lead, we are testing the design of community shelters where women can stay and receive care in advance of their due date.

And by working closely with local leaders, we are strengthening the capacity of our partner countries and communities to one day manage the care of their communities without our assistance. That is exactly what we saw happen in Uganda this past year. When a member of the Parliament recognized the success that Saving Mothers had in recruiting health workers by paying them higher salaries, he encouraged the government to introduce a wage bill.

Today, that bill has increased the salaries for healthcare workers across the country. Around the world, countries are taking real, concrete, steps to dramatically improve the odds for mothers, newborns, and children.

Since the Call to Action in 2012, nearly a dozen countries have launched their own local calls to action and are creating evidence-based plans and data-driven report cards to track their progress. They’ve identified target districts and communities where the highest rates of child and maternal death occur, and tried to focus resources and energy at reducing those rates. That includes countries like India, the DRC, and Nigeria that account for a very large proportion of child death rates today.

At the end of the day, we know that our efforts will only succeed when we work together to identify the most vulnerable communities and target and scale the kinds of solutions that you’ve developed here to those communities. And we know that in doing so we’ll have to invest in measuring and reporting on results, not just so we can talk to colleagues in Congress, the British Parliament or any other donor country community but more importantly so that in-country leaders can see the value of these investments and can make the connection for themselves that when they invest local resources and local capacity in their own health systems they are building the basis for a sounder economy and a more prosperous nation.

You know, just before the holidays, I had the opportunity to visit the Democratic Republic of the Congo. And I spent some time in the eastern part of that country, which is just coming into the potential for some improvements in socioeconomic conditions based on their recent peace deal that was negotiated as part of the Kampala Accords. And I met with young children who had either been the subject of violence—too often young girls who had been severely injured and traumatized by sexual violence during the conflict. And young boys who had spent too many years of their young life in rebel groups, with machetes or machine guns in their hands. And I just take great pride in the fact that each of you, by coming together to develop this kind of program and approach, and by your willingness to extend the reach of these efforts to the places where people suffer the greatest; are going to do more to save more lives, to create the basis for stability in places that really need the fruits of your labors.

So I accepted the invitation today to mostly come and say thank you. Because all too often people will thank military leaders who win victories on the battlefield or presidents who sign peace agreements, but at the end of the day I think this partnership shows that when you can bring this kind of excellence, commitment to mission, and commitment to outcome, to the toughest parts of our planet, you can both help us build a better, safer world, and you can serve as the best and most profound expression of American values, often in the farthest corners of the globe. So thank you for your leadership and thank you for having me this morning. 

Washington, DC

Last updated: January 13, 2014

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