A close-up of a pregnant woman in Calabar, Cross River State, Nigeria. Photo by: MSD for Mothers

Despite major gains over the past two decades, maternal mortality rates remain unacceptably high. According to the World Health Organization, nearly 830 women die of preventable causes related to pregnancy and childbirth every day — roughly one woman every two minutes.

Nearly 99% of maternal deaths take place in low- and middle-income countries — more than half of them in sub-Saharan Africa, and one-third in South Asia. In addition, more than half of these deaths take place in fragile settings, according to WHO. Maternal mortality among adolescent girls under the age of 15 — a population among the most at-risk for maternal death — could be prevented by ensuring access to contraception, yet contraception prevalence has been stalled at 58% worldwide, going as low as 27.1% in sub-Saharan Africa.

Maternity Matters

This in-depth series explores how private sector approaches can help channel both the financial resources needed to end preventable maternal mortality and the knowledge and innovation needed to create sustainable solutions. Learn more about how cross-sectoral approaches can be scaled and replicated to improve maternal health outcomes.

The Sustainable Development Goals have set the ambitious target of improving maternal and reproductive health outcomes, from reducing global maternal mortality rates to fewer than 70 deaths per 100,000 live births by 2030, to ensuring universal access to sexual and reproductive health care services, including family planning, information, and education. Achieving these targets will require cooperation, ongoing investment from many different stakeholders, and innovative partnerships.

The private sector has always played a critical role in women’s reproductive and maternal health, from developing drugs and innovative technologies, to running private clinics. However, Mark Allen, director of strategic partnerships at MSD for Mothers — MSD’s $500 million  initiative to address preventable maternal mortality around the world — said the true potential of private sector support is frequently underutilized in public-private health partnerships, leaving “value on the cutting room table.”

“The private sector has a different way of thinking, solving problems, and finding market-based solutions to address specific needs.”

— Mark Allen, director of strategic partnerships, MSD for Mothers

Creating systems, partnerships, and opportunities to fully utilize private sector talent is imperative if SDG targets for reproductive and maternal health are to be achieved, Allen added.

“Historically, the private sector has been perceived primarily as a funding stream, through corporate philanthropy, and so on,” said Allen. “But the private sector has a different way of thinking, solving problems, and finding market-based solutions to address specific needs.”

Optimizing supply chains

One of the first steps to improving maternal mortality and reproductive health is to ensure that women have access to medicines, medical facilities, and adequate numbers of trained personnel. This can be a challenge for women living in rural areas, far from well-equipped health care facilities.

Rural clinics in remote settings also often face the issue of running out of stock, which can mean that maternal and reproductive health supplies — for example, contraception, or medications to stop heavy bleeding or infection in women giving birth — are unavailable.

“In many [countries in Africa], supply chains have traditionally been run by governments, where incentives are not always aligned, leading to a lack of innovation and a lot of stock-outs,” Allen explained.

Supply chain optimization is one area where private companies — especially those specializing in logistics — have a lot to offer, particularly when it comes to accurately estimating demand, and creating streamlined data and delivery systems.

“Most governments of developed countries recognize that they are not in the business of managing large assets and complex supply chains and that there are private companies that have built their entire existence and competency [on] developing agile supply chains and being service providers to governments,” Allen said.

There are three primary challenges in this area that could be addressed by private companies:

1. Bottlenecks in the supply chain related to commodity, financial flow, and structural inefficiencies — including outdated data systems, such as paper-based records, which can make the transferring and sharing of data difficult.
2. Human resource gaps among government health workers who are often charged with managing local supply chain logistics along with providing care.
3. Problematic financial systems in which health facilities are required to pay upfront for commodities.

By shifting supply chain management to third-party logisticians, stakeholders are in a position to successfully address all of these issues.

Improving access to and quality of care

Another way that private companies can improve access is by creating innovative products appropriate to low resource settings. For example, in rural Kenya, many pregnant women do not have the funds or social support networks that would allow them to make regular visits to health care facilities, which are often many miles away.

There is also a human resource gap: A lack of reproductive health care providers capable of providing high-quality prenatal care means that many pregnant women living in rural areas are not getting the prenatal care they need, putting them at risk of complications later on.

To respond to this challenge, Philips developed a handheld ultrasound device that health workers can bring with them on home visits. Called “Lumify,” the wireless device connects to a tablet or smartphone. It’s also supported by an application platform that allows peer-to-peer image sharing with doctors or other trained technicians in hospital settings, who are then able to help provide remote health care diagnostics and support.

“Digitization is a huge opportunity for private sector contributions, particularly in communities where access is limited,” said Jan-Willem Scheijgrond, vice president and global head of Government and Public Affairs at Royal Philips. “We can empower women by bringing point of access and care directly to them. And we can empower community health care workers with remote support, video trainings-enabled coaching and diagnostics, and other digital solutions.”

Leveraging private sector expertise to improve health care systems

While private companies’ ability to innovate new products remains a critical contribution, Scheijgrond would like to see private sector involvement in addressing critical health care gaps go much further.

“Merely selling health commodities isn’t enough — the entire health system needs to be reinvented to achieve universal health coverage, from the financing to how health care personnel are trained and patients are referred.”

— Jan-Willem Scheijgrond, vice president and global head of Government and Public Affairs, Royal Philips

He believes that effectively leveraging the full value of the private sector for large-scale impact requires giving such actors a seat at the decision-making table. This allows them to be a part of the initial conversations that help to shape health care systems capable of quickly responding to women’s needs, regardless of where they live.

“One of the big problems with just focusing on selling medical devices is they can become obsolete quickly if they are not fully integrated into the health care system, with supportive patient flows and referral systems, and without adequate service, maintenance, and continuous training,” said Scheijgrond. “Africa is a graveyard for unused medical devices.”

With Lumify, for example, a device is only useful so long as a system exists to train rural health care workers to use it, and in a hospital setting, ensuring that hospital staff are on call to provide reliable remote support. If that knowledge isn’t institutionalized into the larger health care system, something as minor as a personnel transfer of one nurse or radiologist can render the device useless if they are the only one with the knowledge to use it.

“What we’ve seen is that merely selling health commodities isn’t enough — the entire health system needs to be reinvented to achieve universal health coverage, from the financing to how health care personnel are trained and patients are referred,” Scheijgrond said. “But because we don’t always know what the solutions are, we need to work closely with governments and other stakeholders to innovate and co-create an ecosystem that actually works.”

Innovative financing in health systems solutions

Unfortunately, current health systems are generally not financed in a way that facilitates private sector involvement at such a foundational level.

According to Scheijgrond, private sector participation in health care systems is commonly financed through two primary methods — grants, or central procurement, which is useful for buying commodities, but less optimal for providing long-term systems solutions.

He explained that he would like to see more private sector involvement to help assess preexisting gaps in health care systems and to develop project proposals aimed at long-term solutions. Because such assessments and proposals are time-consuming and costly, financing becomes very important.

“Right now, there’s a lack of well-designed project proposals from the private sector because it’s so financially risky, so the company that designs a good project today is unlikely to win the project and recover its project development costs,” Scheijgrond said. “There needs to be more flexible financing tools to incentivize the development of these sorts of system innovations, like grants or recoverable loans or first-loss guarantees that assume some of that risk.”

The Global Financing Facility at the World Bank is already piloting a number of financial tools and instruments to incentivize private sector participation and expertise to improve maternal and reproductive health, according to Sneha Kanneganti, GFF’s private sector lead. Some of these tools include results-based financing mechanisms such as development impact bonds — where private companies are compensated based on achieving targets and results — and blended financing, which uses public or philanthropic capital to spur private sector investment.

“There is a tremendous amount that needs to be done on financing for health and nutrition. Donor assistance is plateauing and although domestic budgets are increasing, there’s a big gap,” she said. “One of the main areas we are looking into is how to increase efficiencies of alignments — and how to bring donors and governments around a common set of priorities.”

For example, in one of GFF’s most promising projects, they’ve partnered with the Treasury department at the World Bank to make private capital a more affordable option for countries committed to making improvements in child, maternal, and adolescent health. GFF and its partners were able to successfully raise $1 billion Canadian dollars ($748.9 million) from institutional investors, an amount which was converted into sustainable development bonds issued on the Canadian market.

GFF has also made efforts to mobilize private sector capital through results-based mechanisms or bonds, in addition to making it easier for countries to access those resources.

Mariam Claeson, former director at the Global Financing Facility, on aligning loans and development goals. Via YouTube.

While such social impact bonds are a great first step, Kanneganti believes that it’s important to continue to look for new and innovative ways to engage the private sector to find sustainable financing strategies to reach SDG targets for women’s reproductive and maternal health.

“If we classify what the private sector brings to the table, we know it’s not just service provisions, but also financial resources, the capacity to deliver products and services, expertise, and developing solutions co-designed with governments,” she said.

“In many ways, it’s still an untapped resource.”

The Maternity Matters series is sponsored by MSD for Mothers, MSD’s $500 million initiative to help create a world where no woman has to die giving life. The content of this article is the responsibility of the author(s) and does not necessarily represent the official views of MSD. MSD for Mothers is an initiative of Merck & Co., Inc. Kenilworth, N.J., U.S.A.

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