To end preventable maternal mortality, let’s explore 'business as unusual'

A woman with her children at the Masougbo chiefdom primary health unit in Bombali district, Sierra Leone. Photo by: H4+ Partnership / CC BY-NC-ND

When you think of efforts to reduce maternal mortality, it’s natural to look to governments, the United Nations, the World Health Organization and other national and international bodies charged with responding to global health challenges.

And in many ways you would be right; but that’s not the full picture. It turns out that private health providers and local health businesses — an overlooked source of healthcare in much of the developing world — may also be important partners in the global push to end preventable maternal deaths.

During the last U.N. General Assembly in New York, Merck for Mothers teamed up with Population Services International and the World Bank to host a panel discussion focused exclusively on this topic. Entitled “Business as Unusual: Exploring the Potential of Local Health Businesses to Reduce Maternal Mortality,” the event set out to reframe the way the global health community thinks about ending preventable maternal mortality.

With the world off track to meet Millennium Development Goal 5, we need new and potentially “unusual” solutions to help save the nearly 300,000 women who die each year during pregnancy and childbirth. One of those solutions may rest with private providers and local health businesses.

To date, most global resources to improve maternal health care have focused on strengthening public sector institutions. Historically, groups like private doctors, nurses and midwives, drug shops and pharmacies, and private clinics and hospitals have not been leveraged — even though many women often prefer receiving care in these settings because they are close to home, open long hours, and care personalized and perceived to be high quality.

In fact, the divide between the private and public sector is often artificial. Many providers who work in the public sector in the morning actually transition to a private clinic in the afternoon or evening. No health system is wholly public or private, and these health businesses have untapped potential to support our global goals of reducing maternal mortality.

Thanks to new analyses by the London School of Hygiene and Tropical Medicine — previewed during our event and set to be published later this year — we now have data demonstrating that the local private sector delivers a substantial percentage of maternal health services across the developing world. So shouldn’t private health providers and businesses factor prominently in discussions about reducing maternal deaths?

The “Business as Unusual” panel discussion brought together leaders with deep experience in and understanding of the local private health sector to explore the implications and challenges associated with the LSHTM findings.

Fielding questions from Devex President and Editor-in-Chief Raj Kumar, panelists grappled with issues like financing private care, regulating it to ensure quality, protecting equity and creating systems that are conducive to complementary relationships between the public and private sectors. The conversation was both informative and provocative, and I was personally encouraged to see it steer toward one major theme echoed during UNGA: health coverage for all. This means that a woman has the right to affordable, quality care wherever she seeks it.

Each of the panelists agreed that efforts to reach all women necessitate reaching all the health workers serving those women. As former Botswana Health Minister Joy Phumaphi acknowledged: “Women want respect … they want dignity … they want equity … they want social solidarity … they want universal coverage. Experience has shown that in our developing economies, it has to be a combination of both public and private models to [achieve those goals].”

Dr. Ariel Pablos-Mendez, assistant administrator for global health at the U.S. Agency for International Development, reiterated Phumaphi’s point.

“The solutions to [realize] the bold vision of ending preventable maternal and child deaths require the engagement of the [local] private sector because it’s huge, because it reaches many communities and because there’s a tradition of innovation,” he said.

Likewise, Tim Evans, the World Bank’s senior director for health, nutrition and population, discussed the need to integrate the public and private health sectors, and that, despite their differences and complexities, “all health systems should be driving toward shared outcomes that are commonly owned across whole populations: access, affordability and quality.”

These three goals — access, affordability and quality — are paramount in maternal health. I was pleased to shed light on Merck for Mothers’ work to achieve them, joining with Zacch Akinyemi from PACE to talk about our partnership to strengthen private maternal healthcare in Uganda through social franchises.

As the world rallies around new targets for the Sustainable Development Goals — with our bars set higher, our sights farther and our timelines faster — it is clear that we need new approaches to bring about the world we all envision. For me, that world is one where no woman dies giving life, and to get there, I hope we’re willing to explore business as unusual.

Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

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About the author

  • Priya amerck  harlem 2237

    Priya Agrawal

    Dr. Priya Agrawal is an obstetrician/gynecologist, women's health expert and executive director of Merck for Mothers — Merck’s 10-year, $500 million initiative to reduce maternal mortality. Before joining Merck for Mothers, she was director of research and development for the Women and Health Initiative at Harvard School of Public Health and obstetric lead on the World Health Organization’s Safe Childbirth Checklist Program.