Authors: Mariam Claeson, France Donnay, Melanie Walker, Kate Teela, Becky Ferguson and Joel Segre
Although the Maternal Health Task Force intended to create space for the Maternal Health community to get together to discuss challenges and solutions so that we can improve programs, the Global Maternal Health Conference 2013: Improving Quality of care in Arusha, Tanzania [see conference site, @MHTF on twitter, and the MHTF Blog] achieved much more than that – it was a momentum for change, inspiring a movement that united behind a manifesto. What made it so special?
The movement: This was an abstract driven conference and out of about 2000 submissions, almost 800 were selected for presentation at the conference. The abstracts and presentations, which are available here, helped to underpin and inform the debate about continuum of care [see Family Care International blog post], demand and supply, home deliveries and facility based deliveries, whether to focus more narrowly on well-defined targets or embrace the broader determinants of women’s health, and how to redefine “quality” to include respectful care. Most importantly, the research presented at the conference helped to break through some of the false dichotomies in maternal, newborn and child health, i.e. demand versus supply, home versus facility, mother versus baby, urban versus rural, and sexual reproductive health versus maternal health, and moved the agenda forward towards a common platform for maternal health. For example, when a panel of researchers presented the results of financial incentives in creating demand for services, they all concluded in unison that to achieve impact of these demand creation interventions, we need to focus on quality of services – it is not an either or. The plenary on “respectful” services brought to the fore the human rights, ethics and quality of services perspectives of midwives, community groups and champions for governance and accountability; and, the panel on urban maternal health moderated by Melanie Walker brought in the social, economic determinants and the urban poor context.
To move the R-MNCH platform forward we need to include nutrition, infectious diseases (malaria in pregnancy) and family planning, find opportunities and entry points for integration in antenatal care, intra partum and postpartum interactions, and tackle the most difficult implementation barriers at local levels, often fueled by gender inequalities. This recognition, which was well captured at the large plenary sessions, made this conference an important milestone for many scientists, program managers and advocates.
The momentum: A standing ovation followed Professor Mahmoud Fathalla’ presentation at the closing of the conference, as he brought us along on a historical journey dating back to the Lady of Laetoli. He concluded: “we thank and we appreciate; we regret and we apologize; we promise, and yes, we can.” Check here for his presentation where he elaborates on these themes. Also helping to create a momentum for change was the high level engagement from the political leadership in the region, with the First Lady and Vice President of Tanzania, who attended the conference, and the contribution of the Minister of Health of Rwanda: Hon. Dr. Agnes Binagwahos. Contributing to the momentum and movement was the representation across geographic regions, disciplines and age groups: with the young champions, both researchers and activists. The many scholarships that the MH Taskforce had given to young researchers, helped people who otherwise would not have been able to participate to get to the conference and share their data.
The Manifesto: As a result, it was not surprising that the meeting resulted in a manifesto which was drafted and presented by Richard Horton, editor of the Lancet, in the closing ceremony. The draft is being circulated for comments, and will be finalized and published in the Lancet. It is available in bullet form on twitter via @richardhorton1 with hash tag #GMHC2013. The manifesto can contribute to the discussions about the post 2015 MDG agenda and hopefully inform the meeting in Botswana, where the recommendations from the health community for the new goals post 2015 will be agreed on. Some of the key messages of the conference were:
- We must set a new and challenging goal for maternal mortality post-2015, led and defined by countries
- We must redefine continuum of care to make women central to RMNCH, and include quality, HIV, malaria, and social determinants
- We need a responsive financing mechanism to support countries in implementing their plans to improve maternal health
- We must emphasize reaching women who are socially excluded because of, for example, culture, geography, and education
- We must listen to voices of women in policy. Women must have a platform and power to shape their futures
- For a mother her newborn is a precious part of her life and future. Maternal health must address stillbirths and newborn mortality
- A critical priority for maternal health is the lack of measurement, information, and accountability about maternal outcomes
- An urgent opportunity lies in the power of mobile technology to empower women to connect them to services when they need them
Dr. France Donnay
Senior Program Officer for Maternal Health
Bill & Melinda Gates Foundation