Prof dr Marleen Temmerman Working draft -30 October 2014 “A new, broader, and more inclusive Global Strategy for Women’s and Children’s Health” Advocacy meeting for Members of Parliament on Accelerating the Attainment of MDG5 and Advance Beyond Zero in Kenya Prof dr Marleen Temmerman Nairobi 13 November 2014

Trends in Maternal Mortality: 1990-2013 New estimates released May, 2014, with new data and improved methods of estimating births and female deaths An estimated 289,000 women died in 2013, a 45% reduction from the 523,000 that died in 1990 11 countries with high levels of maternal mortality in 1990 have achieved MDG 5 target (over 75% reduction from 1990 levels). Progress uneven globally: 10 countries account for 60% of the global maternal death burden. India and Nigeria account for nearly one third. Filename

Maternal mortality – causes are known Assessed causes of death of more than 60,000 maternal deaths from 115 countries Pre-existing medical conditions, exacerbated by pregnancy (e.g. diabetes, malaria, HIV, obesity) caused 28% of deaths 28% Published May, 2014 in The Lancet Global Health Filename

Focus on maternal and child mortality 289,000 women died due to complications of pregnancy and childbirth in 2013 2.7 million stillbirths 6.9 million children die before their 5th birthday 3.0 million babies die in their first month of life 2.0 million infants die between 1– 12 months 1.9 million 1 – 5 years Source: WHO, UNICEF, UNFPA, World Bank. Trends in maternal mortality 1990 – 2010, Report 2012. UN Inter-Agency Group for Child Mortality Estimation. Levels and Trends in Child Mortality, Report 2012.

Financing for sustainability The RMNCH Global Investment Framework found that increasing health expenditure by USD 5 per person per year in the countries with the highest burden of maternal and child mortality will yield 9 times the economic and social benefits by 2035 These benefits include: greater gross domestic product growth through improved productivity prevention of 147 million child deaths prevention of 32 million stillbirths prevention of 5 million maternal deaths These gains could be achieved by an additional investment of $30 billion per year, which is equivalent to a 2% increase above the current level of total health spending per capita in the countries with highest burden from maternal and child mortality Financing for sustainability. The new RMNCH Global Investment Framework (2013) found that increasing health expenditure by USD 5 per person per year in the countries with the highest burden of maternal and child mortality will yield 9 times the economic and social benefits by 2035. These benefits include greater gross domestic product growth through improved productivity, and prevention of 147 million child deaths, 32 million stillbirths, and 5 million maternal deaths. These gains could be achieved by an additional investment of $30 billion per year, which is equivalent to a 2% increase above the current level of total health spending per capita in the countries with highest burden from maternal and child mortality. Data from a set of countries using the new methodology for national health accounts (SHA 2011) shows that households and development partners fund the bulk of RMNCH expenditures at country level (see 2014 Accountability report). The average total expenditure on RMNCH remains low at US $9 per capita. Countries rely heavily on assistance from external partners, who contribute 37% on average to overall expenditure on RMNCH. Out-of-pocket payments by households often remain the greatest source of funds spent on RMNCH – this is the most inequitable source of health financing. Moving forward, greater importance needs to be placed on ensuring that financial barriers do not prevent people using essential services.

Kenya data Maternal mortality levels in Kenya changed only slightly between 1990 and 2013, according to latest UN interagency estimates, led by WHO. Maternal mortality ratio, that is number of maternal deaths per 100,000 live births dropped from 490 in 1990 to 400 in 2013 The reduction in maternal mortality during this 23 year period is less than 1% annually, which is much lower than 5.5% required by the MDG 5 target Maternal mortality has increased from 1990 to 2000, and later declined. A main reason for that is the effect of HIV. Estimated maternal mortality levels in Kenya /100 000 births 490 (1990); 530 (1995); 570 (2000); 550 (2005) 400 (2013)

Kenya data Higher declines in maternal mortality levels in Kenya over the last years show that progress was made and that policy and programme actions have worked If we accelerate our efforts further and take collective, sustainable actions to adequately implement effective solutions against main causes of maternal mortality like, hemorrhage, eclampsia, sepsis, complications of abortion and indirect causes, we can envision a future with all preventable maternal mortality are eliminated. To achieve this, it is critically important to 1) focus most vulnerable and disadvantaged segments of the populations, 2) ensure quality of services women receive before, during and after pregnancy, and during childbirth, and 3) make ourselves all accountable

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Update Rationale i. The unfinished agenda “Develop, secure wide political support for, and begin to implement a global plan during 2014-15 to end all preventable reproductive, maternal, newborn, child, and adolescent mortality for the 2016-2030 period—a new, broader, and more inclusive Global Strategy for Women’s and Children’s Health.” iERG 2014, Recommendation 1

Lessons learned from the Global Strategy since 2010 Update Rationale iii. Rationale iii. Lessons learned from the Global Strategy since 2010 What worked well Political leadership and commitment Multi-stakeholder partnerships Accountability framework with CoIA and the iERG Every Woman Every Child global movement What could work better Country plans and priorities leading global collective action Coordination with existing initiatives Reducing fragmentation with new initiatives Sufficient and effective financing for women’s and children’s health

Global MMR < 70 by 2030,no country more than 140/100 000

Strategic objectives: Towards Ending Preventable Maternal Mortality Improve metrics, measurement systems and data quality, ensuring that all maternal and newborn deaths are counted Address inequities in access to and quality of reproductive, maternal, and newborn healthcare services Ensure universal health coverage for comprehensive reproductive, maternal and newborn healthcare   Address all causes of maternal mortality, reproductive and maternal morbidities and disabilities Strengthen health systems to respond to the needs and priorities of women and girls Ensure accountability to improve quality of care and equity Filename

Governance and Leadership Question 4. National governance – representation and voice, effectiveness, regulation and rule of law, control of corruption, political vision Global governance – actors’ comparative advantage, participation of low-income countries, new models of development partnership (e.g. south-south cooperation) Leadership across society – public, private, civil society leadership, parliaments,including through multi-stakeholder partnerships What governance and leadership approaches would help different actors make best use of their comparative advantages for Every Woman Every Child?

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Women, children, adolescents their families and communities Question 5. Healthy people at the heart of sustainable development Developing health literacy and health promoting skills Using community engagement strategies based on the best evidence Ensuring that all voices are heard and engaging in meaningful dialogue on women’s and children’s health Addressing inequities, power disparities and other social barriers to progress Legal empowerment to claim to essential health, development and humanitarian services

© Lieve Blancquaert

Tetanos Vaccine The United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) express their deep concern about the misinformation that is circulating about the Tetanus Toxoid Vaccine. We note with concern that Kenya is one of the 25 countries where tetanus is still a public health problem. Kenya and South Sudan are the only countries in the Eastern and Southern Africa region that are yet to achieve elimination of maternal and neonatal tetanus. The impact of this deadly disease is highest and most serious in women with limited access to hygienic facilities during childbirth. The disease is mainly caused by contamination of the umbilical cord with tetanus spores, which are found in the soil or manure. Indeed, newborns whose families live in underserved and marginalized areas, especially those born to mothers who have not been vaccinated and who are delivered in unhygienic conditions, will die a painful death. These children will die before they have even been given a name. Sadly, fewer than 5 per cent of neonatal tetanus cases are reported because those most affected have limited access to relevant information.

Tetanos vaccine Tetanus is preventable and the vaccine is safe. UNICEF buys a large proportion of the vaccines which are being used in Kenya’s immunization programme. These vaccines are subject to a rigid system of inspection and control, both by the national authorities in the countries where they are produced, and through oversight by WHO and regulatory authorities in the countries receiving the vaccines. The Kenya Pharmacy and Poisons Board also has in place a surveillance system to track and report any issues with the quality of the vaccines, including adverse effects. The manufacturers and national control authorities have provided WHO with unequivocal statements that their vaccines contain only the Tetanus Toxoid vaccine components and that there is nothing in the vaccines which could interfere with fertility or pregnancy. Tetanos kills, not the vaccine!!!