In global health, a few challenges are as urgent and imperative as ensuring safe and dignified childbirth for women everywhere. In Nigeria, the rate of maternal deaths lies at 512 per 100,000 live births, amounting to more than 50,000 countless lives that are lost due to complications during pregnancy and childbirth, particularly in low-resource settings. Recognising this critical need, MSD made a commitment in 2011 to help create a world where no woman would have to face the peril of losing her life while bringing life into the world. This commitment laid the foundation for an initiative that works to build systems and partnerships to improve maternal health care for the most disadvantaged women and communities – MSD for Mothers.
In 2021, MSD’s new CEO, Rob Davis, reaffirmed the company’s commitment to maternal health by committing additional support to global maternal health efforts. At the same time, MSD for Mothers launched the “Strengthening Systems for Safer Childbirth” initiative, a comprehensive strategy designed to transform maternal health systems, ensuring that women across the globe receive safe, equitable, and high-quality care during childbirth.
Nigeria Health Watch recently sat down with Dr. Mary-Ann Etiebet, Global Lead, MSD for Mothers to understand the role of MSD for Mothers in strengthening maternal health systems in Nigeria through private sector integration. Below are some highlights from the discussion.
Improving mixed health systems through holisticinvestment
According to Dr. Etiebet, Because MSD for Mothers recognizes that achieving the goal of safe childbirth is not an isolated effort, it necessitates a comprehensive integration of private sector providers into mixed health systems such as Nigeria’s. Be it a bustling urban hospital or a rural health clinic, the mission is clear: to ensure that women, irrespective of their location, receive care that is not only of high quality, but also respectful and equitable. The vision transcends mere philanthropy; it’s about strategic investment – investment in people and systems that will endure beyond the immediate.
Reflecting on a decade of operations, Dr. Etiebet maintained that MSD for Mothers has gleaned invaluable insights and has recognized that transformative change cannot be achieved by a top-down approach or simply by funnelling resources. Sustainable systems demand more – a holistic view of investment that encompasses people, infrastructure, and innovation. MSD for Mothers has adopted a private-sector lens to its partnerships, acting as a catalyst for innovation and sustainable growth. The guiding principles are simple yet profound: equity, proximity, inclusivity, and collaboration.
The ‘EPIC’ journey
According to Dr. Etiebet, “we are not going to be able to transform systems if we do not change how we work with others and collaborate with others…and unless we’re taking EPIC journeys, we’re not going to sustainably strengthen systems.”
Dr. Etiebet described the components of the ‘EPIC” journey as follows:
Equitable Investment: MSD for Mothers understands that impactful change stems from investing in local organisations, grassroots initiatives, and visionary entrepreneurs. By focusing resources on community-based organizations, the initiative fosters sustainable models that continue to thrive after external support diminishes.
Proximate Leadership: The proximity principle insists that leadership should be rooted in the communities where interventions are deployed. Those who are closest to the challenges hold the reins of change. It ensures that the decisions and actions align with the needs and experiences of the people on the ground.
Inclusivity: A cornerstone of MSD for Mothers’ approach is to ensure that women’s voices are integrated into every facet of their work. It’s not merely about listening but about actively responding to the needs and priorities of women and girls. This approach ensures that interventions are relevant, effective, and truly transformative.
Collaboration: The adage “We go far together” rings true in providing truly impactful solutions for maternal health, particularly in Nigeria’s mixed and deeply fragmented health system. MSD for Mothers recognizes that no single entity can tackle the complexity of maternal health on its own. Partnerships are formed, knowledge is shared, and collective progress is achieved. By aligning investments, innovations, and collaborations, there should be a seismic shift in maternal health outcomes. By investing in people, both healthcare providers and mothers, it enhances the capacity to deliver comprehensive care – care that encompasses not only the technical aspect but also the human touch.
The conversation with Dr. Etiebet highlighted that amid the unprecedented challenges posed by the COVID-19 pandemic, the significance of private-sector engagement became glaringly evident. Health systems across the world faced unprecedented stress, and many teetered on the brink of collapse.
In Nigeria, the response to the pandemic underscored the critical role of private sector participation in sustaining essential healthcare services. With over half of Nigerians relying on private providers for medical care, it was clear that effective crisis response necessitates collaboration between public and private sectors.
She expressed that the COVID-19 experience highlighted the vital role that MSD for Mothers has been advocating for years – the integration of private sector players into a cohesive and inclusive healthcare framework.
By bridging the gap between public and private healthcare, it would build a unified health system, seamlessly blending public and private services, to ensure that women receive dignified, high-quality care, regardless of where they seek it. Undoubtedly, the integration of private sector efforts into government systems is a complex undertaking. It demands a shared vision, concerted effort, and strategic alignment of objectives.
The 4 Ps of Private Sector Integration
Dr. Etiebet emphasizes four key pillars as the foundation of this integration: People, Practices, Processes, and Policies:
People: At the heart of any healthcare system are the people – those who provide care and those who receive it. The government must invest in building the capacity of healthcare providers to expand the scope and quality of services they offer. Training and skill enhancement are not just one-off endeavours; they are ongoing investments in a brighter and healthier future.
Practices: Quality is a non-negotiable aspect of maternal health. The initiative places a keenfocus on ensuring that care is of the highest standard. By upholding quality benchmarks and best practices, it ensures that women receive care that is not only safe but also effective and empowering.
Processes: An efficient and streamlined healthcare system is essential for delivering optimal care. Service providers should work towards harmonizing processes, bridging the gap between public and private healthcare delivery, and ensuring that data and essential commodities flow seamlessly.
Policies: Effective integration hinges on supportive policies. The recently updated ‘Task shifting, Task sharing’ policy and framework for community health workers, for example, plays a pivotal role in maximizing the contributions of local private providers. MSD for Mothers works hand in hand with others to advocate for policies that amplify impact.
Gender inequities, women’s voices, and its rippleeffect of maternal health outcomes
Dr. Etiebet noted that in the United States, the intersection of racial and gender inequities has brought to light the critical role of systemic factors in maternal health outcomes. For instance, Black women in the US are three times more likely to die in childbirth compared to their white counterparts. This sobering reality highlights the inextricable link between gender, race, and health outcomes.
In the context of Nigeria, the urgent need to prioritize gender equity becomes evident. Dr. Etiebet explains that a pressing concern is the glaring gender equity gap that continues to plague maternal health outcomes. She illustrates this challenge by saying that when the map of maternal mortality is overlaid with the map of gender equality, a troubling pattern emerges – inequities in maternal health are closely intertwined with broader gender disparities.
The voices of women and girls must be elevated, not as mere listeners but as active contributors to the design, implementation, and evaluation of interventions. Dr. Etiebet indicated that MSD for Mothers is committed to ensuring that women’s experiences and needs guide every step of the journey. Through human-centered design, feedback mechanisms, and inclusive policy formulation, the initiative is fostering a culture of responsiveness and accountability.
Looking to the future
Despite the strides made, Dr. Etiebet acknowledges that there is still ground to cover. The global data paints a stark picture – Nigeria alone contributes nearly 20% of the world’s maternal deaths. Moreover, staggering disparities exist between different regions and states within the country.
Beyond maternal health, Dr. Etiebet envisions a broader ripple effect of private sector integration. In Africa, where the private sector is a burgeoning source of job creation, investing in local private health sectors can ignite a chain reaction of economic growth. By aligning healthcare initiatives with financial and technological reforms, opportunities for employment, skill development, and economic advancement are unlocked.
Based upon the conversation with Dr. Etiebet, the path forward is clear. We propose the following recommendations – the Nigerian government should adopt a collaborative, holistic, and equity-driven approach to maternal health.
By investing in people, innovating for solutions, and integrating efforts across sectors, Nigeria will not just transform maternal health; it will transform the future for women and girls.
The vision is ambitious, the challenges are formidable, but the commitment is unwavering. As MSD for Mothers continues to catalyse EPIC journeys of equity, proximity, inclusivity, and collaboration, the world inches closer to a future where no woman has to die while bringing forth life.
The content of this article is solely the responsibility of the author and does not represent the official views of MSD. MSD for mothers is an initiative of Merck & Co., Inc., Rahway, NJ USA.
