5 YEARS 3 COUNTRIES 1 MISSION 2018 FINAL REPORT | RESULTS OF A FIVE-YEAR PARTNERSHIP TO REDUCE MATERNAL AND NEWBORN MORTALITY 1 CONTENTS THE JOURNEY TO A SAFE CHILDBIRTH KASONGO AND UCHISHI

Kasongo Chipulou lives in a small It was during one of these visits that village in the northern part of Kasongo met the Safe Motherhood surrounded by . Few Action Group members. Saving Mothers, people in own boats to Giving Life has trained these lay navigate the swampy terrain, so volunteers (known as SMAGs) to

Letter from the Secretariat...... 02 accessing care is often a challenge. improve maternal health in their Systems Approach...... 04 When Kasongo found out she was communities. Throughout Kasongo’s Measuring Success: Impact...... 06 pregnant, she started antenatal care at pregnancy, SMAGs visited her and her A Successful Public-Private Partnership...... 08 Kasomalunga Remote Health Centre, family at home, making sure that she about an hour’s trip from her home. was healthy and helping her plan for a safe delivery at the local health center.

Lunga During labor, Kasongo began bleeding Nigeria...... 10 heavily. When she arrived at Kasomalunga Uganda...... 12 Lake Mansa Bangweulu Remote Health Centre, the nurse — who Zambia...... 14 was trained through the Saving Mothers, Chembe Samfya Giving Life partnership to diagnose, stabilize and transfer women with complications — cared for Kasongo and Strengthening the Whole Health System...... 16 then sent her by boat to A Systems Approach to Address All Three Delays...... 18 Hospital, accompanied by a SMAG. At Innovation Spotlight the hospital, Kasongo gave birth safely Private Care...... 24 with the help of a skilled team of health Community Entrepreneurship...... 25 professionals, also trained by Saving A Dramatic Return on Investment...... 26 Mothers, Giving Life. “It was really scary,” said Kasongo, reflecting on the whole episode. “I was very worried about the baby.” Happily, today, Kasongo and her daughter, Uchishi — whose name A Sustainable Path Forward: Host Government Ownership...... 28 translates to “problems” because the A Model for the SDG Era...... 30 The Legacy...... 32 delivery was so difficult — are home Country Partners...... 33 and doing well.

Kasongo and Uchishi are alive today thanks to Saving Mothers, Giving Life. Photo credit: Amy Fowler/USAID

Cover: Maria Mandira with baby Dalitso at Zumwanda Rural Health Centre in Zambia, where she stayed in a mothers’ shelter before delivery. Photo credit: Amy Fowler/USAID _

REPORT UPDATED AS OF NOVEMBER 2018 2 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT LETTER FROM THE SECRETARIAT 3

Dear Health and Development Colleagues: “...WOMEN, FAMILIES, PROVIDERS LETTER FROM THE When the Saving Mothers, Giving Life partnership AND POLICY-MAKERS NO LONGER launched, many doubted that we could ACCEPT DEATH DURING CHILDBIRTH significantly reduce maternal and newborn AS A TRAGIC BUT UNAVOIDABLE deaths in high-burden, low-resource sub-Saharan African countries in five years’ time. Yet, by PART OF LIFE.” working in partnership with the Governments of Cross River State, Nigeria, Uganda and Zambia, of the initiative. The results featured in this Saving Mothers, Giving Life has achieved report are based on the change between the SECRETARIAT impressive results. baseline and final assessments. With a more robust methodology, some of the final results — In five years, the maternal mortality ratio has while still remarkable — are lower than declined by 44% in Saving Mothers, Giving Life previously reported. districts in Uganda and by 41% in Zambia. In only two years, maternal mortality dropped by I would like to thank our partners at the 28% in Saving Mothers, Giving Life facilities in Ministries of Health in Cross River State, Nigeria, Cross River State, Nigeria. We attribute the Uganda and Zambia who have worked closely partnership’s success to the comprehensive with the Secretariat to ensure that Saving approach undertaken at the outset — Mothers, Giving Life was aligned with their needs, strengthening district health systems to priorities and aspirations — a critical foundation surmount the obstacles to a safe pregnancy and for long-term sustainability. I also feel fortunate childbirth. Saving Mothers, Giving Life did not to work alongside committed and caring limit its focus to one cause of maternal death or colleagues from U.S. Government agencies and one type of facility. Instead, our systems believe that we have benefited immensely from approach created a strong district-wide safety the diverse ideas and expertise of our non- net to protect women’s and newborns’ lives, governmental partners. Together, we have leveraging the infrastructure and lessons-learned accomplished much more than many expected. from the President’s Emergency Plan for AIDS Relief (PEPFAR) which has been so successful in Still, women around the world — many of them reducing HIV/AIDS. poor and from underserved communities — continue to die needlessly from complications Through the efforts of all Saving Mothers, Giving we can treat. Our hope is that other countries MATERNAL MORTALITY Life partners — host governments, private adapt the best practices identified through companies, U.S. government agencies, local and Saving Mothers, Giving Life. When they do, we RATIO DECLINED international NGOs, academic institutions — we are optimistic that we will be much closer to substantially increased the proportion of women ending the global tragedy of preventable giving birth in health facilities and enhanced the maternal and newborn deaths. We believe that UGANDA | 5 YEARS quality of care they received. At the same time, together we have redefined what is possible. we strengthened the capacity of Ministries of Health to provide essential public health services, With best regards, -44% creating a ripple effect that has improved healthcare delivery more broadly. Perhaps most ZAMBIA | 5 YEARS importantly, women, families, providers and policy-makers no longer accept death during -41% childbirth as a tragic but unavoidable part of life. A word about results: for the baseline and final NIGERIA | 2 YEARS assessments of Saving Mothers, Giving Life, we employed gold standard methodologies to -28% ensure that no maternal or newborn death went uncounted. These evaluations went beyond data gathered from facilities to include CLAUDIA MORRISSEY CONLON, MD, MPH rigorous population-based data collection to U.S. Government Lead, Saving Mothers, Giving Life help us understand the comprehensive impact Senior Maternal and Newborn Health Advisor, USAID Photo credit: Echwalu Photography 4 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT MEASURING SUCCESS: IMPACT 5

MEASURING SUCCESS: Stillbirths occurring DISTRICT-WIDE MATERNAL during delivery*** MORTALITY RATIO* 22.4 14.3 -36% 452 255 -44% 2012 2016 Proportion of all facilities IMPACT that reported monitoring PRE-DISCHARGE NEONATAL labor by partograph ** These figures represent some of Saving Mothers, UGANDA MORTALITY RATE 33.3% 92.4% +178% Giving Life’s key successes in supported districts 8.4 7.6 over two years in Nigeria and five years in Uganda -10% 2012 2016 and Zambia. The partnership achieved significant “... WE ANTICIPATE THAT THE Number of pregnant women reductions in maternal mortality and improved GROUNDWORK LAID BY THE who received medication to the quality of care that women receive during prevent mother-to-child pregnancy and childbirth. While improvements in PARTNERSHIP WILL RESULT transmission of HIV/AIDS newborn health have lagged behind, we anticipate IN MORE ROBUST DECLINES that the groundwork laid by the partnership will IN NEWBORN MORTALITY 1,262 6,837 +442% result in more robust declines in newborn mortality in the future. Efforts in each country varied based IN THE FUTURE.” on need, so the most significant indications of Proportion of hospitals success also differ between the countries. conducting maternal death audits

31.3% 94.1% +201% FACILITY MATERNAL Facility Stillbirth Rate*** DISTRICT-WIDE MATERNAL * MORTALITY RATIO* 53.2 36.5 -31% MORTALITY RATIO 313 225 -28% 480 284 -41% 2015 2018 Proportion of live births put 2012 2016 to breast and kept warm

within 30 minutes of birth NIGERIA PRE-DISCHARGE NEONATAL FACILITY STILLBIRTH RATE*** MORTALITY RATE** 34% 95% +179% 2.1 6.2 N/A 30.5 19.6 -36% 2015 2018 Proportion of newborns not breathing 2012 2016 at birth successfully resuscitated

Prior to Saving Mothers, Giving Life, newborn deaths in Cross 84% 95% +13%

River, Nigeria were often not considered significant and, as a ZAMBIA Proportion of all health result, not counted. However, Saving Mothers, Giving Life has The number of HIV-exposed facilities that have at ushered in a shift in mentality — and a new effort to track Proportion of women who received infants receiving medication Proportion of health centers least one long acting newborn deaths. While in the short-term this means an increase in reported newborn mortality, in the long-run we expect this uterotonics in the third stage of labor to prevent mother-to-child offering services 24 hours a reversible contraceptive new attention to data will result in improved programs and to prevent excessive blood loss transmission of HIV/AIDS day, 7 days a week method available anticipate a reduction in newborn deaths in the years to come. 46% 98% +113% 523 1030 +97% 64.8% 95.5% +47% 20.0% 71.3% +257%

* number of maternal deaths per 100,000 live births ** number of newborn deaths per 1,000 live births *** number of stillbirths per 1,000 births 6 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT SYSTEMS APPROACH 7

Christine Kyarisiima’s “Saving Mothers, Giving Life is a unique public-private baby was just partnership to advance maternal and perinatal health in HEALTH SYSTEMS born at the Saving Mothers, Giving Life low resource settings. CDC’s contribution to strengthen STRENGTHENING supported Kibiito maternal and perinatal death surveillance through Saving Health Center IV in Uganda and had not Mothers, Giving Life underscores the key role of yet been named. collaborative work with partners across sectors to protect Photo credit: moms and babies and improve health systems. CDC is SEEK REACH RECEIVE SYSTEMS Amy Fowler/USAID CARE CARE CARE honored to have supported the monitoring and evaluation to determine where this effort has been effective and to estimate the number of mothers and babies whose lives Health systems strengthening is a were saved.” strategy for improving the way an entire health system functions. It is ROBERT R. REDFIELD, MD the backbone of the Saving Mothers, Director, Centers for Disease Control and Prevention APPROACH Giving Life approach — enhancing the interconnected components of In 2012, 11 organizations came the health system simultaneously to together to establish Saving address the three delays to accessing Mothers, Giving Life, a public- lifesaving maternity care: the delays private partnership committed to in deciding to seek, reaching and the ambitious goal of dramatically receiving quality care. reducing maternal and newborn mortality in sub-Saharan Africa Health systems strengthening requires in five years. Saving Mothers, involving both public and private health Giving Life began in Uganda and providers and engaging everyone — Zambia, and in 2015, after from families and communities to promising early results, the district and national governments — initiative expanded to Nigeria. to save women’s and newborns’ lives.

Reducing maternal and newborn The benefits of the systems approach mortality is complex. Even with extend far beyond maternal health. careful planning, pregnancy and A strong, resilient health system childbirth complications can arise that is prepared to save the lives of with little or no warning. Health women and their babies is also better systems need to be nimble so they equipped to deliver care for community can respond immediately in the face That’s why Saving Mothers, Giving Sister Mbambazi Assumpta examines members suffering from a life- of an emergency. This requires access Life is designed to ensure that every Gladys Namusisi at Saving Mothers, Giving Life supported Kakumiro Health Center, threatening illness or a serious injury to the right equipment and medicines, pregnant woman has access to safe Uganda. Photo credit: Amy Fowler/USAID and respond to emerging health crises. appropriately trained staff and the and respectful services during ability to refer patients if necessary. pregnancy, labor and delivery, and, Kasongo and Uchishi were lucky, in the event of a complication, Safe Motherhood Action Group members but not everyone is able to travel so lifesaving emergency care within pose for a photo at the Lunga Health Center far or wait so long for care. two hours. in Zambia. Photo credit: John Healey

2 “Saving Mothers, Giving Life is an Initiative that showed how much can be achieved in a short time with THE ORGANIZING PRINCIPLES THINK SYSTEM MIND THE GAP TWO-HOUR WINDOW COUNT ALL DEATHS IMPROVE QUALITY & EXPERIENCE maximal effort.” The whole health system There can be no “weak Lifesaving care must be, Every maternal and newborn death Every woman deserves high-quality, TORE GODAL CONTRIBUTING TO THE must work well to save link” in the chain of care. at most, two hours away. should be counted and analyzed to respectful care at all times. Special Advisor to the Prime Minister of women’s and newborns’ lives. help prevent future tragedies. PARTNERSHIP’S SUCCESS Norway on Global Health 8 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A SUCCESSFUL PUBLIC-PRIVATE PARTNERSHIP 9

U.S. AGENCY FOR AMERICAN COLLEGE OF NIGERIA INTERNATIONAL DEVELOPMENT OBSTETRICIANS AND A SUCCESSFUL PUBLIC-PRIVATE GYNECOLOGISTS • Interagency lead for U.S. Government • Clinical training and • Secretariat overseeing mentorship for frontline partnership operations health providers • Technical assistance and • Professional society UGANDA oversight for in-country strengthening program teams EVERY MOTHER COUNTS

DEPARTMENT OF STATE • Global advocacy PARTNERSHIP • Transportation and • Initial development of Saving Mothers, referral systems ZAMBIA Giving Life FOUNDING PARTNERS HOST COUNTRY PARTNERS PARTNER INVESTMENT MERCK FOR MOTHERS The 11 founding partners designed From the beginning, host country For every dollar the CENTERS FOR DISEASE CONTROL AND PREVENTION • Private sector Saving Mothers, Giving Life to leverage governments were at the center of Saving U.S. government approaches, business each of their unique strengths and have Mothers, Giving Life to ensure the local partners (as shown • Monitoring and expertise and Merck produced impressive results in saving ownership and sustainability of the model. in the first column) evaluation Fellows the lives of women and their newborns. initially invested, • Technical assistance • Communications and ADDITIONAL PARTNERS other partners and oversight for in- Secretariat support country program teams Over the course of the initiative, the contributed an GOVERNMENT OF NORWAY Saving Mothers, Giving Life partnership additional $1.10. OFFICE OF GLOBAL AIDS has grown to include a broader and more COORDINATOR (OGAC/PEPFAR) • Financing to procure hospital supplies and diverse group of contributors. • Organizational and equipment during technical guidance “proof-of-concept”

PEACE CORPS PROJECT C.U.R.E.

• Community buy-in, • Medical equipment and support and training of supplies volunteer community health workers

DEPARTMENT OF DEFENSE

• Infrastructure improvements

Photo credit: John Healey 10 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT NIGERIA 11

EDUCATING MOTHERS WITH HELLOMAMA NIGERIA MOBILE PLATFORM HelloMama is a mobile platform DECLINE IN MATERNAL MORTALITY that provides messages about 28% maternal and newborn health directly RATIO IN JUST TWO YEARS to women, mothers and household decision-makers through voice and text messages. HelloMama is being deployed at 141 facilities in Cross Saving Mothers, Giving Life chose to the number of newborn deaths. The River State, as well as neighboring focus efforts in Nigeria in Cross partnership’s focus on newborn Ebonyi State, with 50 more facilities River State, a region with a low health has brought renewed attention expected to be added in the coming proportion of facility deliveries and to the issue, and now deaths of years. More than 30,000 women have high rates of maternal and newborn newborns are counted and reported. registered to-date. deaths. The first step was to The improved skills of the health Nelly Oru and Obi Helen are nurse- understand the existing maternity workforce are already reflected in the midwives in the antenatal care unit at safety net by conducting a Health measurable 31% drop in stillbirths, Holy Family Catholic Hospital, a faith- Facility Assessment of all public and and we anticipate this focus on cross river state • based secondary health institution. private maternity clinics and reporting and quality care to result in Working at the only referral hospital hospitals. This assessment revealed a reduction in newborn deaths in the in the area, Nelly and Obi see many very poor conditions and only four coming years. Women in need of more specialized Israel Nwafor reviews text messages services are now referred to the he received from HelloMama while high-risk patients and teach pregnant facilities — 1% of the total — his wife Monica was pregnant with nearest equipped hospital, whether women how to recognize danger signs performed all basic emergency To ensure sustained gains, Saving Chibuzor (in background). Israel and it is public or private. With both Monica will continue to receive age- so they know when to come in to see obstetric and neonatal care functions. Mothers, Giving Life has supported sectors working in tandem, more appropriate messages until Chibuzor a nurse or doctor. “We teach them important health system changes, is one year old. Photo credit: Karen than 90% of women in the State [mothers] things here but they forget,” To encourage women to deliver in including institutionalizing maternal Kasmauski/MCSP now have access to quality Nelly said. “So HelloMama reinforces facilities and improve the quality of and perinatal1 death surveillance at emergency obstetric care within what we teach.” care they receive, Saving Mothers, the state and facility level. Health two hours. Giving Life trained doctors, nurses, providers received training in data midwives and community health collection, analysis and reporting and Nelly Oru (left) and Obi Helen (right) are midwives at Holy Family extension workers in key lifesaving facilities have started sharing data WHAT’S NEXT Catholic Hospital in Nigeria. Photo credit: Justin Maly, Pathfinder practices: recognizing danger signs with district health information during pregnancy; managing systems. The partnership also Given the achievements in Nigeria emergency obstetric and neonatal provided technical support to the in two short years, Saving Mothers, care; performing essential newborn Cross River State Ministry of Health Giving Life is expanding to care; conducting postpartum family to conduct assessments of the quality improve the quality of care in planning; and delivering youth- of data that facilities were providing. additional facilities in Cross River friendly services. This increase in The findings indicate a marked State and increasing the focus on skills led to measurable improvements improvement in the documentation family planning. Saving Mothers, in the quality of care offered. For and reporting of service delivery data, Giving Life is also boosting efforts example, after two years, 98% of especially at the facilities supported to encourage women to deliver in women are receiving uterotonics by Saving Mothers, Giving Life. quality facilities by stepping up during the third stage of labor and community mobilization 95% of newborns are warmed and A key contributor to success in activities and collaborating with put to breast within 30 minutes. Nigeria is the linkage between public, religious and other community private and faith-based facilities, as leaders to champion safe Prior to the start of Saving Mothers, well as primary and secondary motherhood practices. Giving Life, newborn deaths were so facilities, which has led to stronger REDUCTION IN common that they were often not referral systems and improved 31% even counted, meaning that we are working relationships between STILLBIRTHS Mbam Amuche, 27, just delivered under the care of the head midwife at a Catholic hospital run by the Medical Missionaries only now beginning to understand service providers in each sector. of Mary order of nuns. Photo credit: Karen Kasmauski/MCSP

1 Perinatal deaths refer to stillbirths and pre-discharge neonatal deaths in health facilities For additional information on the partnership’s achievements in Nigeria, please visit www.savingmothersgivinglife.org. 12 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT UGANDA 13

MAMA AMBASSADORS “Every Mother Counts invested in ENCOURAGE ANTENATAL CARE the boda boda voucher program, which provides transport vouchers for pregnant and postpartum Margaret Abigaba is a MAMA women to reach health facilities in Ambassador for Saving Mothers, Giving the districts of Kabarole, Life in Kyenjojo, Uganda, educating the Kamwenge and Kyenjojo. The community about safe motherhood UGANDA voucher program has transported practices and encouraging women over 100,000 mothers to health to seek facility-based care. According DECLINE IN MATERNAL MORTALITY facilities and supported the to Margaret, “I used to hear about 44% livelihoods of over 500 boda boda many mothers who had complications from giving birth in the village and RATIO IN FIVE YEARS riders. We are proud of the not coming to the health center. contribution of the voucher I wanted to educate the women in my program in mobilizing communities village [about antenatal care] and the 1 KaBAROLE 8 GULU and addressing the critical delays importance of a healthy baby.” 2 KAMWENGE 9 pader mothers experience trying to reach During Oliver Rwabajuguru’s quality care in health facilities. 8 9 3 KYENJOJO 10 LIRA pregnancy, Margaret offered her 4 KAGADI 11 dokolo Saving Mothers, Giving Life has guidance on antenatal care visits, 7 13 had a notable impact on improving 5 KIBAALE 12 apac transportation to the health facility maternal health outcomes in 10 6 KAKUMIRO 13 OMORO and the importance of HIV testing Uganda, and I am so pleased by for her and her partner. Oliver was 12 11 7 nwoyo the accomplishments of our at Kyenjojo Hospital for her third collective efforts.” antenatal checkup when she started experiencing contractions at just seven The quality of care that women 6 CHRISTY TURLINGTON BURNS months. She delivered Chris Baguma 4 received in health facilities also 5 Founder & CEO, Every Mother Counts in the hospital later that day. “Margaret 3 improved significantly thanks to 1 helped me very much because if I had training and mentoring programs A mother at Kyenjojo Hospital in Uganda uses kangaroo mother Units (SCNU) in select facilities 2 not been taught about the facility, for both private and public health care to keep her premature baby warm. Kangaroo mother care and trained providers on special is one intervention used in the Special Care Newborn Unit (SCNU). I may have delivered at home,” Oliver providers, coupled with supportive care for small and sick babies. Early Photo credit: Amy Fowler/USAID said. “Then my baby wouldn’t have supervision visits to maintain skills. breastfeeding — a key intervention REDUCTION IN 36% received care, so he survived thanks For example, there has been an to save newborn lives — became a to education from Margaret.” impressive 36% reduction in integrated HIV testing and priority and today, 85% of infants STILLBIRTHS stillbirths occurring during labor treatment and postpartum family born in a Saving Mothers, Giving OCCURRING In Uganda today, more than and delivery, as well as an increase planning services into routine labor Life health facility are breastfed MAMA Ambassador Margaret Abigaba (right) with mother Oliver in the rate of caesarean deliveries and delivery services. The number in the first hour of life, compared Rwabajuguru at Saving Mothers, Giving Life supported Kyenjojo two-thirds of all pregnant women DURING DELIVERY Hospital in Uganda. Photo credit: Amy Fowler/USAID living in Saving Mothers, Giving to 9%, up from 5% in 2012. Most of women who received to only 23% in 2012. Together, Life districts give birth in a health notably, the proportion of women prophylaxis or treatment for the these efforts helped contribute to facility, up from 46% in 2012, when who died in a health facility due to prevention of mother-to-child a 10% reduction in newborn deaths Saving Mothers, Giving Life began. pregnancy complications declined transmission of HIV and AIDS before discharge. A few key factors contributed to by nearly half. increased five-fold during the this success. First, Village Health course of the partnership. And Teams mobilized to educate women To help ensure more today, 94% of hospitals have at least WHAT’S NEXT and their families about safe comprehensive care for women, one long acting family planning motherhood and preparing for Saving Mothers, Giving Life method available. In 2016, the Ministry of Health used birth. Next, a boda boda voucher the Saving Mothers, Giving Life program subsidized the cost of “Something I can be very proud of — While there has been steady approach as a basis for the maternal motorcycle taxi transportation, I call it new — is the attitude of progress in improving maternal and child health activities included making it more affordable for mothers in the community. They health, reducing newborn deaths in its updated national-level health women to reach a health facility. had lost hope in the health system. has proven more challenging. In strategy. The government has Additionally, as the partnership With Saving Mothers, Giving Life, 2015, Saving Mothers, Giving Life determined how to fund equipped lower-level facilities mothers now find it convenient to redoubled its efforts to care for implementation in each district, to manage complications of deliver in facilities.” newborns. The partnership and now Saving Mothers, Giving pregnancy and childbirth, many established newborn corners for Life best practices are being rolled

women were able to access care DR. RICHARD MUGAHI resuscitation in all delivery rooms, out across the country. closer to home. District Health Officer, Kaborole District renovated Special Care Newborn

For additional information on the partnership’s achievements in Uganda, please visit www.savingmothersgivinglife.org. 14 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT ZAMBIA 15

A new Saving Mothers, Giving Life supported mothers’ shelter at Nkhanga Rural SAFE MOTHERHOOD ACTION Health Centre. Photo credit: Amy Fowler, USAID GROUPS IN

Matil Dalu Zimba‘s original plan was to give birth to baby Rhema at home, just as she had with her other two children. Then, local SMAG members ZAMBIA came to her village to pay her a visit. They explained the importance of DECLINE IN MATERNAL MORTALITY giving birth in a health facility with 41% the aid of a skilled attendant to help RATIO IN FIVE YEARS ensure that she and Rhema would be healthy. Although Matil was initially skeptical, eventually the SMAGs’ Progress in Zambia is due in large For example, Saving Mothers, Giving regular visits won her over. part to Saving Mothers, Giving Life’s Life built and upgraded mothers’ The SMAG members’ persistence creative efforts to overcome the shelters — residences close to a also made an impact on Matil’s transportation challenges in rural health facility that offer husband, Whyson Luhana, who learned areas, where a woman’s village may accommodations for women in the how critical it was for mom and baby be several hours’ walk from the late stages of their pregnancy so to receive proper care. When Matil’s nearest health facility, and few they no longer have to travel for mentoring approach, together with Zambia also experienced significant A mother waits at the Lundazi Urban Health Center to receive vaccinations for labor started, Whyson took her to people own cars, motorcycles or hours on foot when they go into supportive supervision, has led to advances in perinatal health — her son. Photo credit: Amy Fowler/USAID Lundazi Urban Health Centre to make even bicycles. labor. Now, nearly 50% of Saving an impressive 65% reduction in including a 36% reduction in sure she and Rhema were cared for by Mothers, Giving Life facilities have deaths from postpartum bleeding, stillbirths occurring in the facility — professionals he trusted. an associated mothers’ shelter. the leading cause of maternal thanks to training on dealing with “This is my first girl child, so I am mortality, and a 79% increase in complications during delivery, REDUCTION IN very excited and happy. I love my wife, so I came to see what happens and To encourage women to seek care, cesarean section rates, an indication including resuscitation efforts for 36% STILLBIRTHS take responsibility with her.” Saving Mothers, Giving Life trained of providers’ ability to recognize newborns. More than 3,500 respected community members as and address complications. newborns have been successfully OCCURRING IN Safe Motherhood Action Groups Additionally, providers began using resuscitated since Saving Mothers, Matil Dalu Zimba (left) and Whyson Luhana (right) delivered Rhema 3 8 a new lifesaving technology called Giving Life began, and three- at Lundazi Urban Health Center due to Safe Motherhood Action Group (SMAGs) who teach pregnant women FACILITIES counseling. Photo credit: Amy Fowler/USAID 4 7 about the importance of delivering the uterine balloon tamponade, quarters of facilities now report in a facility, having a birth plan and which can help stop heavy obstetric successfully resuscitating newborns 6 practicing healthy behaviors during bleeding and stabilize women for who were born with difficulty pregnancy and early childhood. transport to a higher-level facility. breathing, compared to just 27% at 16 SMAGs conduct home visits to the start of the partnership. women throughout their pregnancy Likewise, the number of infants 13 12 14 15 to offer guidance and instructions “Lundazi was chosen as one of the who were breastfed in the first hour 5 9 and inform them about mothers’ Saving Mothers, Giving Life of life — another lifesaving shelters. At final evaluation, 96% of ‘proof-of-concept’ districts due to its intervention — increased by over 18 facilities had associated SMAGs. high rate of maternal deaths and 90% in Saving Mothers, Giving Life under-reporting of deaths. Today, supported facilities. Together, these activities have led the rate of maternal mortality in 10 11 to 90% of women delivering in target districts in Zambia has 1 facilities today, a major increase decreased by 41%, and thanks to WHAT’S NEXT from 63% in 2012. improved data reporting systems, 2 1 Kalomo 10 Choma 17 The Saving Mothers, Giving Life 2 Zimba 11 Pemba the district health center is able to Saving Mothers, Giving Life also chart progress and use data to drive model has been incorporated into 3 Mansa 12 Chipata focused on improving the quality of decision-making. It works because Zambia’s national plan for 4 Chembe 13 Petauke facility-based care to prevent and all of the pillars are attached. This reproductive, maternal, newborn 5 Nyimba 14 Sinda treat major causes of maternal holistic approach has brought results. and child health. The approach is 6 Lundazi 15 Vubwi death. The partnership identified a We’re not yet where we want to be, being scaled up nationally with financial investments from the 7 Samfya 16 Mambwe core group of “star” midwives who but we have moved closer.” travel to primary care facilities to government and external sources. 8 Lunga 17 Livingstone supervise and counsel their peers DR. DAVY ZULU 9 Kabwe 18 Luangwa on safe childbirth practices. This Health Director

For additional information on the partnership’s achievements in Zambia, please visit www.savingmothersgivinglife.org. 16 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT STRENGTHENING THE WHOLE HEALTH SYSTEM 17

STRENGTHENING THE WHOLE Here’s how Saving Mothers, Giving Life HEALTH INFORMATION SYSTEMS strengthened the whole health system simultaneously to save women’s and • Performing maternal and newborn death newborns’ lives. audits that help providers identify mortality trends in their facilities and take action to prevent future deaths HEALTH SERVICE DELIVERY • Conducting capacity-building workshops for HEALTH SYSTEM countries’ public health professionals so they “Maternal deaths can better monitor and evaluate progress in are devastating for • Training and mentoring health providers to reducing mortality for years to come families, communities strengthen the quality of the care they deliver and countries. USAID • Increasing the number of health facilities able has been privileged to to provide high-level emergency care to treat lead the dynamic pregnancy and childbirth complications Saving Mothers, ACCESS TO ESSENTIAL MEDICINES Giving Life • Improving the quality of care for small and sick partnership that has babies by training health providers in neonatal • Training providers in supply chain resulted in dramatic resuscitation and Kangaroo Care2 management to reduce stockouts of essential reductions in maternal medicines and supplies deaths by 44% in Uganda and 41% in • Ensuring mothers receive medication to Zambia over the last prevent hemorrhage five years, and a 28% HEALTH WORKFORCE reduction in Nigeria over just two years. • Recruiting and training community volunteers Saving Mothers, to educate women, their families and HEALTH SYSTEMS FINANCING Giving Life is concrete communities about healthy pregnancy and proof that targeted safe childbirth investments to save • Establishing community insurance pools and • Deploying “star” midwives who make monthly women and newborns village savings and loans groups so the cost of visits to local facilities where they work are not only effective, care is not prohibitive for poor families alongside other midwives, modeling best but have the added Health systems strengthening recognizes that practices and offering real-time support and • Educating women and their families about value of creating the many components of a health system are constructive feedback the free public health services to which they lasting improvement interconnected and interdependent, so any are entitled in the delivery of improvements made to one are temporary unless • Addressing workforce shortages by promoting health care.” the other components are strengthened at the task sharing where appropriate and supporting same time. For example, encouraging a pregnant policy changes that incentivize providers to MARK GREEN woman to seek care is only effective if she is able work in rural facilities; utilizing retired Administrator, USAID to reach a well-equipped facility and there is a midwives to fill short-term staffing needs LEADERSHIP AND GOVERNANCE skilled provider available to treat her. • Recruiting local village chiefs as champions for safe motherhood in their communities

• Working with Ministries of Health to build leadership capacity, as well as develop and execute plans to ensure long-term sustainability of health system gains

To complement other efforts, Saving Mothers, Giving Life supported several 2 Kangaroo Care, also known as Kangaroo Mother Care or • Partnering with District Medical Officers and infrastructure improvements, including construction of mothers’ shelters like KMC, is a low-tech intervention that is used to help very district health management teams to ensure the one shown in this photo. Photo credit: Amy Fowler/USAID small and sick newborns stay warm using the mother’s body heat in contexts where infant incubators are not available or the Saving Mothers, Giving Life approach is where electricity is unreliable. integrated into the existing health system 18 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A SYSTEMS APPROACH TO ADDRESS ALL THREE DELAYS 19

A SYSTEMS APPROACH TO ADDRESS ALL Grace Kushemererwa is a radio news anchor on 102 KRC FM in Uganda. Through a partnership with Saving Mothers, Giving Life, Grace uses her daily radio program to educate her listeners about best practices for pregnant women and new mothers, including the THREE DELAYS importance of antenatal visits and facility delivery. When Grace became pregnant Joemark Zimba, Ivy Mtonga, Maliba Maliba Chima (third from left) works with her daughter, Mariam, she applied “Peace Corps is proud to continue UNDERSTANDING WHY Chima and Malita Zimba are all Safe with chiefs and traditional leaders in the best practices she shared on air to our collaboration with Saving WOMEN DIE: THE THREE Motherhood Action Group (SMAG) 15 villages across the region, educating her own life. “If I can talk to these people Mothers, Giving Life to help members in Lundazi, Zambia. They them about the importance of safe encouraging antenatal care, why not me? communities aggressively reduce DELAYS MODEL conduct home visits to families where delivery so they can become champions Let me go check it out so I can tell them maternal and newborn mortality. they talk about nutrition during of change. about it.” Through this partnership, Peace pregnancy, HIV testing and treatment Corps Volunteers work directly Maternal health experts agree that and caring for mom and baby. Photo credit: Amy Fowler/USAID Photo credit: Amy Fowler/USAID with local Safe Motherhood Action the factors responsible for women Groups to educate women and their not receiving the lifesaving care families about the importance of they need can be thought of in three essential maternal health services overarching categories, known as the “Three Delays.” From the very and the risks associated with giving start, Saving Mothers, Giving Life birth at home. Already, Volunteers was designed to address all three and their counterparts have seen a delays to ensure that women are threefold increase in pre-14 week able to receive timely, quality appointments for pregnant mothers. maternity care. The stories on the Peace Corps’ unique presence on next several pages illustrate how. the ground enables Volunteers to work with local leaders and health workers to help secure the 1 community buy-in that sustains long-term results.”

DELAY IN THE DECISION JODY OLSEN TO SEEK CARE Director, Peace Corps

A woman’s decision to seek appropriate medical care might be influenced by things like her knowledge of when, where, why and how to seek services, her understanding of warning signs of a serious complication, the cost of travel to a facility, her concerns about the quality of treatment she will receive and her decision- Mr. Zimba Daveson is a Senior Group Mr. Daveson said. “Men are learning from making ability within her family. Headman — a respected community the SMAGs and encouraging their wives In all three countries, Saving leader who oversees a number of villages and in-laws to come to the facility.” Mr. Mothers, Giving Life focused on near Nkhanga Rural Health Center in Daveson also visits with pregnant women educating women and their Zambia and joins SMAG community in his villages to encourage them to give families about safe motherhood, meetings to reinforce efforts to educate birth in a facility, helping to make facility the importance of giving birth in men on the importance of facility delivery delivery a cultural norm. a facility and preparing for the for their wives. “[The] SMAG program has cost of birth. improved our lives and our community,” Photo credit: Amy Fowler/USAID 20 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A SYSTEMS APPROACH TO ADDRESS ALL THREE DELAYS 21

“The American College of Obstetricians and Gynecologists is A SYSTEMS APPROACH TO proud to be a founding partner of Saving Mothers, Giving Life — a In Cross River State, Nigeria, Saving wonderful and lasting example of ADDRESS ALL THREE DELAYS Mothers, Giving Life engaged community mission-driven partners collaborating stakeholders in 63 wards to set up to become a powerful force for good. effective, sustainable, community-driven Emergency Transportation Services to It has been a privilege to assist our ensure pregnant women get to health fellow professional societies in facilities safely and in a timely manner. implementing innovations to 2 DELAY IN REACHING CARE Saving Mothers, Giving Life supported Ward Development Committees to map prevent maternal deaths, including out catchment areas, recruit and train the use of the uterine balloon volunteer emergency drivers and mobilize tamponade. The lessons learned Once a woman and her family make the decision to seek skilled care in a funds to maintain this system. Within 18 will benefit not only those women health facility, they must determine how to get there. In remote and rural months, over 200 women have been safely whose lives were saved during the areas, the nearest health facility might be hours away and transportation transported, and two thirds of the wards initiative but also those whose options can be limited. Poor infrastructure, difficult terrain and financial are generating funds locally to sustain deliveries will follow. constraints also contribute to delays in reaching care. In Nigeria, Uganda transportation services. and Zambia, Saving Mothers, Giving Life developed innovative strategies Reducing maternal deaths to help women overcome access barriers. Photo credit: Kazeem Arogundade, Pathfinder everywhere is imperative, and we remain committed to working with our partners to fulfill that vision.

HERBERT PETERSON, MD, FACOG Chair of the Global Operations Advisory Group, The American College of Obstetricians and Gynecologists

“Engagement of the U.S. Department of Defense in Saving Mothers, Giving Life was a privilege with high-impact positive consequences that continue to this day. The Zambian Defense Force and Uganda Peoples’ Defense Force fully took on the Saving Mothers, Giving Life mission and successfully enhanced maternal and infant medical care, resulting in lives saved and families remaining intact. Across Uganda, motorcycle taxis are one Giving Life in Kabarole, Uganda. When Importantly, not only have these of the fastest and most reliable ways Sarah Olihiriza went into labor, she sent clinical improvements proliferated Distance and transportation aren’t the women if transportation to a higher-level for pregnant women to travel to health her eldest child next door to call Deo, who and continued, Saving Mothers, only considerations when transferring facility is needed. Thanks to the advocacy facilities, but they can be prohibitively came quickly and transported Sarah up Giving Life created a culture to women experiencing complications to conducted by Saving Mothers, Giving Life, expensive. To address this challenge, mountainous dirt roads for 45 minutes ensure safe pregnancies and higher-level facilities for care — they this training and mentorship has been a Saving Mothers, Giving Life voucher to Nyataboma Health Center III, where deliveries, contributing to family must be medically stable to make the incorporated into the national Emergency program allows women to purchase a Sarah had a safe delivery. When asked health with military readiness.” trip. That’s where the uterine balloon Obstetric and Neonatal Care curriculum subsidized voucher for transportation about his job as a boda boda driver, Deo tamponade (UBT) comes in. In Zambia, to and from the health facility for four said, “I wanted to help people in the to ensure that doctors, nurses and RICHARD A. SHAFFER, PHD, MPH Saving Mothers, Giving Life trained midwives have the skills necessary to antenatal visits, delivery and a post-natal community because I felt bad about the Chief, Department of Defense HIV/AIDS frontline health care providers in a new utilize this lifesaving technology. visit — all for the equivalent of USD 25 deaths of mothers.” Prevention Program technology called the UBT, which treats cents. Deo Mungenyi is a boda boda heavy obstetric bleeding and can stabilize Photo credit: ACOG (motorcycle) driver with Saving Mothers, Photo credit: Amy Fowler/USAID 22 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A SYSTEMS APPROACH TO ADDRESS ALL THREE DELAYS 23

During data review meetings at Immanuel Infirmary Hospital — a private, faith-based A SYSTEMS APPROACH TO facility in Cross River State, Nigeria — Mercy Udo-Ewa, a nurse-midwife and facility data manager trained by Saving ADDRESS ALL THREE DELAYS Mothers, Giving Life, reviews the trends in maternal and newborn health and family planning services with her team. These meetings, which Saving Mothers, Giving Life helped institutionalize, provide the DELAY IN RECEIVING MEDICALLY-APPROPRIATE opportunity to use facility data to identify 3 challenges, monitor progress and plan for QUALITY CARE future quality improvements. “Project C.U.R.E. is extremely proud Photo credit: Olajumoke Azogu of the results of Saving Mothers, Getting a woman to a health facility is critical, but may not be enough to Giving Life, and we are thrilled that save her life if the care she receives there is poor. Too often health facilities we had a part to play in this lack medical supplies and equipment, properly trained health providers important work. and strong referral systems to higher level care. That is why a centerpiece of Saving Mothers, Giving Life is strengthening the quality of clinical care women receive. For us at Project C.U.R.E., these results are greater than the 41 semi-truck sized containers of medical equipment and supply donations. Our partnership with the other members of Saving Mothers, Giving Life means that the nurses and doctors are well trained, sound systems are in place, expectant mothers have access and the tools Project C.U.R.E. provided will be used to save lives. This success will live into the future as others use the lessons we have learned to expand the results in their part of the world. When Gwenny started convulsing during the final month of her pregnancy, her Congratulations. Together, we family rushed her to the nearest rural moved the needle in a very health center. Grieveness is a nurse significant way.” at the Kawama Clinic in Zambia and participated in a Saving Mothers, Giving DOUGLAS JACKSON, PHD, JD Life on-the-job mentorship program President/CEO, Project C.UR.E. on managing complications during pregnancy. When Gwenny arrived at the clinic, Grieveness recognized that she was experiencing eclampsia and Judith Deborah Ahaisibwe, held by her functioning equipment, Judith was sent followed treatment protocols she learned. mom, Immaculate Nakito, was born at home with her parents. She will soon Gwenny administered a lifesaving drug 5.5 months weighing well under two celebrate her first birthday, without any that stabilized Gwenny until she was pounds. Judith was born in a primary complications from her premature birth. transferred to a higher-level hospital for health center near their home and her According to Immaculate, “I appreciate a safe delivery. According to Grieveness, father quickly rushed her — in the middle the service I received here, and without “mentorship is good because you are of the night — by boda boda to the Saving the support of Saving Mothers, Giving Life taught right in your environment. Even Mothers, Giving Life supported Special to build the newborn unit, I would have before you go for formal training, you can Care Newborn Unit (SCNU) at Kagadi lost my baby.” still learn something and save a life.” Hospital in Uganda to save her life. After one month in the SCNU, benefitting from Photo credit: Amy Fowler/USAID Photo credit: Eunice Zimba constant care from trained midwives and 24 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT INNOVATION SPOTLIGHT 25

A newborn rests at the Immanuel Infirmary in Cross River State, Nigeria. Photo credit: Amy Fowler/USAID INNOVATION COMMUNITY ENTREPRENEURSHIP

LAUNCHING SUSTAINABLE MOTHERS’ The Mothers’ Shelter Alliance — SHELTERS IN ZAMBIA a collaboration amongst several SPOTLIGHT Saving Mothers, Giving Life partners — is training community members and In addition to supporting private women staying at the shelters on PRIVATE CARE providers in Nigeria and Uganda, entrepreneurship, business Saving Mothers, Giving Life adopted management and financial literacy. business-driven approaches to Already, more than 20 community- In many countries, people seek care connect women to the care they support mothers’ shelters in Zambia. from private health care providers. need. Both public and private led micro-businesses — ranging Pregnant women are no exception. facilities now apply standard from grinding mills to goat rearing — Mothers’ shelters — residences next Yet the private health sector is guidelines and protocols in are helping pay the operating costs to a health facility where women typically overlooked by quality partnership with the State Ministry for nearly half of the Alliance’s can stay during the late stages of improvement efforts even though of Health, which is able to provide 24 shelters. The success of these pregnancy and after giving birth — the quality of care that private — as oversight to enhance the quality of businesses demonstrates how can be the linchpin in encouraging well as public — doctors, midwives maternity care in all settings. By communities can mobilize to prevent women from rural areas to give birth and nurses offer can vary. As part of better linking public and private maternal deaths and create business in a health facility, but they need to its comprehensive systems facilities, more than 90% of all opportunities with long-term health be sustainable. approach, Saving Mothers, Giving women in Cross River State now and economic benefits. Life is committed to improving the have access to comprehensive quality of care in both the public emergency maternity care if any and private sectors so that women complications arise. receive quality care no matter where they choose to give birth. SUPPORTING PRIVATE PROVIDERS “We understood that we could not IN UGANDA LINKING LOCAL PUBLIC AND PRIVATE rely on business as usual to save lives — we would need to invent CARE IN NIGERIA As small business owners who new partnership models. The may employ members of their success of Saving Mothers, Giving Saving Mothers, Giving Life is communities, private providers Life not only speaks to the strengthening public and private often have different needs than commitment of all partners to this maternity care throughout Cross public ones. In Uganda, Saving vision, it delivers on the promise of River State and helping providers Mothers, Giving Life led an public-private sector partnerships in both sectors work together so innovative effort to help private to solve our most pressing global that a woman receives quality care midwives both improve the quality health challenges.” wherever she seeks it. A Saving of their maternal health services Mothers, Giving Life-commissioned and strengthen their businesses. mapping of the time it takes to Partners provided technical NAVEEN RAO, MD Lead, Merck for Mothers travel to lifesaving care showed support on clinical issues as well as that private facilities are critical to training on financial management, providing comprehensive patient flow and developing emergency maternity care in Cross marketing plans. They also linked By strengthening private health Jenerose Waiswa is an businesses in Uganda, more than enrolled midwife and owner River State. The partnership private midwives to a loan of St. Maama Tereza Clinic The Mothers’ Shelter Alliance introduced an innovative mode of established a network of public and guarantee program which helped 50,000 deliveries took place in Domicilary in Nsenkwa, farming, called key hole gardens, which help women with limited mobility during pregnancy grow food for the shelter. While women private facility clusters that share an pay for upgrades to their clinics, quality-assured private facilities Uganda. Photo credit: Vanessa Vick stay in the shelters, they are taught to grow their own vegetables. integrated record-keeping system enabling them to serve more and over 200,000 women had Many are also adopting the method once they return home. and a seamless referral system to women and families. improved access to care. Photo credit: ZCAHRD/Boston University 26 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A DRAMATIC RETURN ON INVESTMENT 27

A DRAMATIC RETURN ON

An important consideration for any ambitious global health initiative is cost and how to assess return on investment. When it comes to efforts to improve maternal and newborn health, there are few that INVESTMENT have been as rigorous as Saving Mothers, Giving Life in capturing The benefits of a strong health system reach far beyond data on both health outcomes and maternal and newborn health. While Saving Mothers, expenditures — so comparisons are Giving Life has proved effective in decreasing maternal HEALTH INFORMATION SYSTEMS difficult. Early investments in and newborn mortality, it is also strengthening the Saving Mothers, Giving Life target districts were substantial in order health system to address other health needs. • Strong public health surveillance to build infrastructure and systems that are equipped to management systems. After this assess maternal deaths and, to an initial phase, operating expenditures increasing degree, newborn deaths were reduced as interventions were and evaluate progress in reducing HEALTH SERVICE DELIVERY integrated into the health system, mortality are better able to track facilities were better equipped and other health priorities more efficient and systems like • Strengthened frontline health facilities maternal death reviews became allow providers to offer a variety of standardized. These investments quality primary and preventative will continue to yield dividends services, including well-baby visits and ACCESS TO ESSENTIAL MEDICINES and, moving forward, the routine immunizations governments of Cross River State, • Better integration between the public • Improved supply chains ensure that Nigeria, Uganda and Zambia will be and private health sectors allows a variety of medicines are available able to sustain key components of women to receive quality care at health facilities, so providers and Saving Mothers, Giving Life with a wherever they choose to seek patients have what they need, when much lower level of investment maternity care they need it than previously required.

• Facilities newly outfitted with SAVING MOTHERS, GIVING LIFE MANAGED operating rooms and blood banks for cesarean sections are also being used HEALTH SYSTEMS FINANCING INITIAL PARTNERSHIP INVESTMENT HOST GOVERNMENT MANAGED for other surgeries SCA • The Governments of Uganda and LE-U • Improved referral and transportation P Zambia have incorporated Saving systems ensure that patients with • Conducting a rigorous baseline ONGOING OPERATIONS Mothers, Giving Life best practices into critical needs can access the medical evaluation • Targeting their national plans and have outlined care they require • Identifying gaps and areas for investments toward costed implementation strategies to persistent challenges, such as investments • Paying health worker salaries fund these efforts newborn health • Improving infrastructure, like • Continuing to apply established • Leveraging existing materials to HEALTH WORKFORCE access to water and electricity best practices, like maternal train more health workers LEADERSHIP AND GOVERNANCE • Training health workers and death reviews • Community health workers’ strong • Using existing facility data to developing materials • Continuing to equip facilities relationships with the communities measure progress • Seasoned country and district health with medicines they are serving now enable them to • Increasing access to surgical leaders who helped drive the success • Streamlining management provide education and outreach care and blood banks of Saving Mothers, Giving Life are able processes related to many health issues, • Generating demand at the to take on new health challenges that including HIV testing, nutrition, water, community level require managing complex sanitation and hygiene and control of partnerships infectious diseases

Photo credit: Amy Fowler/USAID 28 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A SUSTAINABLE PATH FORWARD 29

HON. DR. JANE RUTH ACENG A SUSTAINABLE PATH Minister of Health, Uganda “Lessons from Saving Mothers, Giving Life were instrumental in shaping the Government’s policy for addressing maternal and newborn mortality in Uganda. These were adopted in the costed Reproductive, Maternal, Newborn, Child and Adolescent Health Sharpened Plan for which the Government will be scaling up to FORWARD the whole country.” HOST GOVERNMENT OWNERSHIP

From the very beginning of the working and chart a course forward partnership, Saving Mothers, Giving by involving all stakeholders — Life focused on ensuring the government, implementing sustainability of its lifesaving gains organizations and community by working closely with the host members — in reviewing data. governments, which will ultimately Now this vital work is happening assume full responsibility — a independently, without support model of collaboration ready for from the partnership. replication in other countries. These are examples of how Saving Mothers, Giving Life’s government Exhildah Chola Chate, a THE LEADERSHIP OF THE MINISTRIES partners have integrated the initiative’s principles and approaches for Safe Motherhood Action KEY ELEMENTS TO SECURE Group member, helps Ruth GOVERNMENT OWNERSHIP AND lasting impact: Mushinge and her husband OF HEALTH IN CROSS RIVER STATE, Moses as they use a bicycle ENSURE SUSTAINABILITY to go to the Mundabi Health NIGERIA, UGANDA AND ZAMBIA HAS UGANDA ZAMBIA Center in Mundabi, Zambia. Photo credit: John Healey BEEN CRITICAL TO THE SUCCESS OF • Host government engagement in SAVING MOTHERS, GIVING LIFE. guiding program strategy, plans • The Ugandan Parliament passed a • The Zambian Ministry of Health and implementation federal wage bill that provides endorsed the Saving Mothers, incentives to physicians who work Giving Life supportive supervision Here are their thoughts on the partnership’s legacy and the road ahead. Namukisa Cissy (third from right) is a • Partnership activities that align alongside nurses and midwives in model, which deploys “star” DR. KENNEDY MALAMA village health team member at Kagadi with national priorities, efforts rural facilities. midwives to mentor their peers, Permanent Secretary, Ministry of Health, Zambia Hospital in Uganda. She was trained and expenditures and is implementing it across the by Saving Mothers, Giving Life to escort DR. IYANG ASIBONG “Saving Mothers, Giving Life’s health systems women from her village to the clinic • The Ugandan Ministry of Health health system. and educate them on the importance of Commissioner for Health, Cross River State, Nigeria approach is a catalytic one because it builds • Funding arrangement that enables assumed the cost of 147 staff who delivering in a facility. Photo credit: ownership — and that is the type of approach that Amy Fowler/USAID host governments to gradually were hired by Saving Mothers, • Zambia’s national guidelines “Cross River can only truly prosper if the health of can be sustained. It ties communities to district increase their financial support as Giving Life. for treatment of postpartum women and children is a priority at all levels of health leadership and national policy makers, donor funding declines each year hemorrhage now include the government with sustained commitment. We all know the adage ‘educate a woman and you and even when support is over, you have a • The Ugandan government has uterine balloon tamponade. educate the whole community; if a woman is strengthened primary health care system. • Capacity building to create a rolled out national guidelines public health workforce that uses healthy, the whole is family is healthy.’ This is why on Maternal Perinatal Death NIGERIA data to drive decision-making in Surveillance and Response — the concerted effort by Saving Mothers, Giving There is heightened political awareness of maternal maternal and perinatal health the first time the government is Life, in collaboration with the Cross River State and newborn deaths. Now, at routine provincial • The Cross River State officially counting perinatal Government, civil society organizations and epidemiological meetings, maternal deaths are Government has incorporated • Enabling policies to sustain gains deaths, demonstrating a international development partners, is so important. discussed and the questions asked: ‘Why are several key components of Saving in improving the quality of care commitment to strengthening mothers dying? What must we do?’ Saving Mothers, Giving Life into the offered in primary health centers data systems to improve the We know our success stories but we need to put it in Mothers, Giving Life has been a wake-up call. system, including trainings, delivery of health services. pen and paper, black and white, so that we can use coordination between private and this to talk to other people and showcase everything Everyone is now concerned when there is the In all three countries, Saving public facilities, data review Saving Mothers, Giving Life and the Cross River death of a mother. We’ve taken this concern and Mothers, Giving Life has provided meetings and the Emergency foundational support to help Transport System. State Government have done to reduce maternal put it into high national targets for improving governments determine what is and newborn mortality in Cross River State.” maternal health.” 30 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT A MODEL FOR THE SDG ERA 31

Over the past five years, Saving Mothers, Giving Life has achieved impressive A MODEL FOR THE reductions in maternal and newborn deaths. THE PARTNERSHIP HAS MOBILIZED THOUSANDS OF COMMUNITY-LEVEL HEALTH WORKERS, TRAINED HUNDREDS OF PUBLIC AND PRIVATE SECTOR PROVIDERS SDG ERA AND UPGRADED INFRASTRUCTURE AND EQUIPMENT IN DOZENS OF FACILITIES.

But the whole of this partnership is Thanks to its strategic design, the far greater than the sum of its parts. partnership was able to Indeed, Saving Mothers, Giving Life demonstrate significant impact for provides a model for health and the investment. Moreover, as Saving development work in the Sustainable Mothers, Giving Life progressed, Development Goal (SDG) era. additional partners came on board, increasing the initiative’s capacity By working across existing health and capabilities. services, Saving Mothers, Giving Life was able to combine the best of Saving Mothers, Giving Life provides disease-specific programs like a framework for how to approach PEPFAR and broad-based efforts to the ambitious SDGs. By engaging strengthen specific elements of the and collaborating with a diverse health system, all while integrating group of partners, the global health the public and private health sectors. and development community will be better prepared to tackle major National, state and district ministries challenges, such as achieving of health led the charge from the universal health coverage, and save beginning, deciding what the millions more lives. partnership would focus on and how programs would be implemented. Local governments and community “Reflecting on the Saving Mothers, leaders took ownership of the Giving Life partnership as it comes projects early on and have driven to an end, I am pleased by its much of the partnership’s success. extraordinary impact. Donor partners provided initial investments to get projects started, With its data-driven approach, this but then worked closely with partnership accomplished what it in-country teams to build regional set out to do: boldly reducing and district-level capacity for maternal mortality in Uganda and overseeing and implementing Zambia. Year-after-year, this programs. The central Secretariat partnership continues to led by USAID helped coordinate the demonstrate significant results in partnership’s many shifting parts and reducing maternal mortality rates kept everything moving forward. in target districts.”

AMBASSADOR DEBORAH L. BIRX U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, U.S. Department of State

Photo credit: Karen Kasmauski/MCSP 32 SAVING MOTHERS, GIVING LIFE 2018 FINAL REPORT COUNTRY PARTNERS 33

MARY GORRETTI MUSOKE COUNTRY PARTNERS THE LEGACY NIGERIA GOVERNMENT • Cross River State Government • Cross River State Mary Gorretti Musoke became the Ministry of Health • Cross River State Primary Health Care Development first girl in her small Ugandan Agency • Federal Ministry of Health village to attend school. Once there, she knew she had to put her IMPLEMENTING PARTNERS • Association of General and Private Medical education to good use, which is why Practitioners of Nigeria • Association of Grassroots Counsellors of she decided to become a midwife. Health and Development Nigeria • Centre for Healthworks, Development and Research Initiative • ExpandNet • Greater Hands Foundations • IntraHealth • Nigerian Society of Neonatal Medicine, Cross River State At first, she went into public chapter • Pathfinder International • Project CURE • Society of Obstetrics service and worked for many years and Gynecology of Nigeria, Cross River State chapter • We Care Solar at Mulago National Referral Immunization and family planning day at Maama Maria Mary is also sharing information Hospital. Soon, Mary was Maternity Centre. Photo credit: PSI and PACE about what works with her considered an expert in her colleagues. As the President of the community and women started UGANDA Private Midwives Association of visiting her at home rather than Uganda, Mary has the ear of 780 seeing her at the hospital — a sign “While my husband was gone on a other midwives and is working with GOVERNMENT • Kabarole District Health Office • Kamwenge District to Mary that women were looking business trip, I went to his work to them to improve the quality of care Health Office • Kibaale District Health Office • Kyenjojo District Health for a more personalized pregnancy collect his check and used the they all provide. She is also advising Office • Ugandan Bureau of Statistics • Ugandan Ministry of Health and childbirth experience. money to buy the building where my clinic is now. He was so, so mad the national government on how IMPLEMENTING PARTNERS • Association of Obstetrics and Gynaecologists when he got home, but now he is best to integrate private midwives of Uganda • Baylor Uganda • Infectious Diseases Institute • proud and loves to tell everyone into the broader health system. Management Sciences for Health • Marie Stopes Uganda • Population that his wife is the smart one who Services International • Uganda Pediatric Association • Uganda Society has the clinic. He even tries to say it Mary, now known as “Maama of Anesthesia • Ugandan Health Marketing Group • University Research was his idea!” Maria,” is an example of the Co., LLC everyday heroes who have helped Mary heard about a social franchise fuel the success of Saving Mothers, of quality private midwifery clinics Giving Life and will take its lessons ZAMBIA serving low-income clients — forward to continue saving lives. supported by Saving Mothers, GOVERNMENT • Health Office • Lundazi District Health Giving Life — and knew this could WITH MARY AND HER Office • Mansa District Health Office • Ministry of Community be an opportunity to get the Development, Mother, and Child • Health Office • additional support and training she COLLEAGUES LEADING THE Zambian Central Statistics Office • Zambian Defence Force Medical needed. Through what she learned, WAY, THE FUTURE FOR Services • Zambian Ministry of Health • Zambian National Blood she was able to improve the quality MOTHERS AND INFANTS Transfusion Services of care she offers and build her business into a larger clinic that IN NIGERIA, UGANDA AND IMPLEMENTING PARTNERS • Abt Associates • Africare • Boston University • employs two other midwives and a ZAMBIA LOOKS BRIGHT. Centre for Infectious Disease Research in Zambia • Churches clinic medical officer. Association of Zambia • Elizabeth Glaser Pediatric AIDS Foundation • Jhpiego, Johns Hopkins University Affiliate • John Snow, Inc. • Marie Stopes Zambia • Population Services International • Project Concern International • RTI International • The University of Zambia • Zambia Mary Goretti Musoke. Photo credit: MSD for Mothers Center for Applied Health Research and Development Saving Mothers, Giving Life is a five year public-private partnership committed to saving women’s and newborns’ lives from complications during pregnancy and childbirth. www.savingmothersgivinglife.org