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 Zambia Kasongo met the Safe Motherhood surrounded by Lake Bangweulu. Few Action Group members. Saving Mothers, people in Lunga District 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 Samfya District 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