“My country has very poor maternal outcomes,” Dr. Ngozi Okonjo-Iweala said recently to a rapt room of leaders from civil society, NGOs, governments, business, and UN agencies. “We’ve brought maternal mortality down—but there hasn’t been enough progress.”
“We have a goal of saving one million lives by 2015, and unless and until we can develop a way of working with the private sector we will not be able to do this,” said Dr. Okonjo-Iweala, the globally renowned economist atop Nigeria’s Ministry of Finance, speaking during the UN General Assembly at an event that focused on scaling up business-driven innovation for maternal health care.
An uphill climb to MDG5
More than 250,000 women continue to die each year from complications of pregnancy and childbirth, and the world is not on track to meet the Millennium Development Goal 5, a pledge to reduce maternal mortality by 75% and achieve universal access to reproductive health. In Nigeria, more than 33,000 women die in childbirth each year.
Ngozi Okonjo-Iweala said that while conducting research for her dissertation in the north of Nigeria, she observed the terrible choices faced by women with difficult pregnancies.
“When they got into trouble [women] had to be evacuated on the back of a donkey or a motorbike, [where there was] a road,” she said, describing the trial of getting to a hospital. “You can imagine [that during] those journeys many lost their lives, their babies or both.” She compared it to her experience giving birth in the United Kingdom—memorable comments also recorded on Maternova’s blog.
Dr. Ngozi Okonjo-Iweala
“My baby had to be in intensive condition,” she said, “I thought, if I was in that village I wouldn’t have stood a chance.”
Expanding public-private partnerships
According to WHO, more than ninety-five percent of Nigeria’s private health expenditure is paid by consumers out of pocket, often to private providers.
Dr. Okonjo-Iweala said that Nigeria was reviewing the constraints affecting health businesses, such as the regulatory environment. A private health sector alliance has been set up in Nigeria with an expanded mandate along the lines of the partnership-focused MDG Health Alliance.
Many other governments are exploring public-private partnerships in health. Speaking after Dr. Okonjo-Iweala was Sweta Mangal, cofounder and CEO of Ziqitza Health Care Limited, an emergency transportation service in Mumbai. Many state governments in India have now contracted with Ziqitza.
Mangal said that a huge proportion of the clients the company’s 865 ambulances pick up are pregnant women. “We’re not a maternity care clinic, but we’ve delivered 5,069 babies!” said Mangal, explaining that, “sometimes when we get to [a woman] she is already delivering.” Ziqitza staff are trained and equipped to handle emergency deliveries.
Challenges to scaling up partnerships
Fostering Healthy Businesses: Delivering Innovations in Maternal and Child Health, a new report from the UN Innovation Working Group’s Task Force on Sustainable Business Models, provides short summaries on promising businesses like Changamka MicroHealth, ClickMedix, Greenstar, eHealth Point, Redplan Salud, LifeSpring Hospitals, Living Goods, and Ziqitza, but also outlines challenges these and other businesses confront as they look to grow.
Chief among them is the difficulty in forming successful partnerships with governments. Private providers are too infrequently consulted when governments make decisions about health policy and financing.
Moreover, the report--which references CHMI's programs database as a source for information about market-based health programs--concludes that health businesses aiming to serve the poor are like any other business in facing common constraints and challenges: these include difficulties accessing capital and management skills, identifying customers in competitive marketplaces, optimizing operational processes, and working out other kinks in the design of a sustainable business model.
Speaker Jill Sheffield, President of Women Deliver
As part of the UN’s Every Women, Every Child initiative, the task force mobilized a diverse group of stakeholders to support new enterprises to improve maternal and child health outcomes in low- and middle-income countries.
The task force recommends establishing an enabling environment for successful businesses, implementing incentives to help businesses serve the poor—like conditional cash transfers, which are being piloted in Nigeria—and spurring new kinds of investment such as social venture capital funds and credit guarantees.
Click the PDF link below to Download: Fostering Healthy Businesses: Delivering Innovations in Maternal and Child Health.