Access to Health

Key Initiatives

MSD for Mothers

MSD for Mothers
Key Initiatives
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The death of a woman from complications of pregnancy and childbirth is a tragedy with devastating effects on families, communities and nations.

Most maternal deaths are preventable, and over the last 25 years we’ve seen a nearly 50 percent decline in the number of women who die from complications of pregnancy or childbirth. Thanks to the commitment of the global health community and national governments, we’ve made great strides in getting women the care they need.

MSD for Mothers is our company’s 10-year,
$500 million initiative to help end preventable
maternal mortality.

Although there has been impressive progress, the world did not meet the Millennium Development Goal target of a 75 percent reduction in the maternal mortality rate by the December 2015 deadline. Today, maternal mortality is prioritized under Sustainable Development Goal 3.1, which calls for a global reduction in the maternal mortality ratio to less than 70 deaths per 100,000 live births by 2030, a sharp decline from the current ratio of 216 per 100,000.

As we enter a new era of development goals, we have much to be proud of, but we also have much work left to do.

OUR APPROACH

MSD for Mothers is our company’s 10-year, $500 million initiative that applies our scientific and business expertise, as well as our financial resources, to help end preventable maternal mortality. We are working to catalyze transformative solutions to strengthen sustainable health systems by focusing on improving access to quality maternal health care women receive in health facilities at the time of childbirth, and improving access to quality modern contraceptives.

We are focused on:

  • Equipping health care providers with the skills, tools and technologies they need to deliver high-quality services wherever women seek care
  • Placing life-saving maternal health products in the hands of women and their providers
  • Empowering women to make informed choices about contraception and get the care they need for a healthy pregnancy and childbirth

We have more than 50 projects in more than 30 countries around the world. Our major programs are based in five countries—India, Senegal, Uganda, the U.S., and Zambia—where our goal is to test innovative models that expand women’s access to affordable, quality care with the potential to be scaled and sustained.

We are also collaborating with MSD offices around the world to support projects that are responsive to local maternal health needs. In countries as diverse as Colombia, Lebanon, Malawi and the Philippines, these grant-based programs are training health providers in maternal care services, linking pregnant women to care, and raising awareness of safe motherhood.

Working alongside more than 75 partners, we have improved access to quality maternal care and modern contraceptives for more than 5 million women around the world.

Our fellowship program, the MSD Fellowship for Global Health, has grown to 40 employees who participated in 12-week assignments with our partners on the ground in India, Uganda and Zambia, providing assistance in business training, business planning, branding, marketing and demand, generation strategy development, data management, quality assurance, feasibility studies, and recommendations for income-generating activities.

In addition, more than 50 employees across the company are heavily engaged in MSD for Mothers, providing technical expertise to support our product innovation efforts and strengthen our programs. They include experts in areas as diverse as pharmacokinetics, cost-effectiveness, marketing, data analysis, supply chain management and information technology.

We continue to raise awareness among our employees about MSD for Mothers and provide opportunities for them to become further engaged. There are now more than 350 employee ambassadors in 26 countries who help support the annual “May is for Mothers” campaign, which reaches employees at 83 of our sites worldwide. Employees have participated in a number of additional activities, including assembling postnatal kits for mothers in Uganda, coordinating mobile phone collections and donations, sharing information about MSD for Mothers with their peers at internal meetings, and volunteering with local nonprofit organizations related to maternal health care.

2015 HIGHLIGHTS

Our major achievements in 2015 include:

  • MSD for Mothers, Ferring Pharmaceuticals and the World Health Organization (WHO) established a collaboration to develop a proprietary formulation of carbetocin, used to prevent postpartum hemorrhage in women after childbirth that is designed to be heat-stable, and in 2015, the WHO enrolled the first patient in a clinical trial to assess the effectiveness of the medicine
  • Decreased stock-outs of contraceptives in Senegal from more than 80 percent in 2011, to less than 2 percent in all public health facilities
  • Nearly halved maternal mortality in facilities in target districts in Uganda and Zambia through our partnership with the U.S. government (Saving Mothers, Giving Life)
  • Implemented evidence-based practices to treat the leading causes of maternal death in five states that account for one quarter of the United States’ 4 million births
  • Unveiled surprising new research showing that a considerable proportion of women receive maternal health care from private health care providers—an important contribution to the field
Improving Access

MSD for Mothers supports projects in more than 30 countries around the world, with intensive focus in India, Senegal, Uganda, the United States and Zambia.

Our goal is to test innovative models that expand women’s access to affordable, quality care and have the potential to be expanded and sustained. We’re striving to find solutions that will have a lasting impact on ending preventable maternal mortality, today and for years to come.

STRENGTHENING LOCAL PRIVATE HEALTH CARE

One way we’re working to increase access to affordable, quality maternal health services is by improving the care delivered by local private providers, such as independent doctors, midwives and drug shop owners. While in the developing world, maternal health is typically thought to be a responsibility of the public sector, women often turn to private providers as a critical source of care. Women seek care from private providers for a range of reasons, including proximity to their home, flexible hours, a sense of personalized care and sensitivity to local needs and customs. However, this care can be unregulated, expensive and of variable quality.

Given the surprisingly high proportion of women who receive health services from private maternity providers, we believe that strengthening the ability of these providers to meet the health needs of pregnant women could have an impact on reducing maternal mortality. In 2015, we continued to support our partners in India and Uganda to set, maintain and deliver standards for affordable, quality care in the local private health sector.

On Sept. 28, 2015, during the U.N. General Assembly, MSD for Mothers joined with the World Bank and Jhpiego to host a special event focused on the often overlooked role of private health care providers in reducing maternal mortality. Titled “Business as Unusual: Harnessing the Reach of Private Maternity Providers to Strengthen Health Systems,” the event brought together a diverse range of speakers to discuss the different ways countries can strengthen private maternal health care and integrate the providers who deliver this care—such as doctors, nurses and midwives—into national health systems. Click here to watch the webcast of the event.

In Uganda, we partnered with Population Services International (PSI) and its local affiliate, PACE, on a project called MSD for Ugandan Mothers (MUM). Together we’re working to ensure that pregnant women—particularly those in remote and low-income communities—have access to affordable, quality maternal health products and services through the ProFam network of privately-owned franchise clinics. This comprehensive project is also working beyond the clinic setting, helping women overcome common barriers to care, such as cost, transportation and limited supplies.

In 2015, MUM expanded the ProFam social franchise to include 142 health facilities in 42 districts nationally (covering more than a third of the country) and improved access to quality care for an estimated 130,000 women.

In India, we’ve partnered with leading health organizations to strengthen private maternal health care in Jharkhand, Rajasthan and Uttar Pradesh—three states with some of the highest rates of maternal mortality in the country.

  • Pathfinder International and World Health Partners are expanding access to maternal health care by linking the public and private sectors, adding maternal health services to an existing health franchise, connecting remote providers to higher-level care through referral and telemedicine, and ensuring that quality supplies reach the last mile
  • Jhpiego and the Federation of Obstetric and Gynaecological Societies of India (FOGSI) are developing standards of quality care and helping providers meet those standards through training, continuous quality improvement and accreditation
  • Hindustan Latex Family Planning Promotion Trust (HLFPPT) is adapting a sustainable franchise network of private hospitals and health workers to a new context so women in rural and peri-urban areas have better access to care throughout their pregnancy

These projects have already strengthened more than 800 health facilities, trained approximately 6,000 health workers and improved access to quality care for more than 350,000 women.

In addition to our programs and evaluation efforts that are identifying and testing solutions to help ensure that private providers are affordable and delivering quality maternal health services, we have undertaken related advocacy efforts. Our goal is to ensure that women have access to affordable, quality maternal health services wherever they seek care, through public or private sources. That’s why we are raising awareness among policymakers, donors and other global health stakeholders about the complementary role of private providers and the importance of working with them to help end preventable maternal deaths.

To support our programmatic and advocacy efforts, we are working with the London School of Hygiene and Tropical Medicine to help us better understand where women receive maternal health care.

In 2015, the London School published the most comprehensive analysis to date of where women receive family planning, antenatal care and delivery services based on demographic and health surveys from 57 low- and middle-income countries. Tropical Medicine and International Health published the results in a series of five articles. Findings demonstrate that roughly 40 percent of women who receive maternity care and family planning services do so from private providers. The findings suggest the need for maternal health policymakers to better understand the role of both public and private providers in order to decrease maternal mortality.

In 2016, we will continue working with our research partners at the London School, our NGO partners on the ground, and other influential groups like the World Bank and USAID to better understand and advocate for a more global focus on leveraging local private providers as a tool to help save women’s lives.

ADDRESSING THE DISTANCE PROBLEM

In Zambia, distance challenges are considered a leading contributor to the country’s high maternal mortality ratio of 224 maternal deaths for every 100,000 live births. Women often have to travel long distances to reach the nearest health facility, making it difficult for them to get the care they need during pregnancy, childbirth and immediately postpartum.

The Maternity Waiting Homes Alliance was launched in 2015 to address this challenge by building and strengthening maternity waiting homes—residences near health facilities where pregnant women can stay until they go into labor and immediately after childbirth.

The goal is to make these homes sustainable by empowering local communities to both effectively manage them and generate income to support their operations through creative entrepreneurial activities, therefore ensuring the homes and the services they provide are available for the long term.

The Alliance is a collaboration among MSD for Mothers, the Bill & Melinda Gates Foundation and The ELMA Foundation, with partners Africare, the University of Michigan, Boston University and the Zambia Center for Applied Health Research and Development. The Alliance is working in conjunction with Saving Mothers, Giving Life, a public-private partnership among the U.S. Government, the Norwegian Ministry of Foreign Affairs, the American College of Obstetricians and Gynecologists, Every Mother Counts, Project C.U.R.E and MSD for Mothers to reduce maternal mortality in sub-Saharan Africa.

EXPANDING ACCESS TO FAMILY PLANNING AND IMPROVING ACCESS TO QUALITY MODERN CONTRACEPTIVES

Family planning is recognized as one of the most cost-effective ways to lower maternal mortality rates, potentially averting one-third of maternal deaths by reducing the overall number of pregnancies and helping women adequately space their pregnancies.

In Senegal, as part of our collaboration with the Bill & Melinda Gates Foundation, we are supporting the scale-up of an innovative supply chain model to eliminate stock-outs of contraceptives at health facilities—a serious barrier to family planning.

In 2015, our partner IntraHealth International increased the availability of contraceptive products nationwide by reducing total stock-outs to less than 2 percent from 80 percent in approximately 1,300 public health facilities, and helped increase the contraceptive prevalence rate to 20 percent from 12 percent nationwide in 2011. In total, our efforts have reached more than 3.2 million women. We’ve also enlisted our employees with expertise in supply chain management to conduct a costing evaluation of this model, which will inform the Senegalese government’s plans for national expansion.

We also ensured that in all of our maternal health programs in India and Uganda, postpartum family planning was an integrated service offered to all pregnant women.

BOLSTERING MATERNAL HEALTH IN THE UNITED STATES

In collaboration with national and local organizations in the United States, we are supporting efforts at the community, hospital and policy levels to help make sure that all women across the country have a healthy pregnancy and safe childbirth.

MSD for Mothers now supports work in 16 states to respond to five major challenges that contribute to maternal mortality in the United States:

  1. Inconsistent management of obstetric emergencies
  2. Lack of good data on why women are dying during pregnancy and childbirth
  3. Rise in chronic conditions among pregnant women (e.g., obesity, diabetes, hypertension)
  4. Inadequate attention to the postpartum period when many deaths occur
  5. Lack of awareness of maternal mortality and morbidity.

The key accomplishments of our U.S. projects in 2015 are:

  • The American Congress of Obstetricians and Gynecologists—District II is working with more than 10,000 health care providers and approximately 120 birthing facilities to develop and implement standard approaches for handling three of the most common childbirth emergencies: hemorrhage (severe bleeding), venous thromboembolism (blood clots), and severe hypertension (high blood pressure)
  • The Association of Women’s Health, Obstetric and Neonatal Nurses is working with more than 55 hospitals to assess and improve clinicians’ ability to recognize women at the greatest risk of obstetric hemorrhage and respond appropriately based on specific indicators. They are also educating nurses about the importance of the postpartum period and developing simple checklists for nurses to review with new mothers as they advise them on identifying signs and symptoms that may require medical attention following childbirth.
  • The California Maternal Quality Care Collaborative is collaborating with more than 120 hospitals in the state to put in place evidence-based practices for managing obstetric hemorrhage and preeclampsia
  • The Association of Maternal and Child Health Programs helped 12 states strengthen their ability to review maternal deaths and understand why they are occurring. Early results have identified a need for state departments of health to focus more intently on chronic conditions like hypertension, cardiovascular disease, substance abuse, and mental health problems among pregnant women.
  • MSD for Mothers is also supporting community-based projects in Camden, N.J.; New York City; and Philadelphia, to help women struggling with chronic health problems receive appropriate care before, during, and after pregnancy

PARTNERING WITH THE U.S. GOVERNMENT TO SAVE WOMEN’S LIVES IN SUB-SAHARAN AFRICA

Saving Mothers, Giving Life (SMGL) is a five year public-private partnership led by the U.S. government to reduce maternal mortality in sub-Saharan Africa, beginning in Uganda and Zambia. MSD for Mothers is a founding partner of the initiative, and our programs in both countries contribute to SMGL’s work to put in place lifesaving maternal and newborn health interventions. At the mid-way point, SMGL has produced impressive results: maternal mortality ratios fell by 45 percent in target facilities in Uganda and by 53 percent in target facilities in Zambia.

For a complete list of our partners, please visit the MSD for Mothers website.

Innovation

ADVANCING LIFE-SAVING PRODUCTS

As a research-based health care company, innovations in life-saving products are one of the most important and distinct contributions we can make to improve maternal health. Our scientists and others are deeply involved in identifying, developing and advancing new and/or improved products to address unmet maternal health needs in the developing world. Our focus continues to be on preventing and treating the leading direct cause of maternal death worldwide: postpartum hemorrhage (PPH).

In 2013, MSD for Mothers, Ferring Pharmaceuticals and the World Health Organization (WHO) established a collaboration to develop a proprietary formulation of carbetocin, used to prevent PPH in women after childbirth, that is designed to be heat-stable—stable even in hot and tropical climates.

PPH is the leading cause of maternal deaths around the world. The development of a medicine that can be stored at elevated temperatures has the potential to significantly improve management of bleeding following childbirth in many countries where cold temperatures during storage and distribution of the medicine are difficult to achieve and maintain. The availability of a heat-stable carbetocin product could help reduce maternal deaths in these countries.

In 2015, the WHO initiated a multi-country clinical study including 30,000 women to evaluate the effectiveness of an investigational heat-stable carbetocin in vaginal deliveries compared to the current standard of treatment, oxytocin. If the results of the study are positive and the medicine is approved by the appropriate regulatory authorities, we intend to make it available in the public sector of developing countries that have a high burden of maternal mortality at an affordable and sustainable price.

MSD for Mothers is also interested in devising an easier-to-administer dosing regimen for magnesium sulfate, the current gold standard for managing seizures in pregnant women suffering from preeclampsia/eclampsia. The first step toward this goal, identifying a dose range using our internal modeling and simulation expertise and data from collaborating universities and hospitals around the world, is scheduled to be completed by the end of 2016.

DIGITAL INNOVATIONS

Digital innovations, especially mobile technology solutions, are playing an increasingly important role in advancing global health and development efforts, empowering people to learn and make decisions about their health and access much-needed health services in new and interactive ways.

MSD for Mothers believes that disruptive innovation through digital technology has the power to transform the quality of maternal health care services being delivered around the world, so we have committed resources to identifying and developing solutions that will tackle some of the most critical obstacles that stand in the way of delivering quality care that could reduce the number of women who die during childbirth.

Beyond providing financial resources to develop digital innovations, our digital experts are providing technical support and strategic insights into technology trends that may have implications for the solutions’ design. MSD for Mothers aims to be a catalyst in helping to leverage technology to address critical and potentially life-saving needs for mothers around the world.

Performance
MSD for Mothers Summary (for priority countries)
20142015
Providers/community health workers trained4,3706,814
Districts/regions reached143110
Women with improved access to quality care3,534,8894,948,803
Women with improved access to modern contraception (in Senegal and India)2,619,8053,607,496
Facilities strengthened to provide quality care1,6822,575
Women delivering in facilities providing high-quality care69,260272,744
Note: Priority countries include India, Senegal, Uganda, the United States and Zambia.