MSD for Mothers
MSD for Mothers
The death of a woman from complications of pregnancy and childbirth is a tragedy with devastating effects on families, communities and nations.
According to the World Health Organization, 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 and childbirth globally. 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.
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.
Although there has been impressive progress and we have much to be proud of, we also have more work left to do.
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 reduce preventable maternal mortality worldwide by catalyzing transformative solutions. We are applying private-sector approaches to improve access to quality maternal health care that women receive in health facilities at the time of childbirth, and to improve access to family planning services.
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 lifesaving maternal health products in the hands of women and their providers
- Empowering women to make informed choices about contraceptives and to get the quality care they need for a healthy pregnancy and safe 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 United States, and Zambia—where our goal is to design, test and advocate for the scale-up of innovative models that expand women’s access to quality care.
We are also collaborating with MSD offices around the world, to support projects that are responsive to local maternal health needs through our Global Giving program. In countries as diverse as Canada, Greece, the Philippines and South Africa, these grant-based programs are providing training for health providers in maternal care services, linking pregnant women to care and promoting health-seeking behaviors.
In 2016, MSD for Mothers supported 10 new projects to improve global maternal health.
Working alongside more than 90 partners, we have improved access to quality maternal care and family planning services for more than 6 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. Our experts complete a range of activities, from developing a communications program for maternity providers in India to providing advice to improve the digital-based tools of our partners.
We also 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 430 employee ambassadors in 28 countries who help support the annual “May is for Mothers” campaign, which reaches employees at more than 80 of our sites worldwide. Employees have participated in 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.
Working alongside our global partners, our major achievements in 2016 included:
- Partnered with Ferring Pharmaceuticals and the World Health Organization to evaluate heat-stable carbetocin, a medicine that could significantly improve the management of severe bleeding after childbirth in countries where reliable refrigeration is challenging.
- Strengthened private maternity care in India and Uganda and developed a first-of-its-kind tool kit to help private maternity providers—from midwives in rural villages to doctors at large, urban hospitals—measure and improve the quality of care they offer.
- Helped transform the public health supply chain in Senegal by integrating private commercial practices that have greatly reduced stockouts of contraceptives and increased reliable access to a full range of contraceptive and other public health products.
- 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).
- Completed the construction of 24 mothers’ shelters in Zambia to help women overcome the distance barrier to reaching quality care.
- Implemented evidence-based practices to manage the leading causes of maternal death in the U.S., now used in more than 300 hospitals in five states.
- Published the first citywide analysis of severe maternal morbidity (life-threatening complications during childbirth), including its prevalence and economic impact on health care systems in New York City.
MSD for Mothers supports projects in more than 30 countries around the world, with an intensive focus in India, Senegal, Uganda, the U.S and Zambia.
Our goal is to design, test and advocate for innovative models that expand women’s access to quality care and can be scaled for greater impact. We’re striving to find solutions to end preventable maternal mortality, today and for years to come.
STRENGTHENING LOCAL PRIVATE HEALTH CARE
One way we’re working to increase access to quality maternal health services is by improving the care delivered by local private providers, such as independent doctors, midwives and drug shop owners. In the developing world, maternal health is typically thought to be a responsibility of the public sector even though 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 quality care in the local private health sector.
In August 2016, we helped launch the Private Maternity Care Quality Toolkit (PMC-QT) to help measure and improve the quality of private maternity care. The practical, user-friendly tool kit incorporates lessons from three years of programming and input from health providers on the front lines and was developed in consultation with dozens of stakeholders in India and Uganda. Key features include clinical standards targeting the most essential evidence-based practices for maternal health care, clear metrics for measurement and simple data collection tools that are useful for doctors at larger, urban hospitals as well as midwives in rural villages. Learn more about the tool kit.
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 worked to ensure that pregnant women have access to quality maternal health services and products through the ProFam network of privately owned franchise clinics. This comprehensive project worked beyond the clinic setting, helping women overcome common barriers to care, such as cost, transportation and limited supplies.
By the end of the project, MUM trained more than 800 health workers, strengthened 142 facilities, and expanded access to quality maternal health care for an estimated 200,000 women in more than 40 districts. Additionally, more than 50,000 women delivered in facilities with high-quality care.
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 expanded 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. Learn more.
- Jhpiego, the Federation of Obstetric and Gynaecological Societies of India and the National Acceditation Board of Hospitals developed standards of quality care and helped private providers meet those standards through training, continuous quality improvement and accreditation. Learn more.
- Hindustan Latex Family Planning Promotion Trust adapted 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. Learn more. These projects have strengthened more than 800 health facilities, trained more than 6,500 health workers and improved access to quality care for nearly 450,000 women.
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 policy makers, 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 continue to work with the London School of Hygiene and Tropical Medicine to measure and evaluate our programs and better understand the providers who deliver maternal health care to women.
In 2016, we worked 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 the reach of local, private providers to help save women’s lives. Our partners continue to evaluate select MSD for Mothers supported models such as social franchising for maternal health in Uganda and India, as well as supply chain innovation in Senegal, the Informed Push Model (IPM-3PL).
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 Mothers’ Shelters Alliance was launched in 2015 to address this challenge by building and strengthening mothers’ shelters—residences near health facilities where pregnant women can stay until they go into labor and immediately after childbirth.
The goal was to make these shelters and the services they offer sustainable by empowering local communities to both effectively manage them and generate income to support their operations through creative entrepreneurial activities.
The shelters are now fully operational and the Mothers’ Shelters Alliance has trained nearly 600 health workers and expanded access to quality maternal health care for more than 7,000 women across eight districts of Zambia.
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 plan and space their pregnancies.
In Senegal, as part of our collaboration with the Bill & Melinda Gates Foundation, we supported the scale-up of the Informed Push Model (IPM-3PL), an innovative supply chain model that has been highly successful in eliminating stockouts of contraceptives at health facilities—a serious barrier to family planning.
Working with our partner IntraHealth, we implemented a phased national expansion of IPM-3PL and, in 2016, the government of Senegal agreed to the model as part of a broader national supply chain reform effort called Yeksi Naa (meaning “I have arrived,” in Wolof). With support from MSD for Mothers, the government will adapt and expand the model to include more than 100 essential products for maternal and child health as well as HIV/AIDS, tuberculosis, malaria and other conditions.
BOLSTERING MATERNAL HEALTH IN THE UNITED STATES
In collaboration with national and local organizations in the U.S., 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 supports work in 16 states to respond to major challenges that contribute to maternal mortality in the U.S.by:
- Improving and standardizing the quality of care women receive during a childbirth emergency
- Collecting stronger data to understand why maternal deaths and morbidities (life-threatening complications during childbirth) are occurring
- Pioneering community initiatives to help women with chronic health conditions receive appropriate care
The key accomplishments of our U.S. projects in 2016 are:
- The American Congress of Obstetricians and Gynecologists—District II worked with more than 10,000 health care providers in New York 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) in nearly all of the state’s birthing facilities
- The Association of Women’s Health, Obstetric and Neonatal Nurses worked with nearly 60 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 also educated nurses about the importance of the postpartum period and developed 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 collaborated 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 intensely on chronic conditions like hypertension, cardiovascular disease, substance abuse and mental health problems among pregnant women.
- The Fund for Public Health of New York completed the first city-wide investigation of the cost and prevalence of severe maternal morbidity.
- MSD for Mothers supported community-based projects in Camden, New Jersey; 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
Launched in 2012, Saving Mothers, Giving Life (SMGL) is a five-year public-private partnership led by the U.S. Government to reduce maternal and newborn mortality in sub-Saharan Africa. MSD for Mothers is a founding partner of the initiative, and our programs in Uganda and Zambia contribute to SMGL’s work to put in place lifesaving maternal and newborn health interventions. SMGL has produced impressive results: maternal mortality ratios have fallen by 44 percent in target facilities in Uganda and by 55 percent in target facilities in Zambia.
For a complete list of our partners, please visit the MSD for Mothers website.
ADVANCING LIFE-SAVING PRODUCTS
As a research-based health care company, innovations in lifesaving 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.
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—even in hot and tropical climates.
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 refrigeration 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 2016, the WHO continued a multi-country clinical study of 30,000 women to evaluate the effectiveness of heat-stable carbetocin in vaginal deliveries compared to the current standard of treatment, oxytocin. Participating countries include: Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the UK. By the end of 2016, more than 15,000 women had been recruited into the trial. The study will be completed in 2017, and, if the results of the study are positive and the medicine is approved by the appropriate regulatory authorities, the collaboration intends to make it available at an affordable and sustainable price in the public sector of developing countries that have a high burden of maternal mortality.
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 2017.
Maternal sepsis, an illness that develops in some pregnant women, as well as women who have recently delivered, is a relatively neglected and highly lethal cause of maternal mortality. To address this unmet need, in 2016, MSD for Mothers initiated support for initiatives focused on the prevention, early detection and early treatment of infections that may lead to sepsis.
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 receive 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 around the world and reduce the number of women who die during pregnancy and childbirth. That’s why we are identifying and developing technology solutions that tackle some of the most critical obstacles to delivering quality care.
In 2016, we continued developing digital-based tool kits to help pregnant and postpartum women receive the care they need when they need it, as well as identify the right services and products for their needs. While these projects are currently being tested in India and Kenya, our goal is to adapt them for health providers and women in other countries.
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 lifesaving needs for mothers around the world.
MSD FOR MOTHERS SUMMARY (FOR PRIORITY COUNTRIES)
|Providers/community health workers trained||4,370||6,814||8,120|
|Women with improved access to quality care||3,534,889||4,948,803||5,760,968|
|Women with improved access to modern contraception (in Senegal and India)||2,619,805||3,607,496||3,714,997|
|Facilities strengthened to provide quality care||1,682||2,575||2,736|
|Women delivering in facilities providing high-quality care||69,260||272,744||358,870|
|Note: Priority countries include India, Senegal, Uganda, the U.S. and Zambia.|