Dr. Naveen Rao

Investing in the Local Private Sector to Reduce Maternal Mortality in India

For most women, the day they give birth is one of the most exciting and joyous occasions of their life. But for far too many women – mainly in the developing world – the day they deliver can be riddled with danger and fear, and can sometimes lead to death. In fact, there were 287,000 maternal deaths globally in 2010.

The loss of a woman’s life during pregnancy or childbirth is one of the most tragic – yet preventable – global health challenges of our generation. The world has made great strides in reducing maternal mortality, but the fact remains that we are not on pace to reach the UN’s Millennium Development Goal 5, which calls for a 75 percent reduction in maternal mortality by 2015.

Through our work at Merck for Mothers – Merck’s 10-year, $500 million initiative to curb maternal mortality worldwide – my colleagues and I have met with people from countries across the developing world and seen first-hand the harsh realities many women face during childbirth. We have spoken with health providers on the frontlines. We have consulted with policymakers. We have met with pregnant women at clinics and in their homes. All of these experiences have shaped our perspective on the way forward. For some health issues, there’s a pill; for others, a device. But when it comes to women dying during pregnancy and childbirth, the problem is much more complicated and multi-faceted. There is no magic bullet.

So, where does that leave us today?

On one hand, we need to find innovative new solutions to accelerate progress in reducing maternal deaths. On the other hand, as national governments face constrained budgets, those solutions need to be sustainable.

With these ambitious objectives guiding our efforts, Merck for Mothers just launched a three-year, $10 million initiative to tackle maternal mortality in India, where the need is as great as anywhere in the world. Despite recent progress, India still has more maternal deaths than any country in the world – almost a fifth of the global total.

As we looked closer at the health landscape in India, we learned several important lessons. First, the majority of people in India actually turn to the local private health sector as their first choice of care, because it is easily accessible, attuned to their needs and routines, and perceived to be high quality. In fact, a recent survey found that 92 percent of health care visits among rural households are to private providers, which includes independent doctors, private clinics, pharmacies, and community health workers. (This figure is 70 percent among urban households.)

Second, we learned that private health care can be unregulated, expensive, and of variable quality. Third, private maternal health care is often confined to family planning and antenatal care. It less commonly extends to critical services like labor and delivery, when life-saving interventions can be performed in the case of complications.

Among the challenges that exist in private care, we also saw an incredible opportunity. What if we could find creative ways of strengthening the care provided by the private sector to reduce maternal mortality? And what if we could do this by working alongside the government and NGOs to help relieve the burden on the public health system?

Merck for Mothers in India sets out to confront these challenges head on. We are excited to be partnering with leading organizations, including the Hindustan Latex Family Planning Promotion Trust, Pathfinder International with World Health Partners, and the White Ribbon Alliance with Gram Vaani. These partnerships are using innovative approaches to engage private providers and improve the affordability, accessibility, and quality of the maternal health services they offer.

The partnerships feature a number of creative solutions that make me hopeful. For example, they are establishing new networks of hospitals, clinics, and community health workers to help reach women in rural communities. They’re bringing maternal health care to women in remote areas through telemedicine and delivery agents. And they’re designing a free phone-based system that empowers women to rate the services they receive so doctors and nurses are held accountable for the care they provide.

Taken together, we expect these partnerships to reach nearly 500,000 pregnant women across Uttar Pradesh, Rajasthan, and Jharkhand – all states that suffer from high rates of maternal mortality.

What is most exciting is how they bring together the key ingredients needed to expedite progress in maternal health: innovation and sustainability. India is known as a crucible of ingenuity in global health, and our new initiative is putting that phenomenon to the test. We believe that by fostering growth in the local private sector, we will set in place a self-sustaining model for reducing maternal mortality in India, and help move the country closer to a day when every woman gets to experience a safe and healthy childbirth – free of danger, free of fear, and full of joy.

Dr. Naveen Rao leads Merck for Mothers.

Health Care