THE AFRICAN HEALTH STATS PROJECT

After a year of planning, design, data collection, verification, testing and translation African Health Stats has today been launched by Dr Kaloko, Commissioner for the Department of Social Affairs, and his colleague Dr Oliwale, Director for Social Affairs at the African Union in Addis Ababa, Ethiopia.

The website, which was designed and built by the AI team, is innovative in its approach to conceptualising complex health information. It provides reliable and verified data on the progress made by African Union member states towards their Maputo Plan of Action and Abuja Call commitments.

AN EXCITING USER EXPERIENCE

The site has been created entirely with the user experience in mind, and every effort has been made to build a website that is not only informative but beautiful. African Health Stats is the first website of its kind to track progress on Maputo and Abuja commitments across the African continent and present that information is a visually accessible and appealing way.

African Health Stats has been built for use across Africa and the bilingual functionality of the site reflects that, all data, text and charts are available in French as well as in English.

33 INDICATORS TO COMPARE

African Health Stats hosts 33 indicators showing data on Reproductive Maternal Neonatal and Child Health, HIV and AIDS, Malaria and Tuberculosis, and Health Financing. There are plans to incorporate additional indicators in the next phase of site development.

One of the key features of African Health Stats is that it allows users to easily compare these 33 indicators within and between countries. The site encourages users to chart, map and visualise data in various formats, and makes clear the complex processes by which these data are collected and why they matter. The site has an open-source policy and all charts are free to download, use and reproduce by any user.

 CONGRATULATIONS

Advocacy International would like to congratulate the African Union’s CARMMA campaign for the creation of this transparent data platform, one that will motivate, inspire and support policy makers in sharing best practises in addressing health challenges across the continent.

AI would also like to congratulate all of the partners who have contributed to the development of African Health Stats and all of those who have helped to make this vision a reality behind the scenes.

It is no coincidence that Guinea, Sierra Leone and Liberia, the countries where the Ebola virus has taken off with such vigour, are three of the poorest nations in the world. Nor is the total inadequacy of their health systems news to us – we have known about these terrible shortfalls for decades. Nonetheless, now that we are hastening forward to prevent the spread of an epidemic that we perceive threatens rich Western countries directly, it might be salutary to remind ourselves about some of the statistics that have been available to us for so long. Even viewed through the lens of narrow self-interest, and quite apart from the humanitarian ethics that should inform our actions, it must surely be clear to us now that neglecting the issue of the social determinants of health is a costly and dangerous mistake that may all too easily expose the whole globe to an uncontrollable pandemic.

Guinea, where the epidemic started, has a population of 11.7 million, and according to the World Bank indicators for 2014, a GNI per capita of $460 in 2013. It has a poverty headcount ratio (at $1.25 a day) of 40.9% of the population. Life expectancy is 56, and the under-fives mortality rate is a shocking 101 per 1,000 – compare the UK 5, and the US 7. The literacy rate is 25%, nearly half a million children are out of primary school, and of those who do enrol only 61% complete. The maternal mortality rate per 100,000 live births was 650 (compare UK 8, US 28). The birth rate is 5 per woman, and only 6% of married women between 15 and 49 use contraception. Fatally, as far as the transmission of communicable disease is concerned, access to improved sanitation (which includes flush/pour flush  (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet)  stands at 19% of the population.

The population of Sierra Leone is smaller, currently standing at just over 6 million, and the GNI per capita is $680. But this slightly higher average is unfortunately not reflected in the poverty indicators. Rather, the poverty headcount, at $1.25 per day, is 56.6%, and life expectancy stands at 46 (the lowest in the world). The under-five mortality rate is 161 – that is, between one and two in ten children die before their 5th birthday (this is the second highest ratio in the world – Angola with 167 being the most tragic). The maternal mortality rate per 100,000 in 2013 was 1,100, with a birth rate of just under 5 per woman, and 11% of those between 15 and 49 using contraception.  In 2012 the literacy rate was 44%, with 72% of children completing primary education. The access to improved sanitation is 13%, while as far as healthcare goes, there are an estimated one to two doctors per 100,000 of the population. In fact, in the World Bank’s tables, which are based on number of doctors per 1,000 population, Sierra Leone and Liberia both appear as 0.0 doctors per 1,000, and Guinea at 0.1.

Liberia, with 4.3 million people, has the smallest population of the three countries in question and, at the time of writing, the highest number of confirmed Ebola cases (4,249).   GNI per capita was $460 in 2013, and the poverty headcount at $1.25 a day was 83.8 in 2007 (latest figures available). Life expectancy in 2012 was 60, and the under-fives mortality rate was 71 per 1,000. Maternal mortality rate per 100,000 was 640, again with a birth rate of just under 5 per woman.  No figures are available for the literacy rate, but in 2011 over 389,000 children were out of primary school, with a primary completion rate for those who were enrolled of 65%. Access to adequate sanitation is 17%.  The WB’s statistics do not give the percentage of doctors to population, but according to the Journal of the American Medical Association, there are just 51 doctors for the 4.3 million inhabitants, and the country has only 620 hospital beds.

Malaria, TB, Diarrhoea and pneumonia are endemic in all these regions. WHO estimated that in 2012 there were an estimated 207 million cases of malaria, and that the disease killed 1300 children under five every day, 90% of them in Sub Saharan Africa. In 2013, 9 million people fell ill with TB, and without proper treatment up to two thirds of these will die. Over 95% of cases and deaths are in developing countries, and Africa carried the greatest proportion of new cases per population with 280 cases per 100 000 in 2013[1] Pneumonia can be prevented by immunisation, adequate nutrition and by addressing environmental factors, but in fact it also remains a global scourge, and is the leading cause of death in children, killing an estimated 1.1 million under-fives every year – more than AIDS, malaria and tuberculosis combined[2]. Diarrhoea, with nearly 1.7 billion global cases every year, is the second leading cause of under-fives death, and is also preventable – but prevention entails access to safe drinking water, improved sanitation, education about the spread of infection and rotavirus vaccination.[3]   At the moment, there is no prospect of achieving such precautionary measures in Guinea, Liberia or Sierra Leone, and the lack of structures, equipment and personnel to combat these diseases at the same time lays the their populations open to the uncontrollable spread of other deadly viruses with the capacity to spread far beyond the borders of their countries of origin.

A number of valiant NGOs have been attempting to address some of these issues for many years, but until now rich nations have offered multiple reasons for failing to take targeted action substantially to improve the dire and disturbing statistics detailed above.  Raging civil wars, coups and corrupt governance, and broken or absent institutions have prevailed in all three countries, and have supplied very plausible excuses for inaction –  but these explanations have been revealed as the pretence that they are by the current international consensus that the world should, and can, provide equipment, skilled staff, and systems finance and advice to combat Ebola. Despite the UN’s proposed trust fund so far failing dismally to realise the $1bn it declares is needed, individual countries are weighing in with equipment and skilled staff. The United States leads the field with a pledge of nearly $142 million in USAID for humanitarian activities in Guinea, Liberia, and Sierra Leone to include construction and support of treatment units, critical training for health care workers, and social messaging and mobilization. It is also sending 3,000 troops to Liberia to assist with healthcare logistics and has committed to building 17 new health care facilities in the region with 100 beds each, and to training up to 500 health care providers per week.[4]. [5]

International donors such as the World Bank and IMF have pledged to provide over $400 million and $130 million respectively, China has committed 174 doctors to Sierra Leone and $37 million in assistance to West Africa, while Cuba has pledged 165 doctors set to arrive in Sierra Leone this month, with an additional 296 going to Guinea and Liberia.

Other countries continue to join the effort. In the UK, where the Commons’ International Development Committee report recently claimed that government aid cuts made before the Ebola outbreak began may have made the situation worse[6], the government has just made a £125m pledge to contain, control and defeat Ebola,[7] and is supplying vehicles, beds, personnel and supplies for the construction and operation of a planned 92-bed treatment centre in Sierra Leone.  In addition to treatment facilities, DFID is also supporting WHO to train more than 120 health care workers per week in Sierra Leone, and has called for partners to staff, manage, and operate four new medical centres.

This assistance is certainly essential to save lives and attempt to limit the spread of infection in the stricken countries, but not only is the international response too little, it is being extended far too late. Like many countries in Africa, Guinea, Liberia and Sierra Leone have inadequate healthcare and educational systems, and appalling sickness and mortality rates, and we have long been well aware of this – while as far as Ebola goes, we have recognised the virus for over forty years. The problem has simply been that no R &D effort has been devoted to producing a vaccine against what has previously been seen as a purely African disease, since there seemed little hope of such a vaccine making money for the pharmaceutical producer. It is only now that Ebola is perceived, rightly or wrongly, to be threatening rich Western countries, that leading companies, led by Johnson & Johnson in the US and GlaxoSmithKline in the UK, are planning to work together to develop the necessary immunisation.

It is now critically important that the three afflicted economies are given increased help to recover after the Ebola emergency is over. The crisis has further destroyed already minimal healthcare systems, hospitals have closed and scarce medical staff have died in the epidemic. Children have been orphaned and family structures broken. But in addition, the epidemic has had devastating effects on other aspects of the economy. Formal and informal trade has been adversely affected by mobility constraints and closed borders; tourism has totally dried up; agriculture has been disrupted and food prices have soared; investor confidence has dropped and foreign firms have suspended operations and repatriated workers; the fiscal balance will worsen as the reduction in economic activity causes a fall in tax revenue and government expenditures rise to meet emergency and post-emergency needs.

All this will make a terrible impact on human welfare. Previous to the epidemic, growth in Liberia and Sierra Leone had been exceptionally high (Liberia  11.3%  and Sierra Leone  20.1% for 2013)[8] , and although much of this growth was due to mining and extractive industry and little of the benefit filtered down to the poor, there is no doubt that the sharp reduction expected will have a disastrous effect on their wellbeing.    A recent World Bank Group Study forecasts the impact of the epidemic on the three countries and the rest of West Africa under both a swift containment and a prolonged persistence scenario of the disease. See the table below.

World Bank Press Release of Report on effects of Ebola epidemic, October 8^th 2014. 

This human tragedy should be seen as a wakeup call to the international community. We live in an immensely rich world where the persistence of abject poverty and its terrible outcome is morally unacceptable and very largely preventable. Even if we discard humanitarian concerns – which we surely should not – it must now be clear that such inequality and suffering is economically inefficient and globally perilous.

The current crisis has shown that we can move swiftly when we feel ourselves under threat. Let us now learn from this horrifying lesson and make sure that the disaster does not recur again.

Susanna Mitchell

In late 2013, a political logjam was broken with agreement on a new interim technocratic government, and this was swiftly followed (26^th January) by adoption of its new Constitution by the National Constituent Assembly (NCA).

Between October 2013 and March 2014, Ai has been involved in work on both gender equality and decentralisation in Tunisia.  Its co-Director Jeremy Smith was main co-creator, of the Charter for Equality of Women and Men in Local Life http://www.charter-equality.eu/?lang=en  when Secretary General of the Council of European Municipalities and Regions (CEMR). , The Charter examines all aspects of a local authority’s work from a gender perspective and invites local governments to sign up to its commitments.

It was a result of Jeremy’s wide experience of European local governance, and work on gender equality at European level that Ai was invited by the Canadian-based (and funded) Forum of Federations http://www.forumfed.org/en/index.php to participate in a forum on equality and decentralisation in Tunisia.

Addressing two workshops on electoral systems and on equality and decentralisation, Jeremy shared with Tunisian colleagues examples from several countries in Africa and Europe of different systems and their pros and cons. He was struck however, by how much we in Britain have to learn from Tunisia. The percentage of women in the country’s National Assembly – elected in 2011 – is higher (at nearly 30%) than the number of women elected to the UK Westminster Parliament in 2012!

Jeremy was also asked to create a “syllabus” for a 6-day course on decentralisation, and lead on its delivery (in French, of course!), for Tunisian civil servants from the regional development ministry, working with international and Tunisian experts.

Participants at a 6-day course on decentralisation led by Jeremy Smith of Ai.

The aim was not just to impart information, but to engage the participants proactively in group working and making presentations – which some had never done before – so that they could deepen their capacity to promote and explain decentralisation to their own colleagues and to the wider Tunisian public.

Amongst other things the course covered:

• The principal dimensions of decentralisation (including international norms and Tunisian Constitution)
• Why decentralise in Tunisia?
• SWOT analysis of the current situation in subnational government
• Examples and lessons from other countries
• The planning and implementation process for decentralisation
• The gender dimension of decentralisation
• Horizontal and vertical decision-making
• The democratic and political process (including civil society participation)
• Organisation and delivery of high quality services
• Economic, social and environmental development, and territorial planning
• The impact of decentralisation on administrations at all levels
• Communicating with citizens, civil society and ministries

The course is backed up by an internet tool, allied with social media, whose purpose is to enable the course organisers to keep engaging with Tunisian participants on local developments in decentralisation.

In total, around 35 civil servants took part in the two courses.  They came from the length and breadth of the country, and were very actively engaged and interested in the subject.  Many of them went on to take part, with both international and Tunisian experts, in regional workshops held across the country. These attracted a mix of civil servants, businessmen and women and civil society.

Jeremy commented:

“It was not an easy assignment, to create a course for civil servants in a diverse country like Tunisia, which faces huge developmental as well as political challenges.  What is exciting is to see how all of them are really dedicated to making a success of their country as it goes through a process of sharing power more widely – even if some had genuine concerns about how decentralisation will work out in practice. 

We underlined the need to take adequate time to prepare it well, and in particular, the need for a strong programme of capacity-building for everyone involved – civil servants and new councillors.”

]]> https://www.advocacyinternational.co.uk/uncategorized/interview-with-efua-dorkenoo-leader-of-end-fgm-social-change-campaign Thu, 10 Apr 2014 11:07:46 +0000 http://advocacyinternational.co.uk/?p=760 Ai is a proud member of the ‘End FGM Social Change Campaign’, led by Efua Dorkenoo in partnership with Options Health Consultancy and DfID. Ai will assist in driving forward the campaign working closely with the wider team on design and messaging across the programme.

More than 125 million girls and women have undergone Female Genital Mutilation (FGM) worldwide and 30 million are at risk in the next decade. The ‘End FGM Social Change Campaign’ is one of the first interventions to focus on stopping the practise.

Efua Dorkenoo, program director at the End FGM Social Change Campaign speaks at a TED event in December 2013. Dorkenoo has been fighting against female genital mutilation since the 1980s. Photo by: Upi Sandhu / TEDxUCL / CC BY-NC-ND

“Unlike other campaigns of similar magnitude, FGM prevention has not received massive investments from the international community,” Efua Dorkenoo said in an exclusive interview with Devex.

Read the full interview here

The Leathermarket is a really wonderful place to work. At the height of the Industrial Revolution the building was home to a tannery but now houses a diverse selection of businesses and entrepreneurial start-ups (framed by some pretty lovely period features).

As for our studio – we forgot to buy blinds so for the moment it’s sunglasses all-round!

Come and visit us

The Leathermarket
Weston Street
London
SE1 3ER

Or give us a call on our new office number

+44 203 327 8599

The Ai team

Our programme director, Efua Dorkenoo, and Lynne Featherstone, Minister for International Development in the UK government,

The Ai team is proud to be a member of the consortium driving a social change campaign, to end FMC/C in one generation. The consortium is led by Efua Dorkenoo of Equality Now in partnership with DfID, and will support the increasing momentum to end FGM/C in Africa. 

Below is the official announcement from DfID and below that a blog written by Efua of Equality Now

On 6 February 2014, International Day of Zero Tolerance to Female Genital Mutilation/Cutting (FGM/C), the UK Government announced the appointment of a consortium of leading anti-FGM/C campaigners and development communications experts, coordinated by Options and including Advocacy International to deliver a global campaign to end FGM/C.

The campaign will support increasing momentum within Africa to end FGM/C and will work at international, regional, national and community levels across Africa to bring about a cultural transformation in attitudes towards FGM/C by:

• Mobilising a critical mass of people, leaders, organisations and networks to unite under a global movement to end FGM/C
• Promoting increased political will and funding in affected countries to tackle FGM/C
• Supporting a network of grassroots activists across Africa to support social change in communities to end FGM/C
• Strengthening and supporting national coalitions against FGM/C within 10 focal countries providing them with expertise needed to bring about social change
• Working with the diaspora in the UK to mobilise people to contribute skills and resources to support efforts to end FGM/C in their countries of origin.

Who we are

The campaign is being implemented by a consortium including:

• Leading campaigning organisations Equality Now [hyperlink with http://www.equalitynow.org/fgm  and FORWARD http://www.forwarduk.org.uk/
• Africa’s foremost communications and advertising agency, Ogilvy & Mather Africa http://www.ogilvyafrica.com/
• The international advocacy agency, Advocacy International  https://www.advocacyinternational.co.uk/
• Options Consultancy Services, providing management and technical oversight http://www.options.co.uk/

The team will be based in Nairobi and London, and is led by Efua Dorkenoo, OBE, former Advocacy Director and current Senior Advisor of Equality Now’s FGM programme, and former technical expert for the WHO, where she assisted the organisation in introducing FGM/C onto the agendas of the Ministries of Health of Member States. The programme will work closely with the United Nations Joint Programme against FGM/C, governments and civil society in focal countries.

What next?

The campaign is currently in its design phase, with a public-facing campaign due to be launched in the second half of 2014. We encourage any individual, organisation or network who shares the vision of an end to the practice of FGM/C in a generation to join the global campaign. Email endfgmc@options.co.uk or info@advocacyinternational.co.uk for more details or to join our mailing list.

Read Efua’s blog here –

On this International Day of Zero Tolerance against Female Genital Mutilation/Cutting (FGM/C), I call on everyone to unite in a global movement to prevent the next generation of girls from undergoing FGM/C. As we start on a new global social change campaign there is a real opportunity to break the cycle and end the practice.

Read more here:

http://blogs.dfid.gov.uk/2014/02/the-silence-has-been-broken-now-lets-break-the-cycle-of-fgmc/

Today, February 6th 2014, is FGM Zero Tolerance Day. It also marks the beginning of a partnership between leading anti-FGM campaigners across the UK who are part of a consortium funded by the UKs Department for International Development (DfID) which aims to end FGM within a generation.

The Social Change Campaign and its partners, including Advocacy International, will support increasing momentum in Africa to end FGM/C. Ai is proud to be part of this momentous work.

One of our consortium partners, Leyla Hussein of Daughters of Eve, has written on the Huffington Post,  announcing the partnership and talking about her work on FGM over the past 11 years.

Visit the Huffington Post website and read more about Leyla’s work

http://www.huffingtonpost.co.uk/leyla-hussein/fgm-zero-tolerance-day_b_4733689.html?&ir=UK

Advocacy International advises a consortium led by OPTIONS UK on an advocacy campaign – MamaYe! – to increase maternal and newborn survival in Ghana. The MamaYe coalition in Ghana is led by Prof Adanu of the School of Public Health, and Vicky Okine of the Alliance of Reproductive Health Rights. Recently the MamaYe coalition appealed to Ghanaian MPs for an increase in spending on maternal and newborn health.

What chances are there of success for this campaign?

First, it is important to note that Ghana has halved levels of poverty since 1992. In that year, nearly 52% of Ghanaians lived in poverty. By 2006 Ghanians living in poverty had been halved to 28%, according to the World Bank.

This is in large part due to the rapid growth in Ghana’s GDP – growth driven by the mining/manufacturing, construction, wholesale/retail trade and to some extent transport.

As a result of these improved conditions government spending on health increased, and, according to the WHO, rose to 15% of GDP. However, according to recent data, in 2012 the Government fell short of meeting this benchmark, spending only 12.5% of its total budget on health.

This fall in health spending may have to do with the wider economic challenges faced by the Ghanaian government in managing government finances.

All the indications are that the level of unemployment, especially among young people, is very high. These levels lead to fiscal imbalances, for the simple reason that Ghana’s talented youth are left idle, and are not contributing tax revenues.

John Yaw Amankrah, Assistant Chief Statistician and Head of Labour Statistics, Ghana Statistical Service argues in a 2012 CEPA briefing paper that “about 60 per cent of the unemployed in Ghana can be found in the 15-24 years age group. This makes Ghana’s youth unemployment rate one of the highest in the world.”

To make matters worse for those lucky enough to be in employment, Ghanaian incomes are falling, according to the World Bank. Rising prices and currency depreciation has led to a decline in the real incomes of workers especially those on fixed incomes. In August 2013 public sector employees were given pay rises of 10% – nearly 2% below current levels of inflation (11.9% in September, 2013, according to the Bank of Ghana). This implies real cuts in civil service pay. In addition the real minimum wage declined as the consumer price index (CPI) lies above the minimum wage index. (World Bank)

Falling incomes implies falls in consumption, which in turn cuts government sales tax revenue, worsening the budget deficit.

Added to this, government revenues (from oil and other sources) have fallen short of expectations as a result of energy disruptions and high real interest rates – intensifying fiscal pressures on Ghana’s government. Foreign borrowing at high rates act as a burden on the budget, and drains the government’s foreign reserves.

Real interest rates in Ghana are indeed high, as the IMF notes. The Bank of Ghana’s base rate is 16% – well above inflation. The rate on Ghana’s 91-day bonds is close to 20%. Because bond rates influence interest rates in the real economy, this implies very high rates on longer term loans to Ghanaian households, small firms and other borrowers.

The Bank of Ghana’s rates are high because they are aimed at global capital markets. They are used to attract foreign investment and to arrest the depreciation of the Ghanaian currency, the Cedi. The effect of high rates however is to cut investment in the domestic economy – further depressing economic activity and employment – and therefore government tax revenues.

To deal with the budget shortfall IMF staff are recommending: “an additional fiscal adjustment of 3 percent of GDP by 2015, using a combination of revenue and expenditure measures, including a reduction in the wage bill as a share of GDP to make room for investment in critical infrastructure and social priority areas.”

In other words the IMF recommends further rises in taxation and cuts in both employment and pay for public sector workers.

This does not bode well for the health workers on Ghana’s public sector payroll.

Regrettably, Ghana has the highest emigration rates for highly skilled employees (46 percent) in Western Africa (OECD, 2005; Docquier and Marfouk, 2005). The medical professions are particularly affected by emigration. It is estimated that more than 56 percent of doctors and 24 per cent of nurses trained in Ghana are working abroad (Clemens and Pettersson, 2006).  Further cuts in healthworker pay will surely encourage more emigration.

And emigration will in turn reduce the number of skilled workers attending to mothers and newborns before, during and after childbirth.

So civil society and the government of Ghana, both dedicated to reducing maternal and newborn mortality rates, face an uphill challenge in increasing funding and human resources for maternal and newborn healthcare.

We were convinced that only when the African public in the countries with highest mortality rates, is full engaged, and there is widespread expectation that women and newborns must survive and thrive after childbirth – only then will attitudes, policies and practices change, and maternal mortality rates in African countries decline. If African politicians and policy makers are to be held to account for the survival of mothers and newborns – then public expectations must rise too. But how to engage the public?  There are several answers to this question, but the one that required the most direct engagement, sacrifice and voluntary activity was: blood donation.

Blood deficits contribute to around 34% of maternal deaths and near misses in Africa. However, Sub-Saharan Africa has the lowest quantity of blood donated for transfusion per person in the world.

The Tanzanian MamaYe campaign, working with the National Blood Transfusion Service (NTBS), Arusha regional Hospital, and the Red Cross,was the first to mount a major blood recruitment and donation campaign, in January, 2013. Tanzanian national estimates based on WHO data project that 80% of blood donated is used for maternal and paediatric patients. Post-partum haemorrhage (bleeding) is acknowledged as the leading cause of maternal mortality accounting for between one in three to one in five of all maternal deaths in Tanzania. Furthermore, there is a critical shortage of blood supplies in Tanzania’s hospitals – with an estimated one-third only of the required 450,000 blood units collected every year.

The campaign launch in Arusha was a great success. After  MamaYe Tanzania had publicised the blood donation event, with radio interviews, posters and banners, more than 1,000 donors responded to the appeal – three times more than the Tanzanian Blood Donation Service was accustomed to. Since then blood donation appeals have succeeded in all five countries – engaging more and more people in the survival of mothers and newborns in their country.

 Learn more about Ai’s work on the MamaYe campaign >

Reframing the issue away from failure, despair and mortality – and towards solutions, success and survival.

As part of our work advising a UKAid- funded consortium whose aim is to reduce maternal and newborn mortality in five African countries, Ai had to think of ways of engaging Africa’s men and women in the complex issue of maternal and newborn health. This is an issue that requires a spectrum of care – from the time that young girls reach reproductive age right through to maturity; and from conception to well after a child is born.

Ai’s leadership team of Ann Pettifor and Maz Kessler began by scoping and assessing public opinion in the five countries.

The Ai team learnt first, that despite its high level of priority at international policy-making level, and despite the activities of MNH experts and NGOs, maternal and newborn survival is not part of the popular public conversation in the five African countries: Nigeria, Ghana, Sierra Leone, Tanzania and Malawi. It is of course central to much private and often silent grief in these countries.

Second, the team became aware of a widespread assumption across the five countries: that death in childbirth was ‘natural’ to quote an educated and sophisticated woman we met in Tanzania, or that alternatively it was “God’s will”. This widespread resignation and fatalism in relation to childbirth, we concluded, is one of the biggest challenges that policy-makers face in reducing maternal and newborn mortality in Africa. Resignation lowers expectations, and inhibits citizens from expecting and demanding that politicians and professionals make improvements in the care of mothers and newborns.

How to change perceptions? How to raise expectations?

Ai’s leadership team began by immersing ourselves in the issue, and quickly found that it was largely framed in terms of death, loss, suffering and mortality. Some of the framing is and was outrageously sensationalist – shocking and guilt-tripping audiences into supporting campaigns and donating to charities working with women and children. We believe that shock and guilt-making tactics do not work. Rather than energising and motivating potential supporters, they paralyse.

We worked on re-framing the issue away from mortality and towards solutions and examples of success and survival. This became the basis of a new campaign for maternal and newborn survival: MamaYe!

Central to the MamaYe communications strategy is the task of identifying evidence-based solutions to ensure the survival of women and their newborns – in order to showcase and celebrate both the solutions and the achievements of those who contribute to survival. We are particularly concerned to demonstrate and communicate to the African public that much can be done by any committed person to save lives, by: e.g. encouraging women to visit ante-natal clinics, taxi-ing a woman to hospital in an emergency; or giving blood.

How to engage Africans in maternal and newborn survival?

Reframing the issue

We know from George Lakoff, Professor of Linguistics at the University of California, Berkeley that:

“Frames are the mental structures that shape the way we view the world…they shape the goals we seek, the plans we make, the way we act, and what counts as a good or bad outcome of our actions. …To change our frames is to change all of this.

Reframing is social change.” (Our emphasis)

From: ‘Don’t think of an Elephant’ by George Lakoff. Published in 2004 by Chelsea Green Publishing, White River Junction, Vermont )

But how to engage Africans? In rich countries, campaigners often engage the public by inviting donations. In Africa, levels of poverty mean that many would be excluded from engagement in the campaign. Other means of engagement – the wearing of wrist-bands, stickers and badges, would be logistically complex, but also seemed unlikely to deeply engage African men and women.

And then one day, our director Ann Pettifor sat in a meeting on maternal health with a group of experts, including an experienced obstetrician, Dr. Sylvia Deganus, of the Ghanaian Ministry of Health, the statistician and demographer, Dr. Zoë Matthews of the University of Southampton, as well as Professor Richard Adanu, Dean of the School of Public Health, Ghana.

The subject of blood donation came up, and Dr. Deganus explained how her work to save mothers’ lives was made extremely difficult by a regular shortage of blood for women haemorrhaging at birth.  Post-partum haemorrhage (bleeding) is acknowledged as the leading cause of maternal mortality in Africa. There followed a long discussion during which Dr. Matthews explained that more than 60% of blood donated in Ghana was aimed at mothers and children.

A light-bulb. Donating blood – given the right conditions – is something that any healthy person can do. Donation agencies would need to undertake screening, and ensure that blood is not contaminated, but given that such agencies already exist, Ms Pettifor felt that a partnership between the MamaYe campaign and national blood donation services could work to the benefit of both.

But above all, donating blood would, at very little cost, directly engage African men and women in the issue of maternal and newborn survival. The sacrifice in giving a pint of one’s blood implies real engagement in the issue. It would also stimulate and deepen discussion and debate about the issue between donors and their friends, families and communities. Above all, it would serve a real purpose: more blood supplies would save lives.

Read more about MamaYe’s Blood Donation Campaign >

or

Learn more about Ai’s work on the MamaYe campaign >

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