Good morning everybody and hello to those online. I don’t know about you, but every day I wake up feeling really fortunate that Atul Gawande is driving Global Health – our Global Health agenda and leading in the way that he is – not only at USAID, but I hope you are feeling that leadership out in the world. I just – Atul, the fact that you’ve been at USAID a year – I have to kind of say, how is that – a little more than a year – how is that even possible for the strategic course that you have put us on. I’m just so grateful to you for answering the call of service. 

Like so many of you, of course, Atul can be doing many things for his day job. Last I checked, he used to do other things, but the fact that he’s taking all those years of experience and curiosity and vision and bringing them to the institution of USAID – could not be more grateful. Grateful, also, for President Biden, for such an inspiring choice. 

I want to join him in thanking the representatives from India and from Senegal, who are co-hosting this conference with us, and who have led this work consistently and effectively for more than a decade. Really, really, grateful for you. 

Eleven years ago, then-Secretary of State Hillary Clinton told participants of the Child Survival Call to Action that the fight against preventable child and maternal deaths was, as she put it, “one of history’s great development stories.” As Atul just alluded to, in just a decade, maternal mortality had declined by a quarter, child mortality by a third. Momentum was strong, as Atul said, the wind was at everybody's back – and Secretary Clinton built on it, challenging the world to end preventable child and maternal deaths in just a generation. 

And, although it’s hard, again, to put oneself back in that time, in that mindset, that was actually an achievable objective at the time. And in 2015 – when I, then, was at the United Nations negotiating the Sustainable Development Goals – as the world celebrated its lowest maternal and child mortality rates in history, the UN quantified the essential task ahead in the 2030 Sustainable Development Goals.

But while some countries are still on track to meet those goals – like in fact our co-hosts, India and Senegal – as we all know, the momentum of the early 2000s has, at best, plateaued. From 2016 to 2020, maternal mortality rates virtually flatlined. Under-five mortality rates, which declined by double digits every five years since 2000, also slowed.

These trends, as you know, stem in part from broader crises. The pandemic, again, as Atul spoke to, raised the risk of premature birth, and conditions like preeclampsia, while also limiting access to care. Rising levels of conflict – again, more conflict happening today than at any time since the end of the Cold War – threaten the safety of health workers and patients alike. And droughts and natural disasters, which are proliferating and intensifying, often lead to higher rates of malnutrition, already associated with nearly half of all deaths of children under five. 

But our solutions, too, in fairness, have fallen short. Early efforts, including those driven by USAID, focused on expanding access to care and treatment. But while we’ve made strides, we haven’t expanded coverage as fast as we would have to if we were to meet the 2030 goals. We haven’t done nearly enough to reach historically marginalized communities, or to affirm the sexual and reproductive health and rights of every woman and girl. And we haven’t focused enough on whether that care is actually effective and actually safe.

To fill in at least some of these gaps, I’m pleased to launch USAID’s new strategic framework to prevent child and maternal deaths – a framework that emphasizes coverage, equity, and quality. 

First and foremost, we’ll continue to expand access to care – which accounted for a significant portion of the gains made in the early 2000s. But it’s clear we could have done so faster. And now, a global health worker shortage threatens to reverse our progress. So, USAID will continue to help partner countries fill resource gaps that are preventing them from hiring more health workers. We will continue to integrate care for mothers and children – providing breastfeeding counseling and voluntary family planning resources during newborn immunization appointments, for example, and sending patients home with treated bed nets to protect against malaria. 

And we’ll continue to find creative ways to connect more pregnant people to care during the most critical moments. And here I’d offer, I think, an exciting example. In Tanzania, pregnant people – this is true actually in so many countries – pregnant people are often forced to walk miles to receive care because of the lack of ambulance care or lack of other forms of other forms of transport to a medical facility – this can contribute to the more than 10,000 maternal deaths every year. So, USAID partnered with the Vodafone Foundation to design and implement a program that some of you may have heard of called m-mama, an Uber-style system of emergency transport – private taxis, on call, driven by a network of community drivers, supplied with emergency kits, staffed by health workers – that can bring patients to facilities that are equipped to treat them. Since 2016, the districts where m-mama operates saw maternal mortality rates drop by 38 percent. We are working to expand m-mama to other countries, starting with Kenya, and just a few weeks ago, the program achieved nationwide coverage in Lesotho.

As we expand coverage though, we must do more to reach the communities that have consistently been left out of the progress that we have made. And to reach those communities, we must understand who they are, what they need, and how we can best support them. 

That is why we are partnering, service of equity, with governments around the world to improve their data tools, and to break down existing data to truly understand who is being left behind. And we’ll continue to work directly with leaders and organizations within those communities – the people whose lived experience provide them not just with a deep understanding of the challenges they face but also of course with an understanding of how best to solve those challenges. 

In Mali, for example, when COVID-19 limited access to care and we saw immunization rates of polio and measles drop, we worked directly with local health facilities to establish mobile vaccination outreach clinics to immunize children in hard-to-reach communities. To address high maternal mortality rates in Indonesia, USAID established “health corners” in popular convenience stores that help women learn the symptoms of high-risk pregnancies and provide referrals to health facilities. And in parts of India, we are training community health workers to provide counseling and access to voluntary family planning methods – which can reduce global maternal deaths by up to two-thirds, and for which the United States remains the world’s largest bilateral donor. 

But access to care just isn’t enough to help end preventable deaths, and an emphasis on equity and reaching marginalized groups, or those that have been left behind, also alone, of course, is not sufficient. Research shows that over half of pregnant people, and over 60 percent of young children who die preventable deaths in low income countries actually do access care – but that care must also accurately diagnose conditions, treat those conditions quickly, and instill a culture where patients are treated with kindness, respect, and dignity.

That is why we are working with governments, the World Health Organization, UNICEF – who I know you’ll hear from shortly – and other partners to train health workers to perform safe and effective obstetric surgeries. We are helping to strengthen standards and systems to quickly and accurately diagnose and treat malaria and other diseases. And we are supporting global advocacy campaigns for women-centered care and research into postpartum anxiety and depression, an under-researched but significant cause of maternal mortality.

I know that many of you here today have been working for years – in some cases decades – not just to increase access to care, but to reach historically marginalized communities, and to focus, of course, on quality, as well. Our new strategy will help us more effectively partner and coordinate with you all. And it will serve as a model for others looking to do the same – because ending preventable deaths among mothers and children will take all of us. As Atul said, working together. 

It will take partner governments directing more domestic funding toward maternal and child health, which we know again with liquidity scarce and governments facing significant debt distress, has been harder and harder to secure those domestic resource commitments. But that is why this must be thought of holistically along with other strategies of working with governments coming out of the pandemic crisis.

It will take the private sector partnering with governments and organizations, like some of yours, to provide resources and expertise that only they can provide.

And it will take all of us – at USAID and beyond – to view ourselves as a support system for local partners driving critical work on the ground. 

Back in 2012, Secretary Clinton’s challenge to the world was entirely achievable. And today, we have to remember that in fact, no matter how it feels right now, no matter the setbacks – it still is. We have everything we need to end preventable maternal and child mortality in a generation, we just have to get to work together.

Thank you so much.

Original source can be found here