Investing on the future
Solomon Zewdu (MD) is the Health and Nutrition Development Lead with the Bill & Melinda Gates Foundation in Ethiopia. In the backdrop of a just concluded conference – 2017 Acting on the Call Summit— held in the capital for two days at the headquarters of the African Union, Solomon sat down with Samuel Getachew of The Reporter to reflect on the highlights of conference, the work of the foundation, which was a noted co-sponsor of the gathering, and some of the efforts that are being made to end child and maternal death within the continent. Excerpts:
The Reporter: The Gates foundation was a co-sponsor of the recent conference on overcoming critical barriers to maternal and child survival. Share with me some of the highlights?
Solomon Zewdu (MD): Mother and child mortality remains to be among the world’s most pressing and distressing challenges. Every year, more than 303, 000 mothers and 5.9-million children die around the world. While significant progress has been made in the last decade, much still needs to be done to ensure young children and their mothers survive and thrive. This was the focus of the fourth Acting on the Call Summit in Addis Ababa, Ethiopia, this week. Delegates from 24 representative core countries that were at the conference issued a ministerial declaration, pledging anew their commitment to realizing the goals of Acting on the Call: to save 15-million children and 600,000 women in the next three years.
The conference heard how Ethiopia has managed to reduce mortality among children under five by two-third in the last three decades. That is a rare achievement. How do you think Ethiopia managed to do that?
A combination of things has taken place in Ethiopia to bring about this success since this is a concerted effort. In the case of Ethiopia, strong political leadership, government commitment and the setting up of a resilient community platform to support an empowered and committed community engagement has played the greater role. The introduction of the Health Extension Platform, established 13 years ago, has served as the vehicle to implement the top down and down up efforts and ultimately translated into effective maternal and child mortality reduction among, many other health sector successes.
One of the areas where the Gates foundation has been highlighted is its work with community health. Why is that still a valuable way to help the health care needs of Ethiopia?
We believe that a community that is aware and empowered has the ability to hold itself accountable and can, in turn, hold the system accountable for delivering timely, responsive, equitable and high quality services; hence, the need to continue investing in strengthening that system.
What are some of the innovative ways Ethiopia can fund its healthcare costs?
Proven methods that have worked to minimize financial risks to the system and those the system aims to serve include community health insurance, increased domestic financing, and sin taxes.
One of the challenges in most parts of the country is that, often times, the most preventable disease is the one that kills children. What can funders as well as recipient countries do to help with what has become a uniform challenge in most African nations?
Improved planning and coordination can maximize priority setting and guarantee that the limited resources are spent on the most relevant and cost-effective interventions. As such, it is paramount that governments have a full understanding and appreciation of their disease burden, their fiscal reality and their assistance portfolio to allocate resources effectively as well as negotiate jointly designed assistance envelopes from funders.
The gathering heard how it is possible to end preventable child and maternal deaths. Is that possible? Is there a nation that has truly eradicated it?
As indicated in the question itself, this addresses preventable diseases that lead to unnecessary deaths if they are not managed effectively. The preventable nature of the diseases points to the possibility of eradicating these unnecessary mortality and morbidity conditions. So, I would say yes, it is possible to eradicate deaths caused by preventable diseases. Given the multi-factorial reasons for death, including resource availability, health complications, human factor, etc., it is hard to say any nation can or has truly eradicated preventable deaths.
What are some of the unique areas the foundation is engaged in when it comes to its programs in Ethiopia?
Based on the principles that all lives have equal value and in the careful crafting of the right assistance for the changes we want to see in the world, and taking into the equation that Ethiopia is a developing country with challenges unique to developing countries, the Bill and Melinda gates Foundation interventions in Ethiopia focus on improving people’s health and wellbeing, helping individuals lift themselves out of hunger and extreme poverty. In addition to our priority investments in Health, nutrition and agriculture, we particularly focus on the empowerment of women and girls since we know that women and girls have a unique power to reshape societies. Investment in a woman’s health and empowerment has had a ripple effect, helping families, communities, and countries achieve long-lasting benefits. Positive generation changes in health status and overall thriving of the next generation is an outcome of this ripple effect. Of course, we are also very cognizant that our resources alone are not enough, so we work to change public policies, attitudes, and behaviors to improve lives by developing strong and transparent relationships with the government, the donor community and the public and private sectors, and foster mutually accountable, aligned and synergistic and catalytic interventions supported by good data, evidence, science and innovation.
How about some of the efforts the foundation has made in terms of vaccines, maternal and child birth programs and does that effort have any impact on the ground?
Maternal and child health and the elimination of preventable maternal and child death remain a core intervention for the Foundation. Despite the realization that vaccines are among the most cost-effective health interventions ever developed, about 1.5 million children die each year from vaccine-preventable diseases. And sadly, more than 70 percent of the world’s unvaccinated children live in 10 countries with large populations and weak immunization systems. Ethiopia is the second populous country and vaccine intervention will generate tremendous divided in both life saved, reduced morbidity and overall economic gains. A recently published study in the journal of Health Affairs has shown that for every one dollar spent on vaccine, societies save up to 44 dollars. We work with the government of Ethiopia through local, international partners as well as global agencies to create the most affordable, effective and efficient system without compromising the quality and efficacy of the vaccines provide to low resource countries. In addition to our vaccine work, we are aware that most maternal and newborn deaths can be prevented using existing, proven, cost-effective interventions. But, the unfortunate reality is that despite their availability, these proven high-impact interventions are not reaching all the women and newborns that need them. Simple interventions such as antibiotics, umbilical cord care, medications that treat excessive bleeding during childbirth, immediate and exclusive breastfeeding, keeping the newborn warm with skin-to-skin contact, increasing the number of women that deliver their babies in a qualified health facility and the practice of effective family planning are but a few of the low-cost interventions. The Foundation again works with highly qualified governmental and partner organizations and systems to maximally capitalize on these interventions while we invest on research activity across the continuum around the world to further improve ways to save the lives of women and newborns. Ethiopia has reached both the child mortality and maternal MDG goals and is a testament that these concerted efforts are effective and truly lifesaving.
By Samuel Getachew