Saving Mothers, Giving Life
Description
• Saving Mothers, Giving Life builds on the existing structures and resources that have been invested in successful national and US Government-supported maternal health and HIV programs, guided by national strategies for maternal and newborn health. To that end, the partnership focuses on the three delays that prevent women from benefiting from lifesaving maternal health services: the delay in seeking services, the delay in reaching services, and the delay in receiving high-quality services. SMGL gains an understanding of the landscape of safe delivery services in a given area by conducting in depth health facility assessments at all health care facilities, public or private, providing delivery services. The SMGL principle that all women should have access to comprehensive emergency care within two hours of the onset of a complication, helps inform the financial and technical inputs in order to maximize coverage and quality of services. SMGL focuses its efforts on the labor, delivery and 48-hour postnatal period as this is the time that women and babies are most vulnerable and the majority of deaths occur. The SMGL approach also support the provision of integrated MNH and HIV care.• Saving Mothers, Giving Life is not a “one-size fits all” model, and these strategies and assessments help inform the most appropriate interventions for each district. SMGL uses rigorous monitoring and evaluation to not only count, analyze, and report all maternal and newborn deaths, but also to track programming and guide the expansion of SMGL. Some key evidence-based interventions include:o Increasing demand by training community health workers, mobilizing community leaders, and promoting services and healthy behaviors. o Enabling access by upgrading facilities, providing transportation vehicles and/or vouchers, and building/refurbishing maternity waiting homeso Improving quality by hiring health care workers and providing on the job training and mentoring.o Strengthening health systems by improving supply chain management of supplies, equipment, and essential medicines, and training in data reporting and M&E.
The Saving Mothers, Giving Life approach fosters host-country ownership, capacity-building and sustainability: • AGOC has been working with the Zambian Ministry of Health to incorporate Uterine Balloon Tamponade (UBT), a low cost and effective technology to treat post-partum hemorrhage (the number one cause of maternal deaths), into the nation guidelines for postpartum hemorrhage management. It also initiated the MOH-endorsed policy shift to allow mid-wives to provide this life-saving care. ACOG is building a network of local trainers who will facilitate the nation-wide roll-out of UBT training. Trainees are also taught how to make UBT kits with local products, should kits not be available. • Project C.U.R.E. provides shipments of customized donated medical supplies, equipment, and related program services to SMGL facilities. After completing comprehensive needs assessments, Project C.U.R.E. produces individualized manifest lists of items for each facility, which are then reviewed and approved by facility directors and ministry of health officials, to ensure that the content is appropriate and needed. After the shipment arrives, they conduct impact evaluations for each container that is delivered to ensure that all equipment is functioning properly and being utilized appropriately. Project C.U.R.E. also holds bio-medical trainings for local engineers in the maintenance and repair of the donated equipment. • Additionally, rosters of mentors who can provide supportive supervision have been established in SMGL districts; this facilitates collaboration, knowledge sharing, problem solving and skills training. Job aids and materials for various technologies and interventions have been distributed among healthcare professionals and facilities, including UBT, Helping Babies Breathe, Helping Mothers Survive, and the BABIES Matrix (a simple tool to capture and monitor perinatal deaths in facilities) among others. SMGL has also fostered south to south collaboration, sharing, and learning between SMGL countries, with SMGL team members traveling to other countries to support and train in data collection and analysis. • Through SMGL efforts, maternal and perinatal death reviews are now standard in SMGL facilities• MOH leaders from both Uganda and Zambia have endorsed the SMGL approach as the standard model for scaling out maternal and newborn services.
Saving Mothers, Giving Life employs a systems approach to addressing maternal and newborn morality by working with both public and private sectors to build on existing national, state, and local platforms. SMGL is coordinated through a secretariat, housed in USAID’s Bureau for Global Health, under the direction of the initiative’s Leadership Council, comprised of representatives from each of the founding partners of the initiative. Each partner of the Leadership Council plays an integral role, outlined below: The United States Government, through USAID, manages SMGL in partnership with CDC, OGAC, the Department of Defense, and the Peace Corps. Together, USAID and CDC lead implementation and monitoring and evaluation (M&E) activities for the initiative with oversight from the Operations Committee and the M&E Committee. The Government of Norway has supported efforts to access donated hospital supplies and equipment through support of Project C.U.R.E. Every Mother Counts leads efforts to strengthen emergency transportation and referral systems in Uganda and advocate for increased support for maternal mortality reduction globally.The American College of Obstetricians and Gynecologists lends scientific, technical, and clinical expertise. ACOG has established networks of trainers and mentors for specific clinical skills, such as use of Uterine Balloon Tamponade for postpartum hemorrhage, and has successfully advocated for national task shifting policies.Merck for Mothers leads programs to strengthen local private health providers through social franchising models in Uganda and Nigeria, and programs to develop entrepreneurial models for maternity waiting homes in Zambia. Project C.U.R.E. provides containers of customized donated medical supplies, equipment to SMGL facilities. Project C.U.R.E. completes on-site needs assessments in all selected SMGL facilities, generates manifests that are signed-off on by district health leaders, oversees door to door delivery, and completes impact evaluations for each container. SMGL operations include a rigorous M&E component that examines not only outputs and program outcomes, but health outcomes—such as the maternal mortality ratio and the perinatal morality rate--with the goal to count every maternal and newborn death and to understand its cause. A comprehensive baseline was undertaken at the inception of the initiative, with regular monitoring and quarterly reporting of 31 district, community and facility level indicators. Indicators are collected and analysed by implementing partners, and cleaned and analysed by CDC and USAID teams in country and headquarters. The M&E committee is also responsible for oversight of external evaluations.
Other stakeholders: Swedish Sida, Lafarge Foundation Zambia Zamnet, ELMA Philanthropies
SDGS & Targets
Goal 4
Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
4.1
By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes
4.1.1
Proportion of children and young people (a) in grades 2/3; (b) at the end of primary; and (c) at the end of lower secondary achieving at least a minimum proficiency level in (i) reading and (ii) mathematics, by sex
4.1.2
Completion rate (primary education, lower secondary education, upper secondary education)
4.2
By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education
4.2.1
Proportion of children aged 24–59 months who are developmentally on track in health, learning and psychosocial well-being, by sex
4.2.2
Participation rate in organized learning (one year before the official primary entry age), by sex
4.3
By 2030, ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university
4.3.1
Participation rate of youth and adults in formal and non-formal education and training in the previous 12 months, by sex
4.4
By 2030, substantially increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurship
4.4.1
Proportion of youth and adults with information and communications technology (ICT) skills, by type of skill
4.5
4.5.1
Parity indices (female/male, rural/urban, bottom/top wealth quintile and others such as disability status, indigenous peoples and conflict-affected, as data become available) for all education indicators on this list that can be disaggregated
4.6
By 2030, ensure that all youth and a substantial proportion of adults, both men and women, achieve literacy and numeracy
4.6.1
Proportion of population in a given age group achieving at least a fixed level of proficiency in functional (a) literacy and (b) numeracy skills, by sex
4.7
By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development
4.7.1
Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education and (d) student assessment
4.a
Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all
4.a.1
Proportion of schools offering basic services, by type of service
4.b
4.b.1
Volume of official development assistance flows for scholarships by sector and type of study
4.c
By 2030, substantially increase the supply of qualified teachers, including through international cooperation for teacher training in developing countries, especially least developed countries and small island developing States
4.c.1
Proportion of teachers with the minimum required qualifications, by education level
Goal 5
Achieve gender equality and empower all women and girls
5.1
End all forms of discrimination against all women and girls everywhere
5.1.1
Whether or not legal frameworks are in place to promote, enforce and monitor equality and non‑discrimination on the basis of sex
5.2
5.2.1
Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months, by form of violence and by age
5.2.2
Proportion of women and girls aged 15 years and older subjected to sexual violence by persons other than an intimate partner in the previous 12 months, by age and place of occurrence
5.3
5.3.1
Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18
5.3.2
Proportion of girls and women aged 15-49 years who have undergone female genital mutilation/cutting, by age
5.4
Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate
5.4.1
Proportion of time spent on unpaid domestic and care work, by sex, age and location
5.5
Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life
5.5.1
Proportion of seats held by women in (a) national parliaments and (b) local governments
5.5.2
Proportion of women in managerial positions
5.6
Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences
5.6.1
Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care
5.6.2
Number of countries with laws and regulations that guarantee full and equal access to women and men aged 15 years and older to sexual and reproductive health care, information and education
5.a
Undertake reforms to give women equal rights to economic resources, as well as access to ownership and control over land and other forms of property, financial services, inheritance and natural resources, in accordance with national laws
5.a.1
(a) Proportion of total agricultural population with ownership or secure rights over agricultural land, by sex; and (b) share of women among owners or rights-bearers of agricultural land, by type of tenure
5.a.2
Proportion of countries where the legal framework (including customary law) guarantees women’s equal rights to land ownership and/or control
5.b
5.b.1
Proportion of individuals who own a mobile telephone, by sex
5.c
Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels
5.c.1
Proportion of countries with systems to track and make public allocations for gender equality and women’s empowerment
Goal 17
Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development
17.1
Strengthen domestic resource mobilization, including through international support to developing countries, to improve domestic capacity for tax and other revenue collection
17.1.1
17.1.2
17.2
Developed countries to implement fully their official development assistance commitments, including the commitment by many developed countries to achieve the target of 0.7 per cent of ODA/GNI to developing countries and 0.15 to 0.20 per cent of ODA/GNI to least developed countries; ODA providers are encouraged to consider setting a target to provide at least 0.20 per cent of ODA/GNI to least developed countries
17.2.1
17.3
Mobilize additional financial resources for developing countries from multiple sources
17.3.1
Additional financial resources mobilized for developing countries from multiple sources
17.3.2
17.4
Assist developing countries in attaining long-term debt sustainability through coordinated policies aimed at fostering debt financing, debt relief and debt restructuring, as appropriate, and address the external debt of highly indebted poor countries to reduce debt distress
17.4.1
17.5
Adopt and implement investment promotion regimes for least developed countries
17.5.1
Number of countries that adopt and implement investment promotion regimes for developing countries, including the least developed countries
17.6
Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation and enhance knowledge sharing on mutually agreed terms, including through improved coordination among existing mechanisms, in particular at the United Nations level, and through a global technology facilitation mechanism
17.6.1
Fixed broadband subscriptions per 100 inhabitants, by speed
17.7
Promote the development, transfer, dissemination and diffusion of environmentally sound technologies to developing countries on favourable terms, including on concessional and preferential terms, as mutually agreed
17.7.1
Total amount of funding for developing countries to promote the development, transfer, dissemination and diffusion of environmentally sound technologies
17.8
Fully operationalize the technology bank and science, technology and innovation capacity-building mechanism for least developed countries by 2017 and enhance the use of enabling technology, in particular information and communications technology
17.8.1
17.9
Enhance international support for implementing effective and targeted capacity-building in developing countries to support national plans to implement all the Sustainable Development Goals, including through North-South, South-South and triangular cooperation
17.9.1
Dollar value of financial and technical assistance (including through North-South, South‑South and triangular cooperation) committed to developing countries
17.10
Promote a universal, rules-based, open, non-discriminatory and equitable multilateral trading system under the World Trade Organization, including through the conclusion of negotiations under its Doha Development Agenda
17.10.1
17.11
Significantly increase the exports of developing countries, in particular with a view to doubling the least developed countries’ share of global exports by 2020
17.11.1
Developing countries’ and least developed countries’ share of global exports
17.12
Realize timely implementation of duty-free and quota-free market access on a lasting basis for all least developed countries, consistent with World Trade Organization decisions, including by ensuring that preferential rules of origin applicable to imports from least developed countries are transparent and simple, and contribute to facilitating market access
17.12.1
Weighted average tariffs faced by developing countries, least developed countries and small island developing States
17.13
Enhance global macroeconomic stability, including through policy coordination and policy coherence
17.13.1
17.14
Enhance policy coherence for sustainable development
17.14.1
17.15
Respect each country’s policy space and leadership to establish and implement policies for poverty eradication and sustainable development
17.15.1
17.16
Enhance the Global Partnership for Sustainable Development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the Sustainable Development Goals in all countries, in particular developing countries
17.16.1
Number of countries reporting progress in multi-stakeholder development effectiveness monitoring frameworks that support the achievement of the Sustainable Development Goals
17.17
Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships
17.17.1
Amount in United States dollars committed to public-private partnerships for infrastructure
17.18
By 2020, enhance capacity-building support to developing countries, including for least developed countries and small island developing States, to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts
17.18.1
Statistical capacity indicators
17.18.2
17.18.3
Number of countries with a national statistical plan that is fully funded and under implementation, by source of funding
17.19
By 2030, build on existing initiatives to develop measurements of progress on sustainable development that complement gross domestic product, and support statistical capacity-building in developing countries
17.19.1
17.19.2
Proportion of countries that (a) have conducted at least one population and housing census in the last 10 years; and (b) have achieved 100 per cent birth registration and 80 per cent death registration
Goal 3
Ensure healthy lives and promote well-being for all at all ages
3.1
3.1.1
Maternal mortality ratio
3.1.2
Proportion of births attended by skilled health personnel
3.2
3.2.1
Under-five mortality rate
3.2.2
Neonatal mortality rate
3.3
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
3.3.1
Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations
3.3.2
Tuberculosis incidence per 100,000 population
3.3.3
Malaria incidence per 1,000 population
3.3.4
Hepatitis B incidence per 100,000 population
3.3.5
Number of people requiring interventions against neglected tropical diseases
3.4
3.4.1
Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
3.4.2
Suicide mortality rate
3.5
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
3.5.1
Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders
3.5.2
Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol
3.6
3.6.1
Death rate due to road traffic injuries
3.7
By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
3.7.1
Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods
3.7.2
Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group
3.8
Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
3.8.1
Coverage of essential health services
3.8.2
Proportion of population with large household expenditures on health as a share of total household expenditure or income
3.9
3.9.1
Mortality rate attributed to household and ambient air pollution
3.9.2
Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe Water, Sanitation and Hygiene for All (WASH) services)
3.9.3
Mortality rate attributed to unintentional poisoning
3.a
3.a.1
Age-standardized prevalence of current tobacco use among persons aged 15 years and older
3.b
Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
3.b.1
Proportion of the target population covered by all vaccines included in their national programme
3.b.2
3.b.3
Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis
3.c
3.c.1
Health worker density and distribution
3.d
Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
3.d.1
International Health Regulations (IHR) capacity and health emergency preparedness
3.d.2
Percentage of bloodstream infections due to selected antimicrobial-resistant organisms
SDG 14 targets covered
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Kate Cassidy, Saving Mothers, Giving Life Initiative Manager