A tipping point for change: saving millions of additional lives in 2013 and beyond

The Lancet, Volume 381, Issue 9864, Pages 350 - 352, 2 February 2013
By Goodluck Ebele Jonathan, President, Nigeria and, H.E. Jens Stoltenberg, Prime Minister, Norway, and co-chairs, the United Nations Commission on Life-Saving Commodities for Women and Children.

“In recent years we have seen gratifying progress towards Millennium Development Goals (MDGs) 4 and 5 (for child survival and maternal health, respectively). The number of child deaths is down from about 12 million in 1990 to about 7 million in 2011 and maternal deaths are down from an estimated 500 000 in 1990 to under 300 000 in 2010.

As a result, the number of children's lives saved every year through our joint efforts is close to the number of children born each year in Nigeria—or equivalent to the whole population of Norway. Nevertheless, we are off track to reach our goals of reducing child deaths by 67% and maternal deaths by 75% by 2015. However, recent initiatives promise to accelerate the progress made to date. After the Millennium Declaration and the launch of the MDGs, action was slow to follow. At the 5-year milestone in 2005 little progress was apparent in low-income countries, and the UN Secretary-General called on these countries “to adopt bold, goal-oriented policy frameworks for the next 10 years, aiming at scaling up investments to achieve at least the quantitative Millennium Goals targets”. But since then we have seen a rapid build-up of national, regional, and global initiatives that reflect the shared responsibility and collective action called for in the Millennium Declaration. 2010 was a landmark year, with the United Nations Secretary-General launching the Every Woman Every Child initiative and the G8, under Canadian leadership, placing maternal and child health at the top of its agenda. The African Union's July 2010 Summit on Maternal and Child Health raised the profile of this important issue across Africa.

We are pleased that in 2012 the global community built on this momentum by launching initiatives to ensure further progress towards MDGs 4 and 5. These initiatives included: the Child Survival Call to Action in Washington DC in June; the London Summit on Family Planning in July; the Saving Mothers, Giving Life partnership meeting at the Global Health Conference in Oslo in June; the launch of Nigeria's Saving One Million Lives initiative in Abuja in October; and the launch of the Open Health initiative in December which called for the mobilisation of further subregional action in east Africa for women's and children's health.

Most importantly, in recent years we have seen strong national leadership in many countries, including Ethiopia, Nepal, and Rwanda. It often manifests itself in initiatives such as the National Rural Health Mission in India, Saving One Million Lives in Nigeria, and the Safe Motherhood programme in Malawi anchored at the highest political level. Such leadership has greatly facilitated integration of international initiatives and partner contributions into national action based on each partner's comparative advantage.

In 2012, Nigeria and Norway had the honour of co-chairing the United Nations Commission on Life-Saving Commodities for Women and Children. This Commission is contributing to the United Nations Secretary-General's Global Strategy. It followed on from the Commission on Information and Accountability for Women's and Children's Health that developed and launched a strong accountability framework in 2011.

The Commission estimated that an ambitious scaling up of 13 life-saving and essential commodities over 5 years would cumulatively save more than 6 million lives. This would include averting 230 000 maternal deaths through increased access to family planning. Achieving these goals would further reduce estimated child deaths to 5.3 million and maternal deaths to close to 200 000 per year. The estimated costs per life saved are low and represent excellent value for money.

For example, more than 1.5 million children could be saved in the next 5 years with two effective treatments: oral rehydration solution and zinc, costing less than US$0.50 per treatment. In September, 2012, we delivered the Commission's report to the Deputy Secretary-General, Jan Eliasson, at the United Nations General Assembly. We recommended ten time-bound actions to dramatically improve access to the commodities. These included ensuring that quality-certified products are available, incentivising health-care professionals to follow the latest national guidance for care, and promoting, at regional and national levels, the manufacture and supply of appropriate commodities.

We are pleased to report that these recommendations have been enthusiastically received, and that significant implementation efforts have already begun in the short time since the launch of the report. Specifically, eight countries—the Democratic Republic of the Congo, Ethiopia, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, and Uganda—have committed to implement the Commission's recommendations as adjusted for local needs and priorities through the Abuja Declaration. In addition, global implementation plans have been developed, financed, and commenced.

An excellent example of a country-led implementation of the relevant recommendations is Nigeria's Saving One Million Lives initiative that aims to save 1 million lives by 2015 through an ambitious and comprehensive scaling up of access to essential primary health services and commodities for women and children. This initiative is the result of a careful analysis of Nigeria's needs and priorities and a nationally designed plan, which is supplemented, as necessary and desirable, by other partners.

It is important that the synergies between these new global and national developments are capitalised on to ensure effective collaboration and tangible, timely results. We are, therefore, pleased to publish this new report of the Global Campaign for the Health Millennium Development Goals, which highlights the recent developments as well as new commitments and approaches by national and global leaders. These commitments come from wide-ranging stakeholders including governments, multilateral organisations, non-governmental organisations, the private sector, and academic institutions. In September, 2012, for example, Norway partnered with the Bill & Melinda Gates Foundation, the Children's Investment Fund Foundation, the Clinton Health Access Initiative, the UK, and Sweden to announce a volume guarantee for the levonorgestrel contraceptive implant, Jadelle, with the manufacturer, Bayer HealthCare, which halved the price of the popular family planning method.

If we can ensure effective collaboration between these efforts, through innovative national leadership, we are convinced we will together achieve a dramatically accelerated reduction in maternal and child deaths. We hope that we can look back on 2013 as the tipping point when the bulk of the Every Women Every Child countries accelerated progress towards MDGs 4 and 5.