Translating Global Targets to Local Action: Lessons From Nigeria
By: Bridget Nwagbara and Osayande Osagie, students at Melbourne School of Global and Population Health, University of Melbourne, Australia.
As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!
Every day this year, about 800 women around the world died due to child birth and pregnancy-related complications. That is close to 300,000 deaths over the course of one year. Although the number is staggering, there has been a 50% decrease in maternal mortality since 1990. The decline is notable, but far from the target set by Millennium Development Goal 5 (MDG 5).
Nevertheless, this achievement has increased enthusiasm among members of the development community, and has pushed for even more ambitious global targets to be set for the development framework beyond 2015. Presently, there is a lot of debate around the global targets, with some advocates proposing absolute benchmarks for maternal health aimed at reducing maternal mortality ratio to less than 50 per 100,000 live-births by 2035, and others proposing a percentile decline similar to the current MDGs.
While reflecting on this, we should take into consideration the fact that progress made in the last 25 years has not been equally distributed. While regions with low poverty rates and better maternal health outcomes have achieved the targets set by MDG 5, underserved regions and vulnerable groups continue to lag behind, making it obvious that maternal mortality cannot be combated with “one-size fits all” targets and strategies. Resources to meet these targets differ across and within countries, making it imperative to critically assess strategies on how to adapt global targets to local scenarios, matching them with local resources and translating them to local action.
Nigeria successfully reduced maternal mortality from 1,100 per 100,000 live births in 1990 to 630 in 2010. This was largely a result of officials’ at the Federal Ministry of Health recognition that family planning is imperative in reducing maternal mortality, and adapted the MDG 5 benchmark of increasing the contraceptive prevalence rate from 2% per year to 36% by 2018. To cascade this national target to the communities, actions were taken by state and local governments to develop implementation plans to expand community based access to family planning.
Taking the lead, authorities in Nigeria’s Gombe State developed a strategic framework and implementation plan to increase contraceptive prevalence from 8.82% in 2012 to 22% in 2018. Developing this strategic plan required active engagement of state government officials, community leaders and implementing partners who control the resources for promoting health issues, and have the authority to mobilize communities to take action, quantify the resources needed to achieve successful implementation and delegate responsibilities to various ministries and agencies. This local implementation plan estimates that investing 6.3 million USD to train frontline health workers to deliver family planning, expand service delivery to the community level and strengthen commodity logistics management will be needed to achieve the set targets and also avert 133,292 disability adjusted life years (DALYs) due to childbirth and pregnancy-related morbidities.
Lessons from Gombe State in Nigeria emphasize that no matter what the benchmarks and targets are set, significant progress cannot be achieved if efforts are not adapted to the local context with significant buy-in from local leaders. These targets also need to be based on the available resources to ensure that activities can be implemented and targets can then be translated into actionable steps at the local level.