My Perspective on Targets and Strategies Set for Ending Preventable Maternal Mortality (EPMM)
The April 2014 Technical Consultation on Ending Preventable Maternal Mortality, Post-2015 Target Setting (EPMM) meeting in Bangkok yielded invaluable implications for countries including my own, Ethiopia. The meeting was well-organized and the content presented in the forum was a fruitful product of an ongoing discussion and thorough thoughts of many experts in the public and maternal health communities.
As opposed to the current Millennium Development Goals (MDG) targets, the post-2015 maternal mortality ratio (MMR) global targets can be viewed as different in two ways. First, instead of one crude percentage reduction of MMR across all nations, the post-2015 MMR global targets take countries’ current MMR baselines into consideration by dividing countries into two groups, those with an MMR <420 and those with an MMR >420. This, from my point of view, is very commendable as it urges countries to move forward realistically. Second, the post-2015 MMR targets propose to have 5-year interim milestones, the first in 2020, which is positive as it allows leaders to evaluate and strategize efforts moving forward to meet endline targets. Although the two new ways of setting and measuring targets are innovative, I had expected to see some sub-targets to describe essential interventions for ending preventable maternal mortality—interventions such as skilled birth attendance and met need for emergency obstetric and newborn care (EmONC).
I can confidently say that the two scenario-specific global target figures are plausible recommendations given the recent, generous, and possibly continuous global, regional and national attention and initiatives bestowed on women’s health as compared to the level of attention some eight years ago. Nonetheless, my concern is on how to measure the baseline MMR when we try to assign the country specific post-2015 MMR targets. While it is recommended to use the 2010 UN interagency estimates of MMR to set country specific targets, they are often inconsistent with the Demographic and Health Survey (DHS) estimates. A good example is my country, Ethiopia, where the estimate of MMR by the UN agencies in 2010 was 350 while the EDHS 2011 showed we were at 676—each putting Ethiopia in a different Post-2015 MMR target group. I can understand there are flaws associated with the DHS, but what made me skeptical to accept the UN estimate are discrepancies between UN and DHS estimates in other outcome indicators like level of births assisted by skilled birth attendants (SBA). This tends to trouble us to find a better estimate somewhere closer to the DHS figure instead of fantasizing the UN figure. I emphasized this remark because it has critical importance in terms of correctly categorizing countries into the two scenarios and thereby setting their specific targets so as to contribute towards the global target.
I can say that setting these global targets has come at an opportune time particularly for Ethiopia, which, through its ministry of health, is currently engaged in a visioning exercise to think broadly and strategically about the long-term development of the nation’s health care delivery system. The purpose of this visioning exercise is to envision a system that will be equitable, sustainable, adaptive and efficient, and will meet the health needs of a changing population between now and 2035. Maternal and child health have a special area in the exercise. With the recently released estimates and strategies from IHME and WHO, the MHTF would certainly be of profound importance in terms of gearing policy-making and guiding programming in maternal health for the time to come.
I believe that the new estimates and strategies would enormously help to invigorate ongoing efforts to curb the global trend of maternal mortality. Cognizant of the current realities and the challenges ahead, reaching the country specific targets and ending preventable maternal mortality are largely dependent on steadfast commitments of countries and governments for effective implementation of identified doable strategies and interventions.