Unleashing the power of communities to build resilient health systems

By Mary-Ann Etiebet, Lead and Executive Director, Merck for Mothers  // October 9, 2019

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The short answer is that we need solutions that cut across sectors — and not just the public and private sectors, although that’s crucial. Those of us working to improve maternal health need to get out of our health bubble. We should be talking to colleagues in energy, water, transportation, education and other fields so that we address the multi-factorial drivers of maternal deaths. And most importantly, we should be co-designing and co-creating solutions with communities if we want sustainable change.


The findings from the recent What Women Want Campaign brought many of these points home. The #1 demand among the 1.2 million women and girls surveyed from 114 countries was respectful and dignified care. #2 was water, sanitation and hygiene. 


There is much work to be done to meet these demands. And this work needs to be rooted in what the community wants and build on the resources communities have. Dr. Agnes Binagwaho, former Minister of Health in Rwanda, identified a need for cultural respect and humility among collaborators. “This can come about by changing the way we educate donors and others who are working in communities,” she said. 


Panelists spoke to the vital role of community health workers and recognized that digital innovations will not be a magic wand; they must be fit for purpose and implemented with community input. We discussed how community health-seeking behavior largely depends on the first encounter at a facility and we talked about results that emphasize prevention and wellness. 


And there was a strong consensus that we are not doing enough to leverage a community’s own strengths. As Dr. Murtala Mai from Pathfinder International challenged: “Let’s unleash the power of women and girls, put them in charge and see the difference it can make.”


Solutions for building stronger, more resilient communities — where mothers, children and families can thrive — are within grasp. Let’s imagine together what the future can look like, for mothers, for health, for communities and for society as a whole. 


* Panelists who participated in this discussion included: Dr. Agnes Binagwaho, Vice Chancellor, University of Global Health Equity and former Minister of Health, Rwanda; Dr. John Coonrod, Executive Vice President, The Hunger Project; Dr. Abdourahmane Diallo, CEO, RBM Partnership to End Malaria and former Minister of Health, Republic of Guinea-Bissau; Dr. Stefan Germann, CEO, Fondation Botnar; Harish Hande, Co-Founder, SELCO; and Dr. Murtala Mai, Senior Program Director, Pathfinder.


Merck for Mothers is Merck’s $500 million global initiative to help create a world where no woman has to die giving life. Applying Merck’s business and scientific resources, we collaborate to improve the health and well-being of women during pregnancy, childbirth and the postpartum period. Merck for Mothers is known as MSD for Mothers outside the United States and Canada.

When a new mother dies from a pregnancy or childbirth complication, it is a sign that the health system failed. It is also a sign that society failed — failed to value and protect the lives of the vulnerable and marginalized, failed to bring together sectors and break down silos to ensure that no woman has to die while giving life.


Both the health system and society failed Salome Karwah, a TIME Person of the Year recognized for her heroic efforts during the 2014 Ebola outbreak in Liberia who died in 2017  from postpartum complications three days after giving birth to her son.

I’ve been thinking about how Salome helped save members of her community but how the health system was not resilient enough to support her in return. At the recent Access Challenge One By One conference, held during the United Nations General Assembly in New York, I asked a panel of experts: How do we build responsive and resilient communities and health systems so that we protect more Salomes?

Ask the Author: Why UHC?


“There are more women dying from poor quality of care than there are dying from lack of access to care. We must therefore ensure that quality of care remains at the forefront of our agenda to deliver the health outcomes we seek for pregnant women around the world. To achieve this, we must ensure that local private providers are strategically integrated into quality of care initiatives, as this is where many women in low-middle income countries access their care."

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