September 22, 2010—A Bangladeshi woman, Safar Banu, age 43, was pregnant with her tenth child. She had wanted to use contraceptives, but her husband forbade her and threatened to divorce her if she did. She did not seek antenatal care—she had given birth to nine children without the help of a clinic, and had neither the time nor the money to go to the clinic.
A week before giving birth, she felt very weak, her body was swollen and burning hot. She feared she would not survive this birth. The husband couldn’t afford to take her to hospital and anyway thought the local healer Gopal Daktar, just as capable—and much cheaper. Gopal gave Safar medicine, although he admitted later that it was just aspirin—her family was too poor for anything else, and in any case, he didn’t know what was wrong with her.
The birth was difficult because Safar was so weak. Afterwards, she was unable to get up. After 5 days, a midwife from the maternal and child health clinic was called. She recommended that Safar be transferred immediately to the district hospital.
The clinic offered to pay for medicines, but transport to a hospital was the family’s responsibility. The family sold half a “kani” of land to pay for transport but it was too late. Safar Banu died the following day at the hospital.
Millennium Development Goal on Maternal Health Continues to Lag
A complex set of factors contributed to Safar’s death—inside the health sector, poor education and transportation, household dynamics, and factors in the wider culture.
World Bank Institute Global Course Equips Health Practitioners with Skills
To meet their needs, the World Bank Institute (WBI) continues to offer its much-demanded course: Achieving the Millennium Development Goals: Poverty Reduction, Reproductive Health and Health Sector Reform program (the MDG course). The course focuses on the MDGs, reproductive health, maternal and child mortality, and gender in the context of health sector reforms, and poverty alleviation.
“Nobody before had taken time to explain to me and many others what is new in health sector reform. Being one of the key persons at district level in implementing government policies, I feel I am now better equipped to forge ahead,” said Haldon Yohane Njikho, Ministry of Health, Malawi.
The course blends health issues with economics and implementation tools, and integrates gender issues and associated modules on AIDS, TB, malaria, and maternal mortality. New approaches such as results-based financing and the Bank’s new Reproductive Health Action Plan are also incorporated.
“Its real value lies in the way it presents the bigger picture—that enables us to see how our particular interests fit into the health system as a whole,” said Sonia de Heckadon, UNFPA Assistant Representative for Panama, who attended the course recently. “It has really made me think at a much-needed policy level. For example, I am developing an adolescent reproductive health project in Guatemala; now I can do so with a much better understanding of the environment in which the project will be developed. I can take into account the potential impact of the reforms and make allowances accordingly.”
Broader Picture for Introducing the Course
When governments started shifting their focus on population from family planning alone to address a broader range of reproductive health needs, they needed trained professionals to work more effectively in the rapidly changing policy environment and understand linkages across different sectors and how they influence each other.
Nobody before had taken time to explain to me and many others what is new in health sector reform. Being one of the key persons at district level in implementing government policies, I feel I am now better equipped to forge ahead.Haldon Yohane Njikho, Ministry of Health, Malawi
This was the context WBI began its work on a learning program to provide “how-to” skills and tools for financing and implementing effective reproductive health services in the new environment.
Challenges and Lessons Learned
One of the early challenges for the WBI course team was how to help course participants, few of whom had little or any training in economics, to understand such key concepts as cost-effectiveness, market failure, and externalities. In the changing program and funding environment of the 1990s, understanding these concepts was increasingly important as reproductive health professionals competed for resources. WBI redesigned key modules on health economics concepts and tools for a non-economist audience.
As the global course evolved over the past decade, WBI also supported regional and national partners to adapt the materials for regional and country level courses. These provided more specific guidance for designing and delivering population and reproductive health programs in particular contexts.
Effective partnerships have been crucial to the success of the MDGs program, including with the Rockefeller Foundation, United Nations Population Fund, Hewlett Foundation, Harvard University, World Health Organization, United States Agency for International Development, and many others.
Over the years, the program expanded and now offers a variety of training events via distance learning and through regional partner networks, which has created an international community of practice.