Challenges

Over 830 women and adolescent girls die each day from preventable causes related to complications of pregnancy and childbirth. Ninety-nine per cent of all maternal deaths occur in developing countries. Addressing preventable maternal deaths requires coordinated and multisector responses, considering the dynamic interaction of vulnerability factors, such as economic and socio-cultural determinants of health; gender, income, ethnic-racial and territorial inequalities; analysis of the root causes; socio-epidemiological contexts for sexual and reproductive health; and the state of national health systems. It demands a complex and delicate integration between local interventions and a global effort to ensure universal, comprehensive and timely attention to pregnancy and childbirth. 

Toward a Solution

The commitment of the countries involved in this partnership to end preventable maternal deaths has served as an impetus for dialogue between and among these partner institutions, capitalizing on the high level of technical expertise of the Fundação Oswaldo Cruz (FIOCRUZ). With support from the United Nations Population Fund (UNFPA), FIOCRUZ has been able to bring together different countries through a harmonized strategy focused on ending maternal deaths.  Angola was the very first country to express a formal request to be engaged in the project, although many other countries have been part of initial dialogues and identification of priorities. The high engagement of the partners and the existence of common challenges were determinant factors in building synergy among the partners involved.  

To facilitate collaboration between concerned countries, the idea of a Reference Centre for Sexual and Reproductive Health and Rights came about anchored on the International Conference on Population and Development (ICPD) as the basis for its larger agenda and framework for collaboration. Hence, it has been named the ICPD Reference Centre for Sexual and Reproductive Health (SRH) and Rights. The initiative is based on similar collaborative solutions developed by UNFPA using an international platform for different levels of decision-making. It demonstrates a good practice to organize, qualify and respond collaboratively to needs of national partners in responding to SRH and rights.

This partnership started in 2019 with a global Memorandum of Understanding signed between FIOCRUZ and UNFPA. The joint engagement involves representatives from several health institutions in Africa, notably Angola’s Ministry of Health and the National Department of Public Health; Cabo Verde’s National Public Health Institute and Ministry of Health and Social Security; and Mozambique’s Ministry of Health. Initial similar discussions are underway with the Ministries of Health of São Tomé and Príncipe, Guinea Bissau and Senegal. 

Within this framework, members of the Community of Portuguese Language Countries (CPLP in Portuguese) have developed a response framework to enhance health systems. Together with Brazil’s FIOCRUZ, many dialogues and proposals for interventions from countries such as Angola, Cabo Verde and Mozambique were designed to guide cooperation modalities. The solutions sought by partners were geared towards a coordinated response starting with identifying gaps in the health care chain to strengthening the national health systems. This is meant to provide quality services to women during pregnancy and childbirth. The successful interventions developed by FIOCRUZ in different Brazilian territories have served as a basis for complementing or redesigning national policies and programmes of other countries. This collaborative spirit serves as the rationale for this south-south and triangular cooperation. 

The ICPD Reference Centre for Sexual and Reproductive Health (SRH) and Rights aims primarily to strengthen national health systems to better respond to SRH issues and to more effectively reduce preventable maternal deaths in CPLP countries. In this sense, FIOCRUZ acts as a centre for sharing experiences for African countries, which in turn also share good practices and methodologies among themselves. The construction of a physical centre is not foreseen as yet so FIOCRUZ is providing support virtually by facilitating the networking and knowledge sharing through a common cooperation governance platform. The collaborative work focuses on organizing demands related to surveillance on maternal deaths, technical training in analyzing contexts; planning, managing and evaluating interventions within the health system; monitoring clinical practices and security indicators; and sharing instruments and methodologies that ensure the promotion of community participation and organization. 

At a global level, the ICPD Reference Centre is responsible for advocacy, political dialogue and forecast governance through an Executive Secretariat, composed of representatives of FIOCRUZ and UNFPA, and a Steering Committee with representatives from government counterparts and other UNFPA partner countries. At a national level, the ICPD Reference Centre ensures the continuity of the cooperation by mobilizing national actors to construct and strengthen national health observatories focused on maternal deaths surveillance, producing evidence and intervention plans on pregnancy, childbirth and postpartum, covering topics such as obstetric emergencies, high-risk pregnancy and adolescent pregnancy, among others.  

In these partnerships, areas of common interest include education, training and research opportunities, a greater focus on technical professionals and managers working in maternal health, co-designing of projects and events at local, regional and global levels, and the development of flagship programs that further advance partnerships around the sustainable development goals.  

Capitalizing on the great experience of FIOCRUZ in international cooperation, particularly in dealing with different actors in varying contexts, the promising innovative element to this cooperation is the emphasis on elaborating integrated solutions that take into account the high level of adaptability to other contexts. This also means ensuring the participation of multiple players in different situations and identifying local responses to regional and global issues. Besides, the Distance Learning Course on Surveillance of Maternal Death and Performance in Mortality Committees, other innovative proposals are being made available to CPLP countries. The programme also includes the education and formative technologies developed by FIOCRUZ tailored to the national health specificities of each country. These include the virtual campus, mentoring of class tutors, and a digital library that can be made available to partners on demand. Overall, this initiative seeks to strengthen national alliances for health and to intensify the role of maternal deaths local committees. It is hoped that this could further improve ways for tracking and monitoring the causes of preventable maternal deaths, and upgrade the information chain available for health professionals, practitioners and decision-makers.

Download PDF