Globally, maternal deaths have declined by 44 percent since 1990. Still, some 830 women and adolescent girls die each day from preventable causes related to complications of pregnancy and childbirth. 99 percent of these maternal deaths occur in developing countries.  

Addressing preventable maternal deaths requires coordinated and multisector responses, considering the dynamic interaction of four dimensions:  economic and socio-cultural determinants of health such as gender, income, and ethnic-racial and territorial inequalities; analysis of the root causes; socio-epidemiological contexts for sexual and reproductive health (SRH); and the contexts 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, childbirth and the puerperium. 

The members of the Community of Portuguese Language Countries (CPLP) have sought to respond to the demands to enhance national health systems. Together with the Oswaldo Cruz Foundation of Brazil (FIOCRUZ), leaders of some of these health systems have conducted dialogues and formulated proposals resulting in a form of cooperation, described below. The solution sought by the partners is a coordinated response at the local and global levels, in the spirit of South-South and triangular cooperation.  

The idea of an International Conference on Population and Development (ICPD) Reference Centre arises from other cooperative solutions developed by the United Nations Population Fund (UNFPA) in which the creation of an international platform and different levels of decision–making has been proven to be a good practice to organize, qualify and address demands jointly with national partners.

The ICPD Reference Center for Sexual and Reproductive Health and Rights hosted by FIOCRUZ aims at strengthening national health systems focused, at this first stage, on reducing preventable maternal deaths in CPLP countries. It embraces as a work methodology the creation of a common cooperation platform, i.e. the ‘Reference Center’, to organize demands and flows of inter-country cooperation initiatives, and to ensure transparent and participative decision-making. At the global level, the ICPD Reference Center is responsible for the advocacy, political dialogue and forecast governance through an Executive Secretariat, composed of representatives of FIOCRUZ and UNFPA, as well as a Steering Committee with representatives from government agencies and UNFPA offices in partner-countries. At the national level, the ICPD Reference Center ensures the continuity of cooperation by mobilizing national actors, producing evidence and intervention plans, and testing and sharing solutions.    

The parties agreed to cooperate in activities of common interest, which will include: education, training and research opportunities; internship programmes; the co-designing of projects and events to take place locally, regionally and/or globally; and the development of flagship programmes that further advance partnerships for the 2030 Agenda for Sustainable Development. 

Despite FIOCRUZ’s vast experience in international development cooperation, there is new element to this initiative, i.e. the creation of integrated solutions that are highly adaptable to many national contexts. For example, among the first initiatives, the ‘Distance Learning Program on Surveillance of Maternal Deaths and Performance of Mortality Monitoring Committees’ is an innovative proposal by FIOCRUZ to provide CPLP countries with education and training technologies tailored to the national health specificities of each country. This programme includes a virtual campus, tutor-led sessions and a digital library. One of its goals is to strengthen national alliances for health and to intensify the role of these Committees in establishing new ways to track and monitor the causes of preventable maternal deaths, and in improving the information chain available for health professionals, practitioners and decision-makers.