Jonathan F. Fanton
MacArthur and Millennium Development Goal #5
March 31, 2008
Your Excellency President Kerim, Deputy Secretary-General Asha-Rose Migiro, Honorable Ministers, Excellencies, Ladies and Gentlemen,
I am honored to speak with you tonight and participate in the conversation tomorrow. The theme of the conference, “Recognizing the achievements, addressing the challenges and getting back on track to achieve the MDG’s by 2015,” is well chosen. We all know that at the current pace we will fall short of meeting most of the goals, and in some cases, not even come close.
The slow pace of progress is not because of a lack of valiant efforts, particularly on the health MDG’s. A few governments of the global North have taken bold steps. Norway and the UK made inspiring announcements at the Women Deliver conference in London last October; and governments of the global South, such as Bangladesh and Honduras have made impressive achievements in reducing maternal mortality among their citizens. I imagine will we hear about Mexico’s efforts on the MDG’s from Ms. Vazquez Mota in a moment. And the UN Foundation has attracted resources from the world’s philanthropists.
While it may not be possible to make all the goals by 2015 – they are ambitious – it should be possible to come close to some and see a positive trajectory that gives confidence that all will be fulfilled in a reasonable time.
Otherwise, the nations and the peoples of the developing world will rightly doubt the sincerity of the process and that will lead to deep cynicism, even despair. Future, well-intentioned efforts will be harder to launch. Trust will be in short supply.
So this conference comes at the right moment. There is still time to get back on track. I am encouraged by the honesty and candor of the background papers and the concrete proposals for picking up the pace.
While private philanthropy and foundations are mentioned, I think the papers underestimate what we can do. In the U.S. alone there are more than 70,000 private foundations that gave away a total of $16.5 billion in 2005, 17 percent of that going to international programs. Among US foundations that give globally, MacArthur ranks fourth, with about 40 percent of our giving to international programs.
The challenge of getting more foundations to work on the MDG’s is twofold:
- to increase U.S. foundations’ giving abroad – both the number of foundations and the amount of money – and
- to link the giving more directly with the MDG’s.
Let us use MacArthur as an example and then talk about how to reach other foundations.
With an endowment of $6.5 billion, MacArthur work in sixty countries and have offices in Russia, India, Nigeria, and Mexico. Our total philanthropy this year will be over $300 million. Our fields of interest include conservation and sustainable development, human rights and international justice, peace and security, and population and reproductive health. We are also starting a new initiative on global migration and mobility. MacArthur has a long history of support for and work with the U.N. Our first direct grant to the U.N. was twenty years ago. Since then nearly 70 grants have followed to just about every part of the U.N.– including UN Development Program, the UN Environment Program, the UN Population Fund, and the World Health Organization.
Even before MDG#5 was set, our Population program had focused on the reduction of maternal mortality. We thought it was a good indication of whether or not women were getting the care and counseling they needed to make healthy reproductive choices. Our focus is on Nigeria, India and Mexico, which together represent one third of maternal deaths in the world.
The statistics on maternal mortality are sobering. More than half a million women die each year from pregnancy complications – about one woman every minute. The inequality is staggering – a woman in Africa has a lifetime risk of dying in pregnancy of 1 in 22; for a woman in the global North, the risk is 1 in 8000. And for each of these deaths, there are 30 women who do not die, but who suffer from a related illness or disability.
It is tragic when these deaths and disabilities happen; it is inexcusable that they happen when we have the means to prevent them. No woman should die giving life – as we are reminded by the UNFPA’s Thematic Fund for Maternal Health. The lack of progress on maternal mortality is not the world envisioned by the signers of the U.N. Charter, who vowed to “to promote social progress and better standards of life in larger freedom.” We should not accept that one woman dies every minute from pregnancy related causes.
MacArthur originally had not made an explicit connection between our program and MDG#5. But a visit to the Foundation from Secretary-General Ban changed all that. He made clear his own commitment to meeting the MDG’s and asked for our help. We are in the process of developing an initiative that will recast our maternal mortality program within the framework of the MDG’s, committing at least $50 million to MDG# 5 over the next four years.
We hope the initiative will be a model for how other foundations – or groups of foundations – can take leadership in each of the MDG’s. This is not only about money, indeed it cannot be: our resources are dwarfed by aid from national governments and international institutions. But our money is flexible and can be deployed quickly to demonstrate interventions that work. We can document the models so we know why they work and how to adapt them to different countries and cultures. We can support NGO’s that advocate for sensible policies and more public expenditures. We can build coalitions that increase public awareness and political will. We can convene the public, private and NGO actors who need to coordinate their efforts.
To date, MacArthur is working to reduce maternal mortality through five approaches. These form the base from which we will expand our efforts.
Our first approach is marrying technology with need. MacArthur has put its resources behind a critical initiative that can reduce maternal mortality dramatically by addressing postpartum hemorrhage, which accounts for nearly 1 in 3 maternal deaths. We have funded research at the University of Ibadan in Nigeria, and combined it with lessons from research in India, that together show how a treatment package can cut maternal deaths from postpartum hemorrhage by 80 percent. The package consists of an affordable drug – misoprostol – for prevention, and an innovative Anti Shock Garment. The garment temporarily halts hemorrhage and buys time to transport the patient to skilled medical care. We have funded Pathfinder to mount a large-scale demonstration in India and Nigeria, and we have received encouragement from the Nigerian government that it will take the package to scale. If applied globally, this treatment could prevent about 130,000 deaths per year. That by itself would represent a 25 percent drop in the mortality ratio and a substantial step toward the 75 percent reduction goal.
Our second approach is helping organizations scale up other promising models. For example, India’s Home-Based Neonatal Care program trains local women to assist mothers and babies during deliveries, bringing up-to-date methods into rural villages. Developed by the Society for Education, Action and Research in Community Health, the model has been adopted by the National Rural Health Mission. Over the next five years, it will be introduced in five Northern states of India, and eventually will become a national effort. The model has been shown to prevent over 60 percent of neonatal deaths and to reduce maternal health problems.
Our third approach is enhancing the skills of health workers. Many maternal deaths occur because the mother does not have access to skilled medical care or because the person providing the care – often a midwife – lacks the ability to identify and respond to critical cases. Each level of care provider – doctors, nurses, and midwives – can be trained to carry out life-saving activities. MacArthur is helping the OB-GYN Society of India train general practitioners to do Caesarian section deliveries. This program is now being scaled up with support from the government. MacArthur also works to improve the curricula of the educational institutions that train these professionals. For example, in Nigeria, Ipas is working with every school of midwifery to help professors better prepare their students for the real demands that they will face on the frontlines of rural health care.
Our fourth approach is creating and sustaining networks of individuals and organizations that are in the field. They need to exchange information and best practices, and plan advocacy that generates political will for change. In Mexico, the National Safe Motherhood Committee brings best practices about screening patients and health technology to all the important actors in government and civil society. It also helps coordinate their efforts to encourage increases in funding for maternal health.
Our fifth and final approach is using our reputational assets – our convening capacity – to bring disparate groups together to achieve consensus. In preparation for last year’s Women Deliver conference, we convened a diverse group of experts from government, civil society, and universities. They forged a consensus on a simple, clear framework for reducing maternal mortality: the “three pillars” of family planning, skilled attendance at birth, and emergency obstetric care. We have been pleased to see that consensus promoted not only at the Women Deliver conference last October, but also described in documents such as the the United Nations Population Fund’s Thematic Fund for Maternal Health.
You may note that in each of the five approaches, we cannot succeed without effective partnerships – particularly with governments of the global South. We recognize that a foundation cannot do everything alone – but we can advance the latest technologies, support research, fund model programs, and promote targeted advocacy.
While our maternal mortality work on the ground in India, Nigeria and Mexico is well along, we know there is much more to be done to advance MDG#5. We want to work with others and are very open to advice about how we can help. We expect to learn a lot tomorrow.
We have a dream of jumpstarting a rapid decline in maternal mortality ratios. We expect to deepen work in our three focus countries. We will work with partners to help other countries in Sub-Saharan Africa and South Asia learn the best maternal health strategies. We will continue to spread the use of the postpartum hemorrhage treatment package but also expand our efforts to address eclampsia, which accounts for 12 percent of all maternal deaths. Solid research has shown that the best drug for eclampsia is magnesium sulfate, but barriers need to be overcome before its use is widespread: National governments need to endorse the drug; doctors need to be educated on its use; and drug companies need to increase its distribution.
Working on these two causes of death together – eclampsia and post-partum hemorrhage – could drop maternal mortality by over 35 percent. Think of it: taking on these two very preventable causes of death alone would bring us nearly halfway to achieving MDG #5.
We are not alone among foundations in supporting progress towards the MDG’s. We chose MDG 5; other foundations also work on programs related to the MDG’s, even if some do not see their work within the MDG framework.
- The Bill & Melinda Gates Foundation and the Rockefeller Foundation are supporting efforts to boost the yields and incomes of millions of small farmers in Africa.
- The Hewlett Foundation is combating HIV/AIDS by linking prevention efforts with reproductive health services in order to reach more people and address the factors that make them vulnerable to infection.
- The Ford Foundation is working on conservation through integrated approaches that combine environmental protection, sustainable resource use, enforcement of legal rights and the creation of environment-friendly rural enterprises.
- And the Nike Foundation, explicitly using MDG #3 on gender equality as a framework for their giving, is taking on the major challenges facing girls and women in the developing world, including inadequate health services, education access, and economic opportunities.
We will learn more when the Secretary-General meets with the Presidents of the major foundations at our annual retreat on May 2. At that meeting there will be Rockefeller, Ford, Carnegie, Gates, Pew, Hewlett, Packard, Sloan, Mellon and more. Together these foundations have assets of more than $115 billion and work in well over 100 countries around the world.
It will be a golden opportunity to galvanize the top foundations to get behind the MDG’s in a more coordinated and determined way. It will be a chance to rally all foundations around Secretary-General Ban’s vision of the MDG’s as “a blueprint to ensure that in a technology-rich and prosperous twenty-first century, no human being should be dying of malnutrition … or be deprived of education or access to basic health care.”
I feel we have a responsibility to work with the UN and its member states to make substantial progress on the Millennium Development Goals.
Let the MDG’s be a driving force in a broad partnership between the UN and philanthropy.
You can count MacArthur to help.