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“Whether it’s a phone-based tool to enable illiterate women to rate the care they receive or new models for connecting women to care in remote settings, we’re harnessing our capacity to innovate to improve maternal health,” explained Dr. Naveen Rao, head of Merck for Mothers, Merck & Co., Inc.'s signature initiative to reduce maternal mortality around the world.
Dr. Rao is responsible for leveraging Merck & Co., Inc.’s science and business expertise to accelerate progress in reaching Millennium Development Goal 5 and advancing Merck's mission to improve and save lives. Dr. Rao returned to the United States in 2011 after six years in India, most recently serving as Head of Medical Affairs for Merck's Asia-Pacific region.
Tell me a little bit about the founding of Merck for Mothers some years ago. What were the underlying ambitions of this 10-year commitment, and why now?
Merck has a long history of taking on persistent global health challenges, whether it’s HIV/AIDS, cervical cancer or river blindness. In each case, we engaged in intense listening and learning from communities and local leaders to identify an intractable health problem where we could make a difference, then we mobilized our resources and joined forces with leading global organizations and partners on the ground to create high-impact, sustainable initiatives. We took the same approach for Merck for Mothers— examining the needs of women and their health providers to design products and services that place the woman at the center of care.
In 2011, it was clear that the world was falling short of its goals for lowering maternal deaths. Too many women were dying during pregnancy and childbirth, and to us, this was unacceptable. As our CEO Ken Frazier likes to say, “We simply could not sit by and allow this to happen.” So we created a $500 million initiative to help accelerate progress on maternal mortality alongside and in partnership with the global health community. We set out to harness our business and scientific expertise to provide transformational and sustainable solutions focused on improving the quality of maternal healthcare women receive at a health facility and increasing women's access to family planning.
Having reached 4.7 million women in 30 countries so far, what are some of the trend lines and insights you've discovered as you've tackled maternal mortality in vastly different environments, cultures and settings?
One of the realities we’ve come to learn is that every country, every district, every community has different circumstances that require different solutions. In maternal health, it’s never a one-size-fits-all approach because there is no magic bullet to solve this problem. That’s why it’s critical to work closely with governments, civil society organizations, and communities that have a deep understanding of the local context and are attuned to women’s preferences and needs.
This has led us to a diverse range of programs to improve the quality of care women receive. In Uganda and India, for instance, we learned that many women turn to local private health providers for their care during pregnancy and childbirth, so we’re helping these midwives, doctors and drug shops deliver products and services that are affordable and high-quality. In Zambia, we learned that women often have to travel long distances over rough terrain to get to a health facility, so we’re working with partners to establish maternity waiting homes where women can stay in the late stages of their pregnancies. And in the U.S. – where maternal mortality is on the rise – we learned that chronic health conditions like diabetes, high blood pressure and obesity are contributing to childbirth complications, so we’ve teamed up with community-based groups that are linking women to services before, during and after their pregnancy.
With regard to your work in India, where the highest number of maternal deaths occur each year, what kind of work are you doing on the ground and what kind of progress have you made?
In India, the majority of people receive healthcare from private providers, including many women seeking maternal healthcare. So we're working with local doctors, nurses and midwives in Jharkhand, Rajasthan and Uttar Pradesh – states with some of the highest rates of maternal mortality in the country – to improve their ability to deliver affordable, high-quality maternal health services. Specifically, our programs are helping set, maintain and deliver standards for care to help ensure healthy pregnancies and safe childbirths. Our partners include Pathfinder International and World Health Partners, Jhpiego and the Federation of Obstetric and Gynecological Societies of India (FOGSI), and the Hindustan Latex Family Planning Promotion Trust (HLFPPT).
Now at their halfway point, these projects have already strengthened 334 health facilities, trained 3,750 health workers and improved access to quality care for more than 100,000 women.
What is the hardest part about moving the needle on this issue?
By far the hardest part about moving the needle on maternal mortality is the fact that this issue cannot be solved with any single intervention. It requires a strong health system that offers women easily accessible, affordable, high-quality services throughout their pregnancy.
One way we’ve attempted to tackle this challenge is through a public-private partnership with the U.S. government called Saving Mothers, Giving Life. Focused in Uganda and Zambia, the initiative set out to save women’s lives by overcoming challenges at all stages of pregnancy: it’s educating women about the importance of delivering at a health facility; it’s helping them reach and afford transportation to local clinics and hospitals; and it’s providing critical medical training and facility upgrades to make sure women receive quality care. In its first year, we actually saw marked improvements: maternal mortality declined by 35% in our target areas of both countries, and we’re now exploring how we can expand this model elsewhere.
As a corporation tackling this challenge, what do you believe is Merck's unique vantage point and skill-set that could really make a difference on the ground, and what kinds of organizations have you partnered with to accelerate impact?
As a data-driven company, we know that true innovation comes from continuous learning. That’s why we’re committed to Merck for Mothers operating like a living laboratory: designing and testing health solutions for women that can achieve broad scale. Whether it’s a phone-based tool to enable illiterate women to rate the care they receive or new models for connecting women to care in remote settings, we’re harnessing our capacity to innovate to improve maternal health. But we also know that companies can’t take on this effort alone, so we’re complementing our expertise and resources by partnering with governments, NGOs, universities, UN agencies and even other companies devoted to the shared mission of saving women’s lives.
We’re also tapping the skills and knowledge of our talented employees. Through Merck’s Global Health Fellowship Program, we’ve connected our staff with our partners on the ground in countries like India, Uganda and Zambia to help them with activities like business operations, accounting and other sustainability strategies – exact areas that have been engines of success for our own business.