Supporting Advocacy for Maternal and Neonatal Health in Burkina Faso

Maternal and infant mortality rates in West Africa are amongst the highest in the world. In Burkina Faso, a woman dies from pregnancy-related complications every three hours. And every three hours, seven newborns die. Moreover, for each maternal death that occurs, twenty to thirty women suffer from pregnancy-related disabilities such as anemia and obstetric fistulae.

A majority of maternal deaths occur as a result of treatable and preventable conditions such as hemorrhage, infection, eclampsia and prolonged labor. Environmental factors, such as poor access to quality emergency obstetric service, also contribute to maternal death and disability. While most maternal deaths are clearly preventable, maternal and neonatal health programs remain severely under-funded in Burkina Faso and in other West African nations. This lack of adequate funding contributes to unnecessary death and suffering for thousands of women, children and their families in the region.

To bring attention to the plight of women and children in West Africa, advocacy efforts are essential. One component of the USAID/WARP-funded Action for West Africa Region; Reproductive Health (AWARE-RH) project is to work with stakeholders such as governments, non-governmental organizations, multilateral organizations, civil society organizations to advocate for appropriate policies and increased funding for improving maternal and neonatal health programs.

One of the ways in which AWARE-RH supports West African countries and governments to allocate more resources for maternal and neonatal health services is through the REDUCE advocacy process which highlights the negative economic impact maternal and neonatal mortality and morbidity can have on a country. REDUCE is an advocacy tool originally developed by the Academy for Educational Development to stimulate policy dialogue and strategic planning on maternal health and safe motherhood.

In August 2005, the AWARE-RH project in collaboration with WHO funded and provided technical assistance to Burkina Faso’s Department of Family Health (DFH) and its local partners to apply this tool in their country’s context. The REDUCE team consisted of AWARE-RH experts and 25-30 local health professionals, economists, demographers and sociologists. Over the course of two weeks, AWARE-RH and WHO assisted members of the team as they collected and reviewed information on health and obstetric factors, and used computer models to estimate the consequences of poor maternal health.

After analyzing the maternal health data, the REDUCE team discovered that implementation of maternal health programs in particular Safe Motherhood programs between now and 2015 would save the lives of 20,000 women and 53,000 newborns. And 745,000 women would avoid disabilities that arise as a result of complications during pregnancy. This program would cost approximately 77 million USD, but would result in a productivity gain of 110 million USD, resulting in a net gain for the nation. These numbers clearly exhibit the significant benefits that investing in maternal death and disability will have on the economy of Burkina Faso if the government prioritizes Safe Motherhood programs. According to Fabienne Richard, a mid-wife with the Projet d'Am-lioration de la Qualit- et de l'Accès aux Soins Obst-tricaux d'Urgence , "By providing statistics on the number of women and children who die every day and the loss of productivity in monetary amounts, this really leaves an impression on the minds [of the audience] and makes the problem more visible."

Together the team used this information to prepare an advocacy plan, which included an advocacy presentation containing key arguments pointing to the need for increased funding and improved policies for maternal health. On their own initiative, the Burkina Faso team also developed a brochure with these key arguments to use in their advocacy efforts.

The Burkina Faso team presented their results at an advocacy event which included media, high-level government officials, members of civil society and other multilateral institutions and donors. After the event, the team continued to advocate for more funding and better policies by presenting the results to other high-ranking members of the Ministry of Health, Finance and other ministries as well as to members of parliament.

The efforts of the Burkina Faso advocacy team helped ensure an increase in the Ministry of Health’s budget from 7% to 8% in 2005 to 11% in 2006. The Director of Family Health feels confident that the REDUCE results made a significant contribution to the efforts aimed at obtaining this increase.

Furthermore, for the first time ever, the Ministry of Health has decided to subsidize emergency obstetric care for cesarean section, administration of antibiotics and oxytocics and manual removal of the placenta. The government has pledged to subsidize 80% of total costs incurred by all women accessing these services. This means that for women across Burkina Faso, the cost of a cesarean section will drop from an average of about 110 USD to 20 USD - a much more affordable amount. Additionally, the government has allocated approximately 733,500 USD for the purchase of contraceptive commodities, since family planning is a service that contributes to the reduction of maternal mortality. Moreover, as a result of advocacy messages from the REDUCE process, civil society in Burkina Faso has committed to assist in efforts to sensitize the public on warning signs during pregnancy and labor and the need to seek immediate care. These actions can help reduce maternal and infant mortality. According to Ghislaine Conombo, Director of the Department of Family Health in Burkina Faso, "REDUCE helped us reinforce our commitment to reach the Millennium Development Goals."

AWARE-RH is also supporting the REDUCE process in Mali, Ghana and Mauritania. In 2006 AWARE-RH plans to support the application of REDUCE in Togo and Niger. Through its technical assistance and funding for REDUCE, AWARE-RH is improving the landscape of maternal health in these countries and is impacting the lives of countless women who have a right to healthy and safe pregnancies.

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