The G-8 Muskoka Summit: Saving Lives Through the New G-8 Maternal and Child Health Initiative

The Muskoka Initiative: Under Canada’s leadership, the G-8 has launched the Muskoka Initiative on maternal and child health (MCH), a comprehensive and integrated approach to accelerate progress towards Millennium Development Goals 4 and 5, which seek to reduce by two-thirds the under-five child mortality rate, and reduce by three quarters the maternal mortality ratio, respectively.  The Initiative will reduce the number of maternal, newborn and under-five child deaths in developing countries by supporting strengthened country-led national health systems in developing countries, to enable delivery of key interventions along the continuum of care.   The Muskoka Initiative includes an initial, two-year commitment by the United States of $1.346 billion covering fiscal years 2010 and 2011, subject to Congressional appropriations.

President Obama’s Global Health Initiative: Four months into office, in May 2009, President Obama placed increased emphasis on U.S. programming for maternal and child health and family planning when he announced his six-year, $63 billion Global Health Initiative (GHI).  The Muskoka Initiative complements the President’s GHI, which partners with countries to improve health outcomes through strength¬ened health systems, increased and integrated investments in HIV/AIDS, TB, malaria and neglected tropical diseases, and through a particular focus on improving the health of women, newborns and children.

While the GHI will be implemented in all countries receiving U.S. health assistance, eight “GHI Plus” countries, Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal and Rwanda, will receive additional technical, management, and financial resources to quickly implement GHI’s approach, including integrated programs and investments across the spectrum of infectious diseases, maternal and child health, family planning, and health systems activities. GHI Plus countries will provide enhanced opportunities to build upon existing public health programs; improve program performance; and work in close collaboration with partner governments, across U.S. government agencies, and with global partners.

The GHI set out ambitious targets for improving maternal and child health to inspire an intensive effort.  They include:

• Reducing maternal mortality by 30 percent across assisted countries;
• Reducing under five mortality rates by 35 percent across assisted countries;
• Ensuring every partner country with a generalized HIV epidemic has both 80-percent coverage of testing for pregnant women at the national level, and 85-percent coverage of antiretroviral drug prophylaxis and treatment, as indicated, of women found to be HIV-infected;
• Doubling the number of at-risk babies born HIV-free, from a baseline of 240,000 babies of HIV-positive mothers born HIV-negative during the first five years of PEPFAR;
• Reducing child undernutrition by 30 percent in food-insecure countries in conjunction with the President’s global food security initiative, Feed the Future; and
• Reaching a modern contraceptive prevalence rate of 35 percent across assisted countries by 2015, compared to a baseline of 27 percent in 2008.

To achieve these goals, the GHI implements a business model that builds on these principles:

• It emphasizes integrated systems-based approaches to infectious diseases, maternal and child health and voluntary family planning to ensure sustainability;
• It uses proven, evidence-based interventions, and phases out strategies that have not produced positive impact on health outcomes;
• It seeks to measure the outcomes and impact of our assistance, rather than funding inputs.
• It innovates for results by identifying, implementing, and rigorously evaluating new approaches that reward efficiency, effectiveness, and sustainability; and
• It supports developing country ownership, assisting them to build domestic capacity to manage their health systems, while leveraging all sources of funding, including their domestic resources, for development.