“17 million people die because of socioeconomic injustice per year. 10 million of them are women.”
These were the words of Dr David Chiriboga (former Minister of Public Health of Ecuador) as he opened the panel discussion at MET’s series launch ‘Who cares for women?’, which was held at the London School of Hygiene and Tropical Medicine on Wednesday 13 January 2016 (and available to view/listen online).
Dr Chiriboga’s call to action highlights the importance of the work MET are currently conducting (funded by MSD for Mothers) offering the most up-to-date and comprehensive analysis of the nationally-representative Demographic and Health Surveys (DHS) across 57 low- and middle-income countries, representing 2.9 billion people. Our work is aimed at understanding where women seek care, the reasons for their choices, and the content and quality of the care they receive. Our datasets standardise the DHS across these countries – a collaborative effort which took more than two years to accomplish.
Strikingly, our analysis of the DHS reveals that a substantial proportion of women have unmet need for modern contraceptives (37%), antenatal care (21%) and delivery care (47%). It also highlights the significant role of the private sector in providing care across these services, and the need to better understand the providers who make up this sector.
‘’The private sector provides 40% of care among women who are using services, but its composition is very diverse’’ explained Prof. Oona Campbell, one of the School’s leading maternal health experts who has led part of this work by MET. Her comments provided fertile ground for debate amongst an invited panel of distinguished experts. Along with Dr Chiriboga, panellists included Prof. Anthony Costello (Director, Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization), and Prof. Anne Mills (Professor of Health Economics and Policy at the LSHTM).
‘‘The public sector has a more limited and coherent set of providers than the private sector. When looking at data for private sector users, I would believe that the poor are going to small local providers whilst the rich go to larger facilities. And this has a lot to do with the quality of care provided’’ argued Prof. Mills.
Dr Chiriboga stressed that “It is important to remember that health is a basic human right and not a commodity. Your access to care should not be in function of your ability to pay.”
The panellists also discussed the implications of MET’s findings for policy makers:
Dr Chiriboga – himself a former Minister of Health – commented: ‘‘In Colombia, the government has very little control over what the private sector does. This reflects a government with less structure. To me, the more these decisions are taken locally, the better. And this is a matter of democracy. This could be re-thought globally.’’
Prof Mills added: ‘’…evidence suggests that funding issues apart, public providers follow more protocols and guidelines than private providers do. The public sector is easier to manage and regulate.’’
Prof. Anthony Costello (Director, Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization) expressed similar concerns in relation to the UK’s National Health Service: ‘’Here in the UK, the government wants to turn the National Healthcare Service to private capital. Will equity be preserved…?’’
Dr Chiriboga concluded by framing the challenges in the context of the status of foreign aid, which impacts the lives of women in need of maternal care services: ‘‘The problem is that the amount of aid given today is about 4% of what is actually needed to provide healthy living conditions and a dignified life for the world’s population. Aid needs to be redefined.’’
At the end of the evening, panelists, academics and the audience had the opportunity to engage in further discussion of the findings over drinks.