Julie Gerberding, Executive Vice President, Communications, Global Policy and Population Health, Merck & Co Inc. USA, in an interview tells Outlook how MSD for Mothers, a global initiative of US based pharmaceutical company Merck & Co. Inc. USA (known as MSD outside of US and Canada), is looking to scale up the program in India, a major focus area.
MSD for Mothers is a 10-year, $500 million philanthropic initiative of MSD Global to help empower women with information, choice and voice to access healthcare. Along with its partners, including the government, the NGOs, academia, professional associations and private companies, the program also seeks to help equip health providers with innovative products and platforms to offer better quality care to reduce maternal mortality rate.
Why has India not been able to achieve the millennium development goals in terms of women and health?
You have 25 million people born every year. I think it is a tall order managing with the geographical distribution and diversity of the population to be able to make any improvement fast. So it is a debate of glass half full and half empty. Surely there has been enormous progress, though not at the stated goal. But we are learning from the MSD for Mothers and all our partners that there is a great deal of alignment on what needs to be done and a lot of things to be optimistic that we are entering a new phase of maternal health improvement.
What has changed in the last two to three years that has helped India reduce maternal mortality rate (MMR deaths), though it still ranks low in global ranking?
It is difficult to say as I am still learning, having come from this roundtable of partners. One of things is that we have improve the quality of care both in the private sector and the public sector. Quality of care in all respect is probably the overarching issue. More births need to be attended, as not all babies are born with attendants present. So health workers need to be well trained to attend to the needs with more speed. Quality measures in treatment and care has improved but needs to be further speeded up.
Another area that I was really amazed at is the environment of partnership is so innovative. Like innovative financing like impact bond which are supporting not just innovation but digitization of provider training, digitization of the patient as consumer who can go on and look up health centres that are judged by the best quality of care they provide and quality providers who can compare themselves with quality care provided in other hospitals. So, digitization is making information exchange incredibly rich. This can help accelerate quality care and reach educational improvements through these digital platforms which are moving people up the ladder on their own skills capability.
How are you facing up to the challenge of ensuring proper utilization of your funds and gathering of right data on the outcomes?
Broadly speaking, in the MSD for Mothers program, since we are spending $50 million every year and India is a disproportionate part of our portfolio, we put a great deal of effort into monitoring and evaluation. We work with the London School of Hygiene and Tropical Medicine in this regard. You will soon see some publications coming out on the success factors so far. So, broadly, we are ensuring that this investments that we are making is bringing results that we intent.
Speaking of innovations, India is also a major player in a study being conducted by WHO of a heat stable drug carbetocin which can prevent post partum hemorrhaging, which along with infection and blood pressure eclampsia are leading causes of maternal deaths. Medicine to stop hemorrhaging requires refrigeration so often if is not refrigerated properly, it just doesn’t work. So MSD and others provided funds and resources to another pharmaceutical company Ferring to carry out the study in which around 7,000 patients from India among 30,000 globally participated. The study results were published earlier this year shows that the new medicine works as well as the traditional medicine. It proves that there could be another intervention available that could improve the outcomes for women. The medicine is not yet licensed and is awaiting regulatory approvals. Ferring has agreed to provide the medicine, once the approvals come and it is licensed, at no-profit price to the public sector in India and at an access price to the private sector in India once the government grants approval to its use and issues license.
MSD for Mothers has been working in five states – Rajasthan, Uttar Pradesh, Karnataka, Maharashtra and Jharkhand. What have been the biggest challenges?
We work in three areas broadly speaking. One is to try to improve the quality of care, which includes provider competency and capability as well as the state of the art medicines and treatments. The second is to really empower women to have knowledge as well as the tools and access to make informed choices particularly about spacing of pregnancies and family planning and also where they want to receive their care and the quality of that care. The third area concentrates on strengthening health systems that overall improves care delivery network. In all these areas we have partners in the projects we undertake. The biggest challenge is putting all these things together and ensuring that women are benefiting from various pieces of the puzzle we and our partners are working to put together. It is a question of not just connecting the dots but also scaling it up as India is a big country.
There are projects where the government seeks the funds and wants to implement it using its own machinery while in some cases, the donor or funder is allowed to implement. Which model yields better results?
These program are not really structured to be government driven. They are more grassroots and partner driven for example one of our really important partners is the Federation of Obstetrics & Gynecological Societies of India (FOGSI). The doctors and the gynecologists have taken it upon themselves to identify the markers of good quality so that they become standards of gynecology and obstetrics care among women. As they begin to define these things and measure them, they are discovering that patients want to come to those doctors that are rate better than others so their business improves. That is because they are actually delivering better quality of care.