What is CARMMA?
No woman should die giving life!
The Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) is an African Union Commission (AUC) initiative to intensify the implementation of the Maputo Plan of Action for the reduction of maternal mortality in the Africa region. Along with UNFPA, several United Nations agencies, bilateral donors and International Planned Parenthood Federation (IPPF) support CARMMA at the national, regional and global levels.
Race to meet the MDGs
CARMMA was initiated by the AUC in recognition of the daunting challenge of reducing maternal mortality in most African countries by 75 per cent (in comparison with 1990's figures) by 2015, as recommended in Millennium Development Goal 5 (MDG5). There is concern that many African countries may not attain MDG5 if efforts are not redoubled. This was despite a decade-long global economic boom prior to the recent global recession, increased international co-operation and economic growth in Africa.
World financial crisis hits women's health
There was also growing concern that social development in general and women’s health in particularly faces new threats from the global financial crisis and economic meltdown, unpredictable aid future, compounded by climate change and food crises, among other challenges.
This campaign was launched within the context of the Maputo Plan of Action, which highlights the need for improvement in women’s health and the reduction of maternal mortality as priorities for African countries to achieve the MDGs and the objectives of the International Conference on Population and Development Plan of Action (ICPD PoA).
CARMMA uses policy discussions, advocacy and community social mobilisation to enlist political commitment and increase resources and societal change in support of maternal health. It is a country-driven undertaking. All African countries are expected to launch CARMMA and have a follow-up implementation plan, as well as to monitor progress.
Countries with highest MMRs launch first
At the continental launch of CARMMA by the African Union (AU) Ministers of Health in May 2009, eight African countries were selected by governments, the AUC, UN and other partners to launch CARMMA at the national level that year. The eight countries selected were Ethiopia, Malawi, Mozambique, Ghana, Nigeria, Rwanda, Senegal and Chad.
Latest data available for 2000-2009 (WHO)
Their selection was based on high maternal mortality ratios, low gender development index, and ready political commitment. They were to demonstrate that maternal mortality reduction can be accelerated.
In conjunction, many other countries strengthened their efforts to reduce maternal mortality, with support from UN agencies and other development partners.
Key focus areas
The four key areas of focus
(a) Building ongoing efforts and particularly best practices;
(b) Generating and providing data on maternal and newborn deaths;
(c) Mobilising political commitment and the support of key stakeholders, including national authorities and communities - mobilising additional domestic resources in support of maternal and newborn health and mobilising communities to let them know that everyone plays a role in maternal health and the reduction of maternal deaths;
(d) Accelerating actions aimed at the reduction of maternal and associated infant mortality in Africa.
Work builds on ICPD, MDGs and Maputo Plan of Action
CARMMA intensifies ongoing efforts geared towards further implementation of the International Conference on Population and Development Plan of Action (ICPD PoA), the MDGs, the Maputo Plan of Action on Sexual and Reproductive Health and Rights in Africa and the Africa Health Strategy. It also complements ongoing efforts for resource mobilisation at the global level to support the strengthening of health systems, including campaigning for the recognition of maternal mortality as a key indicator of a functioning health system.
The objectives are:
• To enhance political leadership and commitment at the national, regional and continental levels;
• To identify and work with national champions to mobilise support and participation at the national level;
• To raise and maintain awareness as well as appropriate responses at the global, continental, regional and national levels;
• To build linkages with global campaigns that seek to ensure the establishment of new and innovative financing mechanisms and the appointment by the UN Secretary General of someone to advocate for the reduction of maternal mortality;
• Promote the recognition of maternal mortality as a key indicator of a well-functioning health system;
• Promote the exchange of experiences and practices, and adopt and replicate best practices of countries that have significantly reduced maternal mortality.
In 2010, no less than 18 countries launched CARMMA – Ethiopia, Sierra Leone, Central African Republic, Cameroon, Uganda, Lesotho, Mauritania, Zambia, Zimbabwe, Guinea Bissau, Senegal, Gambia, Eritrea, Angola, Togo, Benin, Eritrea and Kenya.
In 2011 saw the campaign launched in Botswana, Liberia, Democratic Republic of Congo, Gabon, Tanzania, Equatorial Guinea, Burundi and Burkina Faso. A further six countries
– Egypt, Sudan, Tunisia, South Africa and Mali – also promised to do so by the end of the year.
Driving the launches at the country level are senior political leaders (presidents, vice presidents, first ladies and ministers), in conjunction with the United Nations (WHO, UNICEF, FAO, UNAIDS, UNIFEM, UNFPA), the World Bank, bilateral donors (USAID, DFID), academia and civil society (IPPF, White Ribbon Alliance). They are to mobilise the country and commit to specific actions to reduce maternal mortality in their countries.
Other major stakeholders in national launches include parliamentarians, community and religious leaders and institutions, professional associations such as nurses and midwives associations and medical associations, artists, the media and the private sector. In some countries, the launch of CARMMA has been used to mobilise additional domestic resources for maternal and newborn health.
In many of the countries, the national champions of CARMMA or the national authorities have committed to follow-up activities to intensify the reduction of maternal mortality in their countries, such as:
• Decision taken to launch CARMMA in all districts or states – Malawi, Chad, Zambia, Rwanda, Sierra Leone and Nigeria;
• Adoption of district hospitals for health system strengthening in partnership with the private sector – Malawi;
• Instituted maternal mortality monitoring indicators – Swaziland;
• Decision to use launch of CARMMA to coincide with the Campaign to End Violence against Women, and also raised funding for maternal mortality reduction through pledges – Chad;
• Decision to provide free medical services for pregnant mothers and infants – Sierra Leone.
The momentum to launch CARMMA has been tremendous, and enthusiasm demonstrated by high-level policy makers and communities at the launches has also been great. However, one of the challenges is to ensure that commitments made at the various launches are translated into results-oriented action and sustained maternal mortality reduction. In some of the countries that had not yet launched CARMMA, the issue has been too-frequent changes in Ministry of Health personnel, including Ministers or Director Generals. In some countries, it has been difficult to secure a launch date due to the tight schedules of the presidents or first ladies who wish to launch CARMMA personally.
All countries with high maternal mortality ratios should be supported by the UN system and international development partners to amass efforts against maternal mortality.
CARMMA must be inclusive and reach every person
In view of the multi-sectoral responses and multi-agency partnerships required to address maternal mortality reduction, the launching of CARMMA and other similar efforts should promote the inclusive participation of all necessary stakeholders from governments, UN agencies, other development partners, NGOs, including community institutions and organisations, professional associations, schools, health training institutions and the media. CARMMA and other similar efforts should be country-driven and country-owned action. Efforts should be made to ensure that CARMMA reaches every community and every person.