Innovative Maternal Health Program in Tanzania Expected to Impact At Least 50,000 Mothers and Children by 2016

October 2, 2012

Provided by Bloomberg Philanthropies through PR Newswire

NEW YORK, Oct. 2, 2012 /PRNewswire-USNewswire/ — An innovative maternal health program in Tanzania funded by Bloomberg Philanthropies is projected to impact at least 50,000 mothers and their children over the next three years, Mayor and philanthropist Michael R. Bloomberg announced today.

More than 100 local non-physician clinicians including assistant medical officers and nurse midwives in Tanzania’s most isolated areas have been trained to perform life-saving procedures including caesarean sections since the program began. The number of maternal deaths from bleeding and other complications in Tanzania have been reduced; in one district alone, maternal deaths declined by 32% in less than 2 years due to the project.

To date, more than one thousand babies have been delivered by c-section in villages where women previously had to travel several hours to receive care – often when it was too late. Women in Tanzania deliver an average of 5.5 children in their lifetime, meaning every mother’s life saved not only impacts her and her newborn but also the well-being of her other children.

Tanzania has the eighth highest number of maternal deaths in the world; a woman dies from complications of pregnancy and childbirth almost every hour in Tanzania.

“No one should have to die giving birth,” said Michael R. Bloomberg. “Sadly, in some parts of the world, too many women die due to complications in childbirth because of inaccessible and inadequate care. We are implementing a pilot in Tanzania, a country with one of the world’s highest rates of maternal deaths, where we have built a unique program that we know is already saving lives by providing emergency obstetric care in rural communities.”

“Reducing maternal deaths requires innovative approaches to delivering care in the hardest to reach places,” said Ban Ki-moon, Secretary-General of the United Nations. “I am encouraged by this type of partnership which, as we see in Tanzania, promises to improve the lives of women, their families and communities.”

“Through the efforts of Bloomberg Philanthropies and their partners, we are making progress in reducing maternal deaths in Tanzania which has been a high priority for my government,” H.E. Jakaya Mrisho Kikwete, President of Tanzania, said. “The results-oriented approach of this program has provided life-saving procedures to thousands of women, and we look forward to expanding this effort with the additional support of the H&B Agerup Foundation to save lives and improve the health of Tanzanians.”

“After traveling to Tanzania to see firsthand the work, progress and results of this maternal health program, we saw an opportunity to contribute to the continued development and implementation of this program,” said Helen Agerup, chair of H&B Agerup Foundation. “As an entrepreneur and medical professional, I was impressed by how this program challenged conventional medical approaches to improve mothers’ and children’s health and to save lives in some of the most remote parts of Tanzania.”

“With the contribution of H&B Agerup Foundation and the cooperation of the Tanzanian government, we can deepen this program’s impact in some of the most remote regions of the country,” Bloomberg said. “Early results show a two-fold increase in the number of health center-based deliveries, an important step towards reducing maternal death. As we monitor the progress of this ground-breaking work, we think it has the potential to become a model for other countries in Africa where maternal deaths are unacceptably high.”

Facts About Bloomberg Philanthropies Maternal Health Initiative

According to the United Nations, almost 300,000 women die globally from pregnancy and childbirth every year. For every woman that dies, another 20 suffer an injury, illness or disability, often with life-long consequences.

99% of maternal deaths occur in developing countries with over half of these in Sub-Saharan Africa. Tanzania has the fifth highest number of maternal deaths in Sub-Saharan Africa.

Access to comprehensive emergency obstetric services can prevent most maternal deaths, yet women continue to die because there are few facilities with skilled personnel and the distances are long. The crux of the Bloomberg Philanthropies Maternal Health Program is the decentralization of life-saving health care services to the level of the village, where it is needed the most. The approach has two components:

1) Upgrading Infrastructure
Almost every community in Tanzania has access to a health care center that can provide basic health care services. The Bloomberg Maternal Health Program has upgraded these health centers by constructing operating rooms and other critical infrastructure needed for comprehensive emergency obstetric care.

2) Training healthcare workers
Most remote communities of Tanzania do not have a medical doctor, and obstetricians are almost non-existent in rural areas. Tanzania was an early adopter of a practical solution known as “task-shifting” which allows non-physician clinicians to provide health care services. Non-physician clinicians are much more likely to work in isolated communities than doctors. Recognizing this, our program trains non-physician clinicians – called Assistant Medical Officers (AMO) – to manage complicated deliveries, including caesarian sections, and nurse midwives to administer anesthesia.

Today, Bloomberg Philanthropies announced a new investment in the program through a partnership with Geneva-based H&B Agerup Foundation over the next 3 years — bringing the total commitment to $15.5 million since late 2006. The program operates in close consultation with the Tanzanian Ministry of Health and Social Welfare. It is implemented by the World Lung Foundation and is evaluated by the Centers for Disease Control and Prevention (CDC), in partnership with the CDC Foundation.

Tanzania: By The Numbers
The United Nations’ Millennium Development Goal (MDG) 5 calls for a 75% reduction in maternal mortality rates by 2015. At the current rate of progress, Tanzania is not on track to reach MDG 5. Our program strives to accelerate progress and early results suggest we are headed in the right direction. We are showing that women will use life-saving medical treatments and facilities when they are easily accessible and provide high-quality care.

So far:

  1. Nine extremely remote heath centers have been upgraded. Prior to the program, patients had to travel 3-4 hours to the nearest hospital. Now, emergency obstetric care is available in the community.
  2. More than 100 non-physician clinicians have been trained in comprehensive emergency obstetric care or anesthesia.
  3. Health center utilization for delivery care has increased substantially, from about 3,500 deliveries per year in all 9 health centers prior to the program to about 9,000 in 2011 after the intervention.
  4. More than 1,000 c-sections have been performed
  5. The Ulanga district, one of 7 districts where the program is operating, saw a 32% decline in maternal deaths after the program was implemented.
  6. Conservative projections show that at least 50,000 women and children will be impacted by our work.

About Bloomberg Philanthropies 
Bloomberg Philanthropies works primarily to advance five areas globally: the Arts, Education, the Environment, Government Innovation, and Public Health. In 2011, $330 million was distributed. For more information please go to Follow us on Twitter @BloombergDotOrg.

SOURCE Bloomberg Philanthropies

Source: PR Newswire


Bloomberg Businessweek – Ryan Medicaid Plan

The other Paul Ryan plan: $800B in Medicaid cuts

By By Ricardo Alonso Zaldivar on August 15, 2012

WASHINGTON (AP) — There’s another Paul Ryan plan for health care, a fundamental change in caring for the poor and disabled that would affect many more people than the Medicare overhaul the GOP vice presidential candidate is best known for.

Under the Wisconsin congressman’s Medicaid plan, states would take over the program. At the same time, Ryan’s budget would reduce projected federal spending on Medicaid by about $800 billion over 10 years, dramatically shrinking it as a share of the national economy.

Medicaid serves about 60 million people, roughly 10 million more than Medicare. It’s a diverse population brought together by need. Most Medicaid recipients are low-income children and their mothers, but the costliest cases are severely disabled people, many of them seniors in nursing homes.

Ryan would also repeal President Barack Obama’s health care law, expected to add at least 11 million more people to Medicaid.

Ryan’s Medicaid plan is in sync with his new boss, Republican presidential candidate Mitt Romney.

“Gov. Romney … believes that states are far better positioned to design programs that effectively serve those in need,” said campaign spokeswoman Andrea Saul.

But no matter who runs Medicaid, such cuts would result in millions of vulnerable people losing health insurance, according to advocates for the poor and some nonpartisan economic analysts.

“Medicaid is already a very lean program,” said Edwin Park of the Center on Budget and Policy Priorities, which advocates for low-income people. “It is not a program where you can magically glean huge efficiencies by just devolving it to the states. The only way to compensate for funding reductions of this magnitude would be to institute deep, damaging cuts to beneficiaries and the health care providers who serve them.”

Bring it on, says Wisconsin Health Secretary Dennis Smith, who oversees Medicaid in Ryan’s home state. Smith, who works for Republican Gov. Scott Walker, says states can cut costs without gutting services by running Medicaid more efficiently.

“Everybody agrees that there is excess cost in the health care system, so by golly, give us the flexibility to address it, and we will,” said Smith. “We can serve the people on Medicaid with the adjustments the Ryan budget. We can make that work.”

For example, Wisconsin is now charging some low-income adults a modest monthly premium for Medicaid, tapping a new funding source to pay for valuable benefits, Smith said. And the state is looking for ways to help frail elderly people keep living at home, avoiding the costly alternative of a nursing home.

Growing enrollment has turned Medicaid into a big share of state budgets, and since Washington sets many of the rules, the program is a source of constant tension between federal and state governments. On average, the federal government pays about 60 percent of Medicaid costs, and states cover the rest. The Supreme Court recently gave some latitude to states chafing at Obama’s health care law, saying they are free to opt out of its Medicaid expansion.

Obama has largely shielded Medicaid from cuts in budget negotiations with Congress. But his administration has proposed new ways to allocate funding that could be used to dial back the federal share.

Ryan’s plan goes beyond tweaking. It would essentially rip up the Medicaid manual and start all over again. States would get a lump sum from Washington, a “block grant” indexed to reflect population growth and inflation. The idea has governors split along party lines.

Ryan’s Medicare plan, shifting future retirees to private insurance, would phase in over a decade or more. The Medicaid changes would come much more rapidly. The proposal has not been fleshed out, leaving many unanswered questions. For example:

—What happens if a state’s economy tanks?

Under current law, the federal Medicaid share is pegged to program enrollment, not population growth, said John Holahan, director of the Health Policy Center at the nonpartisan Urban Institute. That means federal funding increases when the Medicaid rolls swell. But under Ryan’s plan, “there are no provisions to automatically deal with recessions,” said Holahan. “The demand for Medicaid goes up at the same time state revenue is going down.”

—Would low-income and disabled people still have a legal right to coverage?

Converting Medicaid into a block grant would end the current right to coverage under federal law, and it remains unclear what rights could be preserved. Most analysts say states would insist on the flexibility to reduce their Medicaid rolls. The Urban Institute estimates that between 14 million and 27 million people would lose coverage because of Ryan’s spending restrictions.

—What sorts of safeguards would remain in place for seniors in need of nursing home care?

Although frail elderly people must spend down most of their savings before they can qualify for Medicaid, a federal law shields spouses from becoming impoverished. It’s unclear what would take its place.

Supporters of state control say governors and legislatures are closer to the people and would not harm their own constituents.

Back in Ryan’s state, the jury is still out.

Medicaid covers nearly 1 in 5 Wisconsin residents, and hospitals have a major stake in the outcome. Joanne Alig, senior vice president for policy with the Wisconsin Hospital Association, says they would need to know more about the plan to reach conclusions.

“While I think we are supportive of looking at alternatives to the Medicaid status quo, the devil’s in the details,” she said.

Insurers Join Effort to Eliminate Fraud

from Bloomberg

By Alex Wayne – Jul 26, 2012 12:26 PM ET

UnitedHealth Group Inc. (UNH) and WellPoint Inc. (WLP), the largest publicly traded health insurers in the U.S., agreed to share more information with regulators in an industrywide partnership with the government to root out fraud.

The initiative targets theft of doctors’ identities and overbilling, including in Medicare, the $500 billion U.S. health insurance program for the elderly and disabled. The partnership may lead to sharing billing claims data, which could be mined for aberrations, said Richard Migliori, executive vice president of health services for Minnetonka, Minnesota-based UnitedHealth.

“There are mutual interests here in doing a better job at detecting what’s probably some $80 billion-plus per year in fraudulent payments across private and public sectors,” Migliori said in an interview. “There’s lot of enthusiasm for doing this right.”

Today’s announcement falls short of a full data-mining agreement, a long-range goal that the government said would help spot fraud such as when doctors charge different insurers for care delivered to the same patient on the same day in two different cities. There are obstacles to providing that information, particularly patient privacy and confidentiality concerns related to sharing claims data, Migliori said.

Health and Human Services Secretary Kathleen Sebelius, Attorney General Eric Holder and insurance industry leaders will discuss the partnership at 1 p.m. local time at the White House in Washington.

“This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars,” Sebelius said in a statement.

Humana, Amerigroup

The collaboration includes America’s Health Insurance Plans, the industry’s main lobby group in Washington, and the Blue Cross Blue Shield Association, which represents state Blue Cross and Blue Shield plans. Along with UnitedHealth, Humana Inc. (HUM) and Amerigroup Corp. (AGP) are among companies participating, according to the government.

The Justice Department has estimated that Medicare and Medicaid, the health system for the poor, are plagued by at least $60 billion in fraud a year. The Government Accountability Office, the investigative arm of Congress, reported in 2009 that an increase in bills from several states for home health care was partly because of “fraudulent and abusive practices.”

To contact the reporter on this story: Alex Wayne in Washington at

To contact the editor responsible for this story: Reg Gale at