Zulfiqar Bhutta: “You Cannot Reach Global Targets without Reaching Everyone who Needs to Be Reached”

Dr. Zulfiqar Bhutta, Director of the Center of Maternal and Child Health at Aga Khan University and Professor at the Hospital for Sick Children of Toronto, gave the seventh Global Health Lecture on July 3^rd, at the CaixaForum in Barcelona. After the lecture, he kindly agreed to answer some questions on maternal, newborn and child health. Here is an extract of the interview.

Despite considerable progress, the world is still off-track for reaching the Millenium Developmental Goals 4 and 5, that seek to reduce child mortality and improve maternal health. In your opinion, which have been the main obstacles? 

A lot of the global progress on the MDGs has been driven by countries with large economies like Brasil or India but there are also examples of small countries like Rwanda, Bangladesh or Costa Rica that have made tremendous progress despite their limited economies. It has been a mixed picture. One of the major obstacles has been reaching the poorest and more vulnerable, as well as a lack of scaling-up. For many interventions, the coverage rate is of 30-40%. You cannot reach global targets without reaching everyone who needs to be reached.

What strategies would be the most cost effective to improve newborn survival?   

You have to start with strategies that work for mothers: increasing age at marriage, improving family planning coverage and insuring that every woman delivers at a health facility with skilled health attendants. Close to 3 million lives can be saved just by focusing on the day of birth. Then after that, breastfeeding and keeping small babies warm. None of these interventions require a lot of money. They require the knowledge and political will to implement at large scale.

Much of the knowledge to avoid preventable maternal, newborn and child deaths is already generated. In terms of research, what are the missing pieces that should be prioritized?

A lot of our effort has to go into implementing what we know in different contextsWhile it is true that we know what works, we don’t know enough on how to implement this knowledge and even less on how to do it in different places such as conflict areas. A lot of our effort has to go into implementing what we know in different contexts. We need to have the humility and wisdom to work with the different communities and societies to understand their barriers and help to breach them. 

There are more than 1 billion adolescents in the world and 9 out of 10 live in low and middle income countries. Despite this, adolescent health has been a neglected issue up to now. What are the main actions required to fill in this gap?

Health systems do not cater to the needs of adolescents that are often regarded as young adults or grown-up childrenFirst, we need to recognize that the problem exists. Health systems do not cater to the needs of adolescents that are often regarded as young adults or grown-up children. Second, we need to reach adolescents. Not all of them can be reached at schools. Many adolescent boys are in the work force and adolescent girls are at home as child brides. We have to ensure education for girls as a fundamental right. Third, we require more knowledge on their common problems that are very different from those of young children and include accidents, suicide and pregnancy-related complications or abortions.

There is only one Sustainable Development Goal that specifically focuses on health. What are the main challenges to keep maternal, newborn and child health at the centre of the agenda?

There is already a lot of support at the highest level for protecting maternal and child health with the new global strategy ‘Every woman, Every child’ that will be ratified in September. What we need to do now is to focus on the inclusiveness of this strategy, including newborns and adolescents. I am very supportive of the sustainable development goals that reflect the reality on how health can be addressed via health-sensitive sectors such as education, environment and sanitation.