Namibia’s ongoing efforts offer lessons for other countries seeking to improve maternal health, as well as for health programs tackling HIV/AIDS, malaria, tuberculosis, or other conditions.

Up to a half a million women die each year around the world because of complications arising from pregnancy or childbirth. The majority of these deaths occur in sub-Saharan Africa.¹ Since they are largely preventable, they represent a tragedy playing out every day across the continent. Progress on maternal health there is hampered by health systems that are understaffed, underfunded, and overwhelmed—and thus too fragile and fragmented to deliver the required level or quality of care. Consequently, many countries in sub-Saharan Africa will struggle to meet the United Nations’ Millennium Development Goals for reducing child and maternal mortality by 2015.²

Nonetheless, some countries are making headway. Our recent work in Namibia, for example, suggests that coordinated, targeted interventions led by local stakeholders can accelerate improvements in maternal-health outcomes. The key is to work with local health leaders to develop solutions that improve the quality of health care, increase access to it, and promote its early uptake.

The resulting interventions being pursued in Namibia are straightforward and practical—improvements in the training of midwives, cheaper antenatal clinics inspired by the design of shipping containers, operational fixes to reduce ambulance response times and wait times at clinics, a radio talk show to educate patients and stimulate demand—yet are collectively powerful. A closer look at Namibia’s ongoing efforts offers lessons for other countries seeking to improve maternal health, as well as for health programs tackling HIV/AIDS, malaria, tuberculosis, or other conditions.

In a related video, McKinsey’s Thokozile Lewanika gives a behind-the-scenes look at several of the efforts underway to improve maternal health care in Namibia.

Preventable tragedies

The global health community has long understood that improving the health of women during pregnancy, childbirth, and the postpartum period represents a massive opportunity not only to save women’s lives but also to improve neonatal, infant, and child health outcomes directly. Further, most maternal deaths in low-income countries are preventable—arising largely from pregnancy-induced hypertension, hemorrhage, or sepsis. Still, up to a quarter of a million women die in sub-Saharan Africa each year because of problems associated with pregnancy or childbirth.

In Namibia, the incidence of maternal and neonatal mortality has doubled in recent years (Exhibit 1). A woman in Namibia today is almost 100 times more likely to die during pregnancy than a woman in Europe. This difference partly reflects Namibia’s high rate of HIV/AIDS infection (more than 20 percent of the women at the country’s antenatal clinics are HIV-positive) and partly reflects limited access to health facilities (Namibia has the world’s second-lowest population density, with barely two people per square kilometer).

In a bid to stem Namibia’s rising maternal-mortality rate, the country’s Ministry of Health and Social Services (MOHSS), in partnership with McKinsey, the Synergos Institute, and the Presencing Institute from the Massachusetts Institute of Technology (MIT), established the Maternal Health Initiative, or MHI (see sidebar “About the initiative”). It focuses on a microcosm of Namibia’s health system to develop a replicable approach for improving maternal health care across the country.

The MHI chose to set up its pilot project in the Khomas region, the most populous of Namibia’s 13 regions and the one with the worst uptake of antenatal services.³ (Less than 7 percent of pregnant women there receive antenatal checkups during the first trimester.) Within Khomas, the team focused on four of the largest suburbs of Namibia’s capital, Windhoek: Hakahana, Katutura, Okuryangava, and Samora Machel, which have a collective population of about 80,000. It focused in particular on these areas’ busiest hospital and primary–health care clinic, Katutura Hospital and Okuryangava Clinic, respectively.

Next, three subteams were formed to design and develop prototype maternal-health solutions for problems associated with community mobilization, the capabilities of health workers, and health system operations, respectively. Each subteam included a variety of local frontline health leaders and other stakeholders—for instance, nurses, social workers, ambulance drivers, and middle managers.

Finally, to ensure local ownership and accountability (as well as to expand future initiatives across Khomas) a regional delivery unit was established under the guidance of the chief medical officer in Khomas. It provides managerial oversight, monitors the performance of the region’s improvement in maternal health service delivery, and integrates the activities of the subteams with those of the health ministry’s regional team.

The subteams quickly identified and implemented several interventions to improve the supply of maternal care in Khomas and to raise demand for care among local women. While it’s too soon to claim victory over Namibia’s maternal-health problems, the results thus far are encouraging.

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¹ World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund, and the World Bank, Maternal Mortality in 2005, World Health Organization, 2007.
² In addition to meeting other social, educational, and health targets, the United Nations seeks to reduce child and maternal mortality rates and drastically reverse the spread of HIV/AIDS and malaria by 2015. For details, see un.org/millenniumgoals.
³ Common antenatal services include measuring blood pressure, conducting blood and urine tests, monitoring weight, taking fundal height measurements, and answering general questions about diet and fetal movements.

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