Bruno Meessen
In January 2010, Amnesty International released a report "Giving life, risking death: Fighting maternal mortality in Burkina Faso". For the Human Rights NGO, this was another step into its new field of action: social rights. During our workshop in Bamako, the actions of the NGO were debated. Over lunch, I interviewed the two most vocal debaters. On the one hand, Dr. Sankara Salif, responsible for the coordination of the national plan on the “subsidy for deliveries and emergency obstetric and neonatal care” of the Ministry of Health; on the other Roger Minoungou, Coordinator of "Growth & Activism" of Amnesty International Burkina Faso.
Roger, explain us a bit the reason why Amnesty International is committed to the issue of maternal health in Burkina Faso?
RM: Amnesty International is a worldwide movement of volunteers who work for the protection of human rights. Since its birth in 2001, Amnesty has focused on civil and political rights. Since 2001, the movement has expanded its mandate to defend social, economic and cultural rights – domains where violations were evident. In Burkina Faso, official figures reported that 2,000 women died each year during delivery. This was seen as a serious violation of the rights to maternal health, to life - human rights essential to the exercise of other rights - because these deaths are often preventable.
Specifically what was your approach in Burkina Faso?
RM: It was inclusive and participatory. As for civil and political rights, Amnesty has the required in-house expertise. Not being maternal health professionals, we had to take a coordination approach. Research lasted about two years. The research team took into account the approaches to health and human rights by the various ministries and the National Assembly, including how the public budget is constructed. At the same time, the team met with health professionals at central and decentralized levels, visited 12 rural health areas and examined 50 cases of maternal deaths. The movement has given a voice to the people – the ones who are most concerned with the problems of access to maternal health services. We did not want to miss the goal of producing something beneficial to rights holders.
Salif, how has this approach been appreciated by the Ministry of Health?
SS: We congratulate Amnesty for its approach, the work is interesting, but one can also deplore the fact that the process has not sufficiently recognized the efforts of the government. The support that our states expect is positive support. With its study, Amnesty made a lot of noise. The title of the report "Giving life, risking death" was stigmatizing. There is an old Burkinabe saying which says "the pregnant woman has one foot in the grave" - but this is certainly not the case anymore. This type of message discourages decision makers. During the implementation of the subsidy policy of deliveries and emergency obstetric and neonatal care, we had difficulty communicating all of the changes to all the beneficiaries. I regret that Amnesty did not take advantage of its community level activities to help us reach women with the message of their new entitlement.
The example of Yalgado (note from BM: the University Hospital, which is dysfunctional like many national hospitals in sub-Saharan Africa) is not representative of all the Burkinabe hospitals. Finally, I regret that this document has not been used to mobilize more resources. The financing efforts of the Government for the funding of maternal health are already very important: 11 billion CFA – Amnesty should have recognized that commitment. The state remains the largest contributor by covering 97.2% of the cost of the policy! As Fabienne Richard said at the end of one of the Bamako workshop sessions: NGOs are welcome, but must learn to listen to the needs of governments.
Roger, how does Amnesty respond to this frustration? What is your strategy today?
The report recognized the efforts of the government with its subsidy. But it also identified weaknesses in the monitoring mechanisms of the policy already in place. In the research phase, we didn’t only visit Yalgado. We also appreciated the project in "Secteur 30" of Ouagadougou. It is hoped that such initiatives will be consolidated. But in rural areas, we also saw people who, despite the subsidy policy, could not access care. 46% of the population live below the poverty line; 900 CFA remains high price to pay. The report also recognised the real efforts of health workers; not everything was negative.
We maintain a good collaborative relationship with the Ministry of Health. We also sought to solicit comments from the Ministry of Health on the report. We also work with organizations that work in favour of a policy of full exemption (note from BM: with the current policy, users have still to pay 20% of the cost). We continue our advocacy efforts with donors, one way being through a working group on the issue of financial access. It is the responsibility of the State of Burkina Faso to present something concrete to donors. And then we will march forward!
In January 2010, Amnesty International released a report "Giving life, risking death: Fighting maternal mortality in Burkina Faso". For the Human Rights NGO, this was another step into its new field of action: social rights. During our workshop in Bamako, the actions of the NGO were debated. Over lunch, I interviewed the two most vocal debaters. On the one hand, Dr. Sankara Salif, responsible for the coordination of the national plan on the “subsidy for deliveries and emergency obstetric and neonatal care” of the Ministry of Health; on the other Roger Minoungou, Coordinator of "Growth & Activism" of Amnesty International Burkina Faso.
Roger, explain us a bit the reason why Amnesty International is committed to the issue of maternal health in Burkina Faso?
RM: Amnesty International is a worldwide movement of volunteers who work for the protection of human rights. Since its birth in 2001, Amnesty has focused on civil and political rights. Since 2001, the movement has expanded its mandate to defend social, economic and cultural rights – domains where violations were evident. In Burkina Faso, official figures reported that 2,000 women died each year during delivery. This was seen as a serious violation of the rights to maternal health, to life - human rights essential to the exercise of other rights - because these deaths are often preventable.
Specifically what was your approach in Burkina Faso?
RM: It was inclusive and participatory. As for civil and political rights, Amnesty has the required in-house expertise. Not being maternal health professionals, we had to take a coordination approach. Research lasted about two years. The research team took into account the approaches to health and human rights by the various ministries and the National Assembly, including how the public budget is constructed. At the same time, the team met with health professionals at central and decentralized levels, visited 12 rural health areas and examined 50 cases of maternal deaths. The movement has given a voice to the people – the ones who are most concerned with the problems of access to maternal health services. We did not want to miss the goal of producing something beneficial to rights holders.
Salif, how has this approach been appreciated by the Ministry of Health?
SS: We congratulate Amnesty for its approach, the work is interesting, but one can also deplore the fact that the process has not sufficiently recognized the efforts of the government. The support that our states expect is positive support. With its study, Amnesty made a lot of noise. The title of the report "Giving life, risking death" was stigmatizing. There is an old Burkinabe saying which says "the pregnant woman has one foot in the grave" - but this is certainly not the case anymore. This type of message discourages decision makers. During the implementation of the subsidy policy of deliveries and emergency obstetric and neonatal care, we had difficulty communicating all of the changes to all the beneficiaries. I regret that Amnesty did not take advantage of its community level activities to help us reach women with the message of their new entitlement.
The example of Yalgado (note from BM: the University Hospital, which is dysfunctional like many national hospitals in sub-Saharan Africa) is not representative of all the Burkinabe hospitals. Finally, I regret that this document has not been used to mobilize more resources. The financing efforts of the Government for the funding of maternal health are already very important: 11 billion CFA – Amnesty should have recognized that commitment. The state remains the largest contributor by covering 97.2% of the cost of the policy! As Fabienne Richard said at the end of one of the Bamako workshop sessions: NGOs are welcome, but must learn to listen to the needs of governments.
Roger, how does Amnesty respond to this frustration? What is your strategy today?
The report recognized the efforts of the government with its subsidy. But it also identified weaknesses in the monitoring mechanisms of the policy already in place. In the research phase, we didn’t only visit Yalgado. We also appreciated the project in "Secteur 30" of Ouagadougou. It is hoped that such initiatives will be consolidated. But in rural areas, we also saw people who, despite the subsidy policy, could not access care. 46% of the population live below the poverty line; 900 CFA remains high price to pay. The report also recognised the real efforts of health workers; not everything was negative.
We maintain a good collaborative relationship with the Ministry of Health. We also sought to solicit comments from the Ministry of Health on the report. We also work with organizations that work in favour of a policy of full exemption (note from BM: with the current policy, users have still to pay 20% of the cost). We continue our advocacy efforts with donors, one way being through a working group on the issue of financial access. It is the responsibility of the State of Burkina Faso to present something concrete to donors. And then we will march forward!
