Only 20% Believe Evidence Drives MNH Prioritization. The Other 80%? Budgets and Politics.
Summary
Are MNH priorities clear heading into 2026? AlignMNH’s Real Talk unpacks best buys, politics, financing, and why local context and country ownership matter.
Crystal Clear or Clear as Mud? Real Talk on MNH Priorities
“Are maternal and newborn health priorities crystal clear, or are they clear as mud as we head into 2026?”
That’s the deceptively simple question moderator Mercy Juma posed to kick off AlignMNH’s third Real Talk conversation. And if the lively discussion that followed is any indication, the answer is: it’s complicated.
The “Best Buys” Debate
Everyone in global health is talking about efficiency and prioritization right now. With shrinking budgets and countries working to ensure their health systems are funded, the concept of “best buys” – interventions that give the biggest bang for the buck – sounds appealingly simple.
But is it?
Dr. Cheikh Faye, Director of Countdown to 2030, offered a nuanced perspective: “Where we sit at the global level, we think things are clear because we’ve been providing all the evidence, all the science. But when applied to the country level, there are a lot of disparities. What can our health system realistically deliver, sustain, and scale?”
Dr. Lia Tadesse, former Minister of Health of Ethiopia and now Executive Director of Harvard’s Ministerial Leadership Program, brought the view from the decision-maker’s seat: “What we need to do for MNH, the interventions needed to improve maternal newborn health – most of them are really known. The problem is we have very limited resources. How do we do it? That’s really the challenge.”
Nothing For Us Without Us
Nafisa Jiddawi, Founder & CEO of WAJAMAMA in Zanzibar, brought the conversation to the frontline with a powerful reminder about local context.
“One size definitely does not fit all,” she said. “You cannot come to Zanzibar and say, ‘This solution worked in Ghana, it’s also going to work here.’ Even if you come to Tanzania and try to implement a solution that works on the mainland, it may not work in Zanzibar.”
Her prescription? Spend time on the ground, not just with ministry officials, but with frontline workers, community health workers, and the women themselves.
“Nothing for us without us,” Nafisa emphasized. “I really believe in that, and I wish more people took that statement seriously when designing solutions.”
One participant raised another critical point in the chat: “Priorities still skewed towards maternal, less focused on newborn care.” A reminder that even within MNH, there are competing priorities that need attention.
The Poll That Made Everyone Think
Before the conversation, AlignMNH ran a social media poll asking: “When it comes to prioritizing health interventions, what really drives the decision?” The options were evidence, budgets, or politics.
The results were sobering: only 20% said evidence. The remaining 80% was split evenly between budgets and politics.
“How does this make you feel?” Mercy asked the panelists.
Lia didn’t sugarcoat it: “Even when you have evidence, if there is no political commitment, there is no intervention. When it’s evidence-informed, it becomes a very strong approach, but without political commitment, things are not implemented – at least not in a way that can be sustained.”
Cheikh pushed further on the governance question: “How many of us talk about health system governance? Sometimes you bring everything to the table, but when decisions are being taken, you’re not even there. There’s just one person somewhere taking a decision that impacts everyone’s life, despite all the science.”
The Scientist’s Dilemma
Cheikh was candid about the challenges facing African scientists trying to influence policy: “Until now, if you’re a university person, a good professor close to government, your voice isn’t always heard.” He shared that when a person moves to a global organization, “suddenly people say, ‘This is a high-level expert.’ That person has been saying the same thing for years!”
His call to action? “It’s our role as scientists to accompany our governments, to distill evidence in language that is understandable, in something simple for them to understand. And please – let’s stop with the models. There’s no model that will work everywhere.”
Country Ownership: More Than a Buzzword
Lia shared Ethiopia’s approach to maintaining country ownership while working with donors: “The Ministry of Health and Ethiopia’s approach in terms of alignment towards country priorities has been very strong. We push for one plan, one budget, one report – harmonizing and asking donors to fund government for implementation whenever possible.”
But she acknowledged the constant pressure: “There is always pressure, particularly on investing in specific projects versus investing in the national plan. It’s not always perfect, but we’ve had good successes in terms of alignment around country priorities.”
As one participant eloquently put it in the chat: “The owner of the granary decides what the family eats. When governments, not partners, increase domestic financing for their health priorities, they will become intentional in prioritizing their national contextual health priorities.”
Bi-Directional Partnerships
Nafisa offered a vision for the path forward: “In the perfect world, there would be bi-directional partnerships with frontline workers and government representatives, bi-directional partnerships between women and frontline workers, bi-directional partnerships with funders. There just needs to be a lot more conversation, a lot more advocacy.”
The Bottom Line
This Real Talk made one thing clear: MNH priorities aren’t crystal clear, and pretending they are doesn’t help anyone. The path forward requires:
- Local context matters: Global “best buys” must be adapted to local realities
- Political commitment turns evidence into action: We have the science – what’s missing is the leadership to implement it
- Domestic financing drives ownership: The owner of the granary decides what the family eats
- Governance needs attention: Who makes decisions, and how, matters enormously
- Bi-directional partnerships ground solutions in reality: Listening to frontline workers and communities – nothing for us without us
As Mercy wrapped up, she stated: “This is not a conversation we can conclude. That’s the essence of Real Talk, to get us thinking, reflecting, having these conversations in our WhatsApp groups, walking down for coffee, talking about the uncomfortable truths.”
The conversation continues live at IMNHC 2026 in Nairobi, where financing, priorities, and sustainable solutions will be front and center. Because when it comes to saving mothers and babies, we can’t afford to keep things muddy.
Stay tuned for more from AlignMNH’s Real Talk series, where uncomfortable truths meet honest dialogue.