Will MNH Survive the Global Health Reform Agenda?
The Silence That Said Everything
Picture this: A room full of maternal and newborn health experts at the International Maternal and Newborn Health Conference in Nairobi. The moderator, Mercy Juma, asks them to define “global health reform.”
Hands go up. Voices chime in. Integration. Primary health care. Country ownership. Domestic financing. Sovereignty.
Then Mercy asks the follow-up: “Did anyone talk about maternal and newborn health in these global reforms?”
Silence.
“No one spoke about maternal and newborn health,” someone finally admits.
In that moment, the entire premise of Real Talk #4 crystallized. If we—the MNH community—aren’t centering mothers and babies in conversations about the future of global health, who will?
The Setup: Why This Conversation Mattered
For those new to the series, Real Talk is where we tackle the questions that keep MNH practitioners up at night through unfiltered conversation between experts who don’t always agree. No polished PowerPoints. No pre-approved talking points. Just honest exchanges about what’s really happening.
The first three Real Talks held virtually followed a thread: if the workforce gap won’t close, we must innovate. If we innovate, we must finance sustainably. If we finance sustainably, we must prioritize intentionally. And if we prioritize intentionally, countries must lead.
That logic brought us to Nairobi with the biggest question yet: As global health shifts toward integration, primary health care, and country ownership, where do mothers and babies fit? Will they remain visible, or will we assume the system carries them along? This conversation in the series was a special collaboration between AlignMNH’s Real Talk series and Amref Health Africa‘s platform, AHAIC Dialogues, Catalysing Voices.
Starting Where It Matters
Mercy asked the panel to explain global health reform—but to speak to her 85-year-old aunt in the village. It forced the conversation away from policy jargon and toward lived reality.
Prof Anne Kihara, President of FIGO (Emeritus), cut straight to the point: “Global health reforms for me, I start with the centrality of women and babies and children. Why? Investment in human capital.”
The vision was radical. The reform agenda must put women at the center not as “reproductive instruments or vessels” but as whole people who shape economies and drive development. Anne called for multi-sectoral integration: “We have compartmentalized women as reproductive commodities. Let’s take her holistically and with the roles she’s supposed to do right from the household to the economies of nations.”
Dr Mike Mulongo, Health Systems and Financing Lead at Tunu Consulting, brought it back to decision-making: “Global health reform… would really be how the world makes decisions on health, what policies and laws they follow, and then how those decisions then, you know, go down to the grassroots.” The shift, he explained, is moving from decisions made “up there” by donors to decisions made “down here” by countries.
But here’s the tension: what if countries don’t prioritize maternal and newborn health in their domestic budgets?
The Visibility Problem
Integration into primary health care sounds good on paper. It promises efficiency, sustainability, and country ownership. But the panel didn’t shy away from the risk.
“The problem is you integrate and then you hide things and then you don’t see them,” Mike warned.
Even as Kenya has invested in integrated systems, maternal health indicators have declined since 2024. The question became urgent: how do you keep priorities visible even as you have them integrated?
Ring-fencing MNH budgets came up—and quickly became controversial. As Mike explained: “If we verticalize or ring fence for maternal and child health, will we ring fence for all these other things that we think are priority? Then it becomes administratively inefficient.”
The solution? Don’t just ring-fence. Prioritize MNH as core to primary health care, and ensure resources follow that priority.
Buildings Without People
An audience member from Kenya’s counties brought a sobering observation: “For the longest time MNH has been brick and mortar. Right now, go to our counties, go to the field, you will find we have so many buildings, but we do not have the people working.”
Should we reorient toward the “software”—behavior change, empowering community structures, accountability mechanisms—rather than just infrastructure?
Anne pushed further: “You cannot generate wealth without health. Do your situation analysis.” Every nation needs to understand its localized context before designing reforms. Cookie-cutter solutions won’t work. Context matters.
A participant also confronted Kenya’s priorities. The Ministry of Education receives 700 billion shillings while the Ministry of Health gets 141 billion. The question was direct: “Should you be healthy before you go to school or should you be going to school when you’re not healthy?”
Who Holds Power to Account?
An audience member asked the question many were thinking: How do we talk about financing and reform when leaders steal health funds and then use private systems themselves?
The panel didn’t dodge. “I think we have to be able to help our people to raise accountability voices. Citizens’ roles do not end in elections. It continues in putting leaders to account,” Boniface Mbuthia, Technical Director of Health Financing at Amref Health Africa, responded.
Mike noted: “The reality is that we need to get to the point where the citizens are informed and rise to the occasion to claim what is rightfully theirs because these public resources are theirs.” Boniface added: “Within this changing global health reforms, accountability cannot be diluted. We should even be more accountable with our resources than we have been with the resources from other countries.”
They asked: where are MNH voices in public dialogues, technical working groups, political manifestos? Many African nations are heading into elections. Are we speaking up? Why aren’t medical associations more central to accountability? Why don’t MNH experts build stronger relationships with journalists?
The Poll: Optimism or Risk?
Before wrapping up, Mercy revealed poll results: 82% said the reform agenda is an opportunity. 7% said it’s a threat. 11% said it’s both.
Was the MNH community being too optimistic?
Boniface responded: “The rating of opportunity gives us a lot of hope. However, we must make that hope a reality.” He noted that some African countries lose 500 mothers per 100,000 live births, while others lose only 5-10. “We owe it to our citizens to make good service a reality, not a promise.”
Mike framed it this way: “I think it is an opportunity in itself. There are risks. We are not burying our heads. So the question is how do we mitigate this risk in the short term?”
Looking to 2035
Mercy closed by asking the panelists to imagine it’s 2035 and maternal and newborn health hasn’t just survived these reforms—it’s thriving. What did we get right?
Anne: “You transformed your health system.”
Mike: “You invested, you became more efficient with the resources that you have and you used evidence to improve the quality within your constraints.”
Boniface: “You put your patient at the center and you combine the resources to address the underlying problems, so that you can be able to offer better services.”
Three simple sentences. Three foundational truths. Transform systems to serve people. Use resources efficiently and follow evidence. Address root causes, not just symptoms.
So, Will MNH Survive?
The answer: Yes—but only if we act now.
The global health reform agenda is happening whether the MNH community engages or not. African countries are setting their post-2030 health priorities right now. If maternal and newborn health isn’t visible and prioritized in these processes, it risks being sidelined for a generation.
But visibility requires more than advocacy. It requires:
- Grounding strategies in localized situation analysis—understanding specific disease burdens, health system constraints, and community priorities rather than applying one-size-fits-all approaches
- Valuing and scaling African-led solutions—recognizing that sustainable innovation comes from the communities and practitioners who understand the challenges best, not just external actors
- Ensuring MNH is positioned as foundational to primary health care, not a competing vertical program
- Active engagement in domestic budget processes, not just donor conversations
- Accountability structures that empower citizens, professional bodies, and media to hold systems to account
- Moving from brick-and-mortar investments to “software”—behavior change, community empowerment, quality of care
Mercy started the session by noting that no one mentioned maternal and newborn health when asked about global health reform. By the end, the room understood why that silence is dangerous—and what it will take to change it.
Real Talk has always been about naming the tension and building through it. This conversation in Nairobi did exactly that. The reform agenda is an opportunity. But opportunities don’t deliver themselves. They require courage, coordination, and the willingness to speak up—even when, especially when, the stakes are mothers’ and babies’ lives.
Real Talk is AlignMNH conversation series tackling the challenging questions that keep MNH practitioners up at night. Because when it comes to saving mothers and babies, we can’t afford to stay silent.