In Rural India, An Innovative Partnership Is Saving Mothers and Babies

August 1, 2018 By Alexandra Teisan

In the Indian state of Rajasthan, approximately 80,000 newborns die each year and maternal mortality is 50 percent higher than the national average – putting the state’s infant and maternal mortality rates well above the global average.

Far too many health facilities in India are unable to provide adequate care for pregnant women. As one Indian nurse described, “We do not have a gynecologist now. No blood facility. So if there is any case that needs blood we refer the case to Allahabad hospital-Sadguru Seva Trust.” That hospital is more than 100 kilometers away.

Beyond the obvious tragedy of losing a child or a mother, the long-term consequences of maternal mortality can be severe and far-reaching. Children who have lost a mother are more likely to suffer from illness or malnutrition, and are at an increased risk of depression and social isolation. What’s more, families who lose a mother also lose a potential breadwinner and caregiver, which can further entrench families in poverty and stymie economic growth in communities.

In an effort to help save mothers and babies in India, Merck’s global initiative, Merck for Mothersa 10-year, $500 million initiative to help create a world where no woman dies giving life— joined forces with the U. S. Agency for International Development (USAID) to help small Rajasthani health care facilities meet new nationally-accredited standards for maternal care. In order to reach this ambitious goal, Merck for Mothers and USAID turned to an innovative financing mechanism: a development impact bond. Under this results-driven approach, private investors–in this case, UBS Optimus Fund–provide capital upfront and receive a return from a third-party donor if the program is successful.

USAID Administrator Mark Green is especially supportive of this model, explaining that “this level of accountability is wonderful. It’s what American tax payers expect, but more importantly, it’s what those we serve in the developing world deserve… This Development Impact Bond is just the beginning of what is already a growing new suite of innovative development finance tools that can accelerate and catalyze progress.”

In Rajasthan, USAID and Merck for Mothers have partnered with a number of organizations including PSI to implement the Utkrisht Impact Bond – the first impact bond to be applied to global health. The bond’s objective is to ensure that 440 small health care facilities across the state achieve the new standards of care. If successful, the bond could improve care for 600,000 pregnant women and result in as many as 10,400 lives saved. During this first phase, USAID and Merck for Mothers have committed to repaying the initial investments if performance targets are met – the goal being for the Rajasthani Government to take over financial responsibility in a potential second phase.

Implementing the higher standard of care in local hospitals will help Indian mothers like Munira. When Munira experienced complications during her third pregnancy she was turned away from three private medical facilities because they couldn’t treat her condition. But with the Utkrisht Impact Bond’s standardization of medical care across Rajasthan state, more women will have access to health facilities during childbirth and to the care they need for pregnancy-related complications.

As the largest and most ambitious development impact bond to date, the Utkrisht Impact Bond has raised hopes for the future of Rajasthani maternal care. It’s fitting then, that the bond is named for the Hindi word “excellence” as it not only raises the bar for maternal and infant care, but for the future of global health.

Learn more about the Utkrisht Impact Bond here: