2015 MERCK FOR MOTHERS PROGRAM REPORTMERCK FOR MOTHERS PROGRAM REPORT / OCTOBER 2015 / 3 Merck for Mothers is proud to be a founding partner of Saving Mothers, Giving Life (SMGL),

2015 MERCK

FOR MOTHERS PROGRAM

REPORT

2 / MERCK FOR MOTHERS PROGRAM REPORT / OCTOBER 2015

MERCK FOR MOTHERSBringing Merck’s scientific and

business expertise to the

challenge of maternal mortality

Designing and testing solutions to save women’s lives during pregnancy and childbirth

Advocating for the change that women deserve

MERCK FOR MOTHERS PROGRAM REPORT / OCTOBER 2015 / 1

Empowering women to make informed choices about contraception and get the quality care they need for a healthy pregnancy and safe childbirth.

*Merck for Mothers is known as MSD for Mothers outside the U.S. and Canada.

DR. NAVEEN RAO

LEAD, MERCK FOR MOTHERS

DR. PRIYA AGRAWAL

EXECUTIVE DIRECTOR, MERCK FOR MOTHERS

A MESSAGE FROM LEADERSHIP

We’re striving to make transformative contributions in three ways:

Now in our fourth year, Merck for Mothers is working alongside 75+ partners on 50+ programs that are helping pave a smoother path to safe motherhood for women in 30 countries around the world.

Together we are investing in two areas we believe will have the greatest impact on ending preventable maternal deaths, especially in countries with the highest maternal mortality burden:

• Improving the quality of care women receive in health facilities at the time of childbirth

• Improving access to high-quality modern contraceptives

Saving women’s lives from pregnancy and childbirth complications is complex, demanding innovation every step of the way. As Merck has learned from tackling other global health challenges like river blindness, HIV/AIDS and cervical cancer, we must take a comprehensive approach that goes beyond any single intervention if we are to achieve substantial and sustainable gains in health.

So we’ve asked ourselves: how can Merck for Mothers apply the company’s business and science expertise to make the greatest contribution?

WE ARE PLEASED TO SHARE THIS UPDATE

ON THE PROGRESS OF MERck FOR MOTHERS *,

MERck’S 10-YEAR INITIATIvE TO REDUcE

MATERNAL MORTALITY.

So where are we now? To date, our partnerships have helped 5+ million women gain reliable access to quality maternal healthcare and modern contraceptives. This number grows every day. And as we generate data on what is succeeding — and as importantly, what is not — we are advocating to bring programs to scale and help improve the lives of millions more women across the globe.

We are grateful for our creative partners and emboldened by our shared vision of a world where no woman dies giving life.

Be well,

Equipping health providers with the skills, tools and technologies they need to deliver high-quality maternity and family planning services wherever women seek care.

Placing lifesaving maternal health products in the hands of women and their providers.

ENABLING HEALTH PROVIDERS

Developing anD Delivering lifesaving proDucts

EmpowEring womEn


Four years into our 10-year initiative, our partnerships have made impressive

strides to help improve maternal health worldwide:

BY THE NUMBERS

1.5+ MILLIONWOMEn WITH IMPROVED

ACCESS TO qUALITy MATERnAL HEALTHCARE

2,500+FACILITIES

STREnGTHEnED TO PROVIDE qUALITy CARE

5,400+3.5+ MILLIONWOMEn WITH IMPROVED

ACCESS TO MODERn COnTRACEPTIVES

5+ TOTAL nUMBER OF WOMEn

WITH IMPROVED ACCESS

TO qUALITy MATERnAL

HEALTHCARE AnD MODERn

COnTRACEPTIVESMILLION

50+PROGRAMS

75+PARTNERS

30cOUNTRIES

PROVIDERS AnD COMMUnITy

HEALTH WORKERS TRAInED


Merck for Mothers is proud to be a

founding partner of Saving Mothers,

Giving Life (SMGL), an ambitious

public-private partnership to reduce

maternal and newborn mortality

in sub-Saharan Africa. In less than

three years, SMGL has seen

maternal mortality drop by 45% in

target facilities in Uganda and

53% in target facilities in Zambia.

MATERNAL MORTALITY NEARLY HALvED

IN UGANDA AND ZAMbIA

KEY ACHIEvEMENTS

• U.S.Implemented evidence-based practices to treat the leading causes of maternal death in five states that account for one quarter of the nation’s four million births and inspired government support of quality improvement efforts in eight additional states

• SENEGALDecreased stock outs of contraceptives to less than 2% in all public health facilities (from more than 80% in 2011) and helped increase the contraceptive prevalence rate to 20% nationwide (from 12% in 2011)

• UGANDAExpanded a social franchise network of private providers offering quality-assured maternal health services to 140 health facilities, covering one third of the country

• iNDiAImproved the quality of private maternity care through social franchising, training, quality improvement and government accreditation in three high-burden states with a total population of 300+ million

• ZAMBiADesigned community-managed, entrepreneurial maternity homes, and initiated partnership to develop them and evaluate whether they are an effective solution to help women receive timely, quality care


OUR GLOBAL PARTNERS & PROGRAMS

IndIa

Hindustan Latex Family Planning Promotion Trust

Jhpiego and the Federation of Obstetric and Gynaecological Societies of India

Pathfinder International and World Health Partners

White Ribbon Alliance for Safe Motherhood and Gram Vaani

Senegal

IntraHealth International

Uganda

Association of Obstetricians and Gynaecologists of Uganda

HealthPartners Uganda

Population Services International and PACE

Save for Health Uganda

Transaid

UnIted StateS

American Congress of Obstetricians and Gynecologists — District II

Association of Maternal and Child Health Programs

Association of Women’s Health, Obstetric and neonatal nurses

California Maternal quality Care Collaborative

Camden Coalition of Healthcare Providers

Fund for Public Health in new york

Maternal Health Task Force

Maternity Care Coalition

northern Manhattan Perinatal Partnership

ZambIa

Africare and the University of Michigan

Boston University and Zambia Center for Applied Health Research and Development

global gIvIng

Al-Hayat Chaînes de Vie (Morocco)

British Pregnancy Advisory Service (U.K.)

Centre de Coopération Internationale en Santé et Développment (Haiti)

Comunità di Sant’Egidio ACAP OnLUS (Mozambique)

Concern Worldwide USA (Malawi)

Doctors with Africa Cuamm (Ethiopia)

Ethno-Medizinisches Zentrum e.V. (Germany)

Health[e] Foundation (Rwanda)

InMED Partnerships for Children (Jamaica)

Jhpiego (Myanmar)

John Snow Inc. (Ukraine)

Lebanon Family Planning Association for Development and Family Empowerment (Lebanon)

Maternity Foundation (Ethiopia)

Medics Without Vacation (Democratic Republic of Congo)

mothers2mothers (Malawi)


Organización Para Ayuda Entre Los Pueblos (Democratic Republic of Congo)

Pan American Development Foundation (Argentina, Colombia, Mexico)

Pathfinder International (nigeria, Peru)

Project HOPE (Indonesia)

Sinergias (Colombia)

Sociedad Mexicana de Salud Pública (Mexico)

Swiss Tropical Public Health Institute (Tanzania)

Turkish Family Health and Planning Foundation (Turkey)

UMATI (Tanzania)

Universidad Central de Venezuela (Venezuela)

U.S. Fund for UnICEF (South Africa)

Väestöliitto, The Family Federation of Finland (Finland)

World Lung Foundation (Tanzania)

Zuellig Family Foundation (Philippines)

SavIng motherS, gIvIng lIfe

American College of Obstetricians and Gynecologists

Every Mother Counts

Government of norway

Peace Corps

President’s Emergency Plan for AIDS Relief

Project C.U.R.E.

U.S. Agency for International Development

U.S. Centers for Disease Control and Prevention

U.S. Department of Defense

U.S. Department of State

other PartnerS

• Bill & Melinda Gates Foundation

• Columbia University Mailman School of Public Health

• The ELMA Foundation

• Family Care International

• Ferring Pharmaceuticals

• London School of Hygiene & Tropical Medicine

• M4ID

• Population Council

• Vecna Cares

• United Nations Foundation

• Wellframe

• Women Deliver

• World Health Organization

reSearch granteeS

• Gynuity Health Projects

• Maternova

• Rice University



Health providers are not always equipped with the skills, tools and technologies to deliver high-quality maternal healthcare

ENSURING EVIDENCE- BASED CARE AT U.S. HOSPITALS

After rapid declines in maternal deaths, the rate of maternal mortality in the U.S. has more than doubled in the past 25 years. An estimated 60,000 women nearly die from pregnancy- and childbirth-related causes each year.

We forged a partnership with leading doctors, nurses and quality improvement associations to accelerate the development of nationally-endorsed, evidence-based practices to treat the three leading causes of maternal death in the U.S.: excessive bleeding, high blood pressure and blood clots.

Following the rapid progress in five states, the U.S. government is supporting quality improvement efforts in eight additional states.

CHALLENGE

60,000

PROGRESS IN THE U.S.

THE MATERnAL MORTALITy RATIO HAS MORE THAn DOUBLED SInCE 1990, EVEn AS

DEATHS GLOBALLy HAVE DECLINED By 45%

THE U.S.’ GLOBAL RAnK BASED On

MATERnAL MORTALITy RATIO — BEHInD

nEARLy EVERy OTHER DEVELOPED nATIOn

64th2XTHE APPROXIMATE

nUMBER OF WOMEn WHO nEARLy DIE

DURInG PREGnAnCy OR CHILDBIRTH EVERy

yEAR In THE U.S.

8 STATES that will be participating in government-supported

expansion of quality improvement efforts

300+ HOSPITALS with improved quality of

obstetric care in five states

1 MILLION WOMEN with access to improved quality obstetric care — one quarter of all women who give birth annually


hospitals and clinics strengthened

health workers trained

deliveries in strengthened health facilities

women with improved access to quality care

750+

4,700+

167,000+

246,500+

• Expandedasuccessfulmaternitysocialfranchise network to Rajasthan

• Helpedprivatematernityprovidersmeetstreamlined quality standards for labor and delivery services and advocated for their inclusion in national accreditation guidelines

• Broughtcareclosertowomeninremoteareas by enlisting private community health workers, introducing telemedicine and leveraging private distribution channels to deliver supplies at the “last mile”

Working in Jharkhand, Rajasthan

and Uttar Pradesh

PROGRESS IN INDIA

In low-and-middle-income countries, about 40% of women receive antenatal care, delivery services and family planning from private health providers.

We are committed to saving more lives by ensuring quality care wherever a woman seeks care.

Strengthening local, private maternal healthcare

We are developing a new

digital tool to guide clinical

decisions in real time, giving

health providers immediate

support to manage labor

and delivery care. The tool

will capture data on the care

health providers offer, allowing

clinicians and managers to

use automated data to inform

quality improvements efforts

at facility, district and

national levels.

data are crItIcal to

ImProvIng QUalItY

44%Private

Antenatal Care

40%Private

Delivery Services

37%Private

Family Planning


hospitals and clinics strengthened

health workers trained

deliveries in strengthened health facilities

women with improved access to quality care

140+

700+

22,400+

114,000+

• Expandedandintroducedmaternalhealth services into a social franchise network of private providers

• Helpedprivatematernityprovidersoffer quality-assured emergency obstetric care and provided business management training

• Expandedasocialfranchisenetworktourban areas in Kampala to help decongest overcrowded public hospitals

PROGRESS IN UGANDA

Working in 42 districts —

more than a third of the country

bUIldIng PrIvate mIdwIveS’ caPacItY

to Serve more women

In 2009, Jane joined PACE’s ProFam network, a franchise of local clinics, to expand her business and serve more women. At the time, she only had a one-room clinic, but she knew she wanted more.

Before I joined ProFam and the MSD for Ugandan Mothers (MUM) program, I wasn’t as busy as I am now. It’s that simple. They have provided training in how to help me make my services more affordable so they can be available to more women.”

With help from ProFam and the MUM program, she’s doing just that.

Jane has been trained on the management of obstetric emergencies, family planning services, cancer screening and infection prevention as well as business

management, enabling Jane to continue to expand her services to meet the needs of women in her community.

Now, Jane’s clinic serves about 30 women a day and delivers about 25 newborns a month.

Why do so many women attend her clinic? Jane says her clinic provides “a lot of love.”

Photo credit:Julius Caeser Kasujja

“ People call me Mama ProFam. Because of ProFam and the MUM program’s trainings, I’m more confident in everything I do.”

“

Photo credit: IntraHealth International 10 / MERCK FOR MOTHERS PROGRAM REPORT / OCTOBER 2015


PROGRESS IN SENEGAL

Eliminating stock outs of modern contraceptives

Even the most capable health provider may not be able to save a woman’s life if essential products are not availableCHALLENGE

In July 2015, the first patient enrolled in a clinical trial to evaluate the effectiveness of heat-stable carbetocin, a reformulated medicine to prevent excessive bleeding after childbirth. Unlike the current standard treatment, heat-stable carbetocin is designed to be stable at room temperature, even in hot climates where most maternal deaths occur.

If the results of the study are positive, we will work together with our partners with the aim of making the medicine available in developing countries that have a high burden of maternal mortality at an affordable and sustainable public-sector price.

ADVANCING A LIFESAVING MEDICINE

• Adaptedprinciplesusedinthe commercial sector to develop an innovative supply chain model

• Completedcostinganalysistoidentifyoptions for expanding the model nationally

• ExpandedtheInformedPushModeltopublic health facilities nationwide

Working in all

14 regions of the country

Photo credit: IntraHealth International

“ A few years ago, supplies of contraceptive products were chronically running short,” describes Dr. Bocar Mamadou Daff, Director of the Reproductive Health and Child Survival Unit at the Senegalese Ministry of Health. “Women were being turned away empty handed. I heard that women were rowing canoes across the Doué River to buy contraceptives on the other side because the shelves at their health post were empty.”

The Informed Push Model turns the contraceptive order and delivery process upside down. The project

shifts responsibility for forecasting, ordering and delivering supplies from overworked health providers to skilled private suppliers.

As Mr. Ndiaye, Head Nurse at Tiaba Niassène health post, enthusiastically

described, “We must have everything on the Push. If it weren’t for the Push, I would have to close my post today to go collect medicines. [Now] I stay at the post and the medicines come to me.”

PRIVATE SECTOR MODEL TRANSFORMS

SUPPLY CHAIN FOR FAMILY PLANNING

decline in stock out rate of contraceptives since 2011

increase in contraceptive prevalence rate since 2011

public health facilities benefitting from the model

women with improved access to modern contraception

80% 2%

8% POINTS

1,300+

3.2 MILLION



USING MOBILE PHONES TO EMPOwER wOMEN TO BE INFORMED HEALTH CONSUMERS

Women are not always armed with the tools and knowledge to be stewards of their own health

CHALLENGE

Photo credit: White Ribbon Alliance India

We’re developing three phone-based tools to help pregnant and postpartum women receive the care they need, when they need it.

Rating care

A voice-based platform will help women learn about the maternal healthcare they deserve and rate the services they receive.

Learning about family planning options

Individuals seeking family planning services will be able to call a free hotline to learn about different options, identify the best ones, receive a referral to a nearby health facility and later rate the quality of care received.

Monitoring health after childbirth

A postpartum app will help women in the U.S. and the U.K. know what to expect during the postpartum period (when 60% of maternal deaths occur), identify warning signs and maintain good health after childbirth.

1

2

3

In Zambia, many women live miles from the closest health facility with few, if any, affordable and safe transportation options.

We are supporting new, community-managed models of maternity homes — residences near health facilities where pregnant women who live in remote areas can stay until the late stages of their pregnancy and immediately after childbirth. And we’re exploring creative, entrepreneurial ways to make these homes sustainable.

PIONEERING COMMUNITy-BASED PROGRAMS RESPONSIVE TO wOMEN’S NEEDS



Camden, NJ

Philadelphia, PA

New York, NY

commUnItY health workerS offer a lIfelIne

for Pregnant women In PhIladelPhIa

When Jackie met Sharice, Sharice was pregnant, homeless, jobless and recently diagnosed with diabetes.

Sharice was completely overwhelmed by the fragmented system,” says Jackie Torres, a community health worker at Maternity Care Coalition (MCC) in Philadelphia. “She kept asking me, ‘How am I supposed to take care of my baby, when I can’t meet my own needs?’”

Increasingly, women in the U.S. are entering pregnancy with a more complex set of needs and there are huge disparities in maternal health outcomes across race. Thanks to MCC’s Safe Start MOMobile program, Sharice and many other women are getting the support and care they need.

Jackie became a trusted source and critical link to existing resources, helping Sharice secure a place to live, find healthy food and better communicate with her health providers.

In the U.S., some of the areas hardest hit by maternal mortality are low-income communities where chronic diseases like obesity, high blood pressure and diabetes are on the rise. Our partners are developing new models of care involving community

health workers specially trained to help pregnant women with complex health problems have a healthy pregnancy and safe childbirth — and maintain lifelong good health.

“ Sharice recently said to me, ‘Before I met you, I didn’t have a plan. Now I have goals for my life,’” says Jackie. “To see this woman who faced such extreme challenges making these huge strides is incredible.”

“


EvERY DAY, MERck EMPLOYEES PROvIDE THEIR bUSINESS AND ScIENTIFIc EXPERTISE TO AMPLIFY OUR IMPAcT

LEvERAGING THE BEST OF MERCK TO SAvE WOMEN’S LIvES

cOLLAbORATING WITH GLObAL cOLLEAGUES TO RESPOND TO LOcAL NEEDS

In countries as diverse as

Ethiopia, Indonesia, Mexico and

Tanzania, we are supporting

programs to train health

providers in maternal care

services, link pregnant women

to care and raise awareness of

safe motherhood.

“ The Merck Fellows brought a business mindset to our challenge of delivering health services — and now we have a better plan to sustain our work for the long term.”

HANNA BALDWIN, CHIEF OF PARTy, MSD for UganDan MotherS

35,000+HOURS COnTRIBUTEDEXPERT ADVISORS PROVIDInG

TECHnICAL SUPPORT TO STREnGTHEn PROGRAMS

50+40GLOBAL HEALTH FELLOWS WORKInG DIRECTLy WITH

PARTnERS On THREE-MOnTH ASSIGnMEnTS In THE FIELD

“ During my fellowship, I worked with the White Ribbon Alliance, a Merck for Mothers-supported nGO in India.

The initiative focused on raising the “voice of the voiceless” and leveraging market efficiency to lower preventable maternal mortality in India. The immersive learning experience over 90 days helped me uncover latent skills, appreciate organizational complexity and energized me to

become an alliance builder and a change catalyst. I have learned to listen, seek first to understand and

collaborate effectively across functions and cultures.”

SIVA MURTHY, DIRECTOR, U.S. PAyER MARKETInG OnCOLOGy

30 PROJECTS

24 COUNTRIES


“ Working with Merck for Mothers is one of the most engaging assignments I’ve had at Merck. We are able to implement innovative and disruptive solutions which will make a real difference in the world.”

MICHELLE MOSOLGO, EXECUTIVE DIRECTOR, InFORMATIOn TECHnOLOGy

“ From my years of experience in hepatitis, I’ve seen the valuable role that community health workers can play to improve access to lifesaving care. It’s been a privilege to share my experiences with Merck for Mothers as we explore new ways of helping pregnant women with chronic disease receive the care they need for good long-term health.”

EIRUM CHAUDHRI, EXECUTIVE DIRECTOR, SCIEnTIFIC AFFAIRS

“ I greatly appreciate the opportunity to share the tools we use to evaluate real world evidence. By demonstrating the value of an innovative supply chain model that eliminates stockouts of contraceptives from an economic perspective, our team could provide further insight to the government’s decision to expand access to family planning across Senegal.”

ERIk DASBACH, EXECUTIVE DIRECTOR, OUTCOMES RESEARCH

TOGETHER, WE CAN HELP END PREvENTABLE MATERNAL DEATHS

We are honored to play a role

in global efforts to achieve

the Sustainable Development

Goals. Through our ongoing

commitments to address

important health challenges,

including maternal health,

HIV/AIDS, cervical cancer and

neglected tropical diseases,

we are mobilizing the best of

Merck to help save and improve

lives around the world.

kenneth Frazier, Merck Chairman and CEO

For the latest updates on our programs and progress, visit MerckforMothers.com. You can also join the #EndMaternalMortality conversation by following @MerckforMothers on Twitter and Facebook.

Documents

2015 MERCK FOR MOTHERS PROGRAM REPORTMERCK FOR MOTHERS PROGRAM REPORT / OCTOBER 2015 / 3 Merck for Mothers is proud to be a founding partner of Saving Mothers, Giving Life (SMGL),