Sitting here in Delhi at the Global Maternal Health Conference in the India Habitat Center, I feel proud to be Indian. Yes, in part it is that the conference is well-run, and the speakers are thoughtful and thought-provoking, but also it is the fact that India is among the countries showing steady decline in the numbers of deaths related to pregnancy. In fact, the latest The Lancet numbers suggest we may be achieving as many as 4% fewer deaths every year in India.

These numbers reflect years of work and commitment on the part of many groups, including the Indian government. At the conference’s opening session, a number of government representatives spoke, including Dr. Montek Singh Ahulwalia, the deputy chairman of the planning commission. He pointed out that in 2004, India spent less than 1% of its GDP on public health; today that number is 1.2%. In the next five years, the government plans to increase spending on health to 3% of the GDP. In terms of the government’s focus on saving women’s lives, Minister of Health and Family Welfare Ghulam Nabi Azad said, “Finding the solution is not the challenge; the challenge is in implementing the solution.” Azad shared the government’s strategy of prioritizing districts that are in particular need of intervention and funneling additional human resources into the health system to strengthen the country’s ability to deliver health services. Even as we scale-up our funding and focus on public health and maternal health, Dr. Gita Sen, professor at the Indian Institute of Management in Bangalore, urged the global community to look beyond its focus on lowering maternal mortality rates to actually measuring women’s health outcomes in a variety of ways that account for the social, economic, and human development context.

A number of experts from other countries spoke as well, including:

• Rafael Lozano of the Institute for Health Metrics and Evaluation who recognized the global progress in stopping maternal deaths but encouraged the audience to continue to press ahead in communities where progress is still slow.  
• Lale Say from the World Health Organization talked about the 30 countries with highest numbers of maternal deaths; these countries also have poor maternal death tracking systems. She reinforced the importance of comprehensive birth and death registration, which enables us to truly understand the state of maternal health and death in these countries.
• Wendy Gordon from Immpact, the Initiative for Maternal Mortality Program Assessment at the University of Aberdeen, demanded that we do more to discuss and analyze our failures as a global health community, insisting that there are more lessons in failures, which often are not shared, than in successes.
• Saroj Pachauri from the Population Council stressed the need to prepare for the new numbers on maternal mortality that the United Nations will release, which may differ from The Lancet estimates released earlier this year, and how the global health community will reconcile and explain these differences.

I had the pleasure to present several IntraHealth-led experiences, along with my colleagues Madhuri Narayanan, Fatou Ndiaye, and Sara Stratton:

• In Uganda, expansion of human resources for health, especially in the nursing field
• In India and Uganda, alternative supervision approaches to compensate for a shortage of people in supervisory positions
• In Rwanda and Mali, strengthened pre-service education
• In Senegal, integration of indicators on use of active management of third stage labor in the national level tracking of health performance.

Toward the end of the day, I was thrilled to hear about work similar to IntraHealth’s in Nepal, India, and Tajikistan on creating call centers and working with communities to provide emergency transport to women with childbirth complications and providing women with cash incentives to make maternal health services more accessible and encourage their use.

It has been a motivating week so far, and I look forward to sharing more of the development from Delhi soon.