Scaling up the Interagency Strategy for the Reduction of Maternal and Neonatal Mortality in Vulnerable Communities to support national health priorities in Colombia

In 2015, the Ministry of Health of Colombia, local governments and indigenous leaders in collaboration with UNFPA, WFP and UNICEF,  launched the Interagency Strategy for the Reduction of Maternal and Neonatal Mortality in Vulnerable Communities.

The SDG3 GAP supports such collaborations by providing a platform and relevant tools to enable multilateral agencies to work more closely together with the aim of increasing efficiencies by aligning support to national priorities and plans. The collaboration benefits from each individual agency’s technical expertise and resources and reduces costs through joint activities.

While Colombia has made progress in reducing maternal and neonatal mortality, the death toll across indigenous communities is five times higher than the national average. Access to health care is hampered by social and cultural factors as well as geographical barriers. The Interagency Strategy supports the health system in northern Colombia by providing additional tools and training to health workers to ensure that the rights, cultural beliefs and customs of indigenous women are respected in public hospitals.

Yasmin Epieyú, a Wayuu traditional birth attendant from Uribia

Yasmin Epieyú, a Wayuu traditional birth attendant explains that 'it is not easy for us [Wayaúu women] to head to a hospital and to feel another person is watching us.'

'It’s been a tough job to bring together the Wayaúu’s indigenous mothers to a hospital which is far from their home place where they live together' confirms Eilin Karina Orozco, Assistant Coordinator, Maternity Unit, Talapüi Hospital Uribia. She further explains that 'The more we adopt the environment to theirs, the higher will be the access to medical assistance and therefore the reduction of maternal deaths and both neonatal and perinatal deaths.'

Dr. Gerardo García, Obstetrician and Gynocologist, Talapui Hospital Uribia, reflects: ‘We used to attend childbirths but we didn’t realize the importance of vertical birthing position.’ He explains that they now provide the option for women to give birth vertically in the company of traditional birth attendant from their own communities similar to how they give birth in their homes.  The multidisciplinary team also includes bilingual social workers who provide translation services to ensure that expectant women feel comfortable.

Zaida Epieyú, who currently lives in Uribia, Colombia’s indigenous capital in the North of the country, is a beneficiary of the strategy and is choosing to give birth at Hospital Nuestra Señora del Perpetuo Socorro.

Zaida Epieyú receiving antenatal care at Talapiü Hospital in Uribia

'I would like to give birth here in [Sorocco] hospital because I feel well here and I receive quick assistance,' says Zaida. See Zaida’s story.

Since the Interagency Strategy for the Reduction of Maternal and Neonatal Mortality in Vulnerable Communities was launched in 2015, the maternal mortality ratio (MMR) in Colombia has dropped from 355 cases in 2015, equivalent to an MMR of 53.7 deaths per 100,000 live births, to 224 cases with an MMR of 37 in the year 2023 (preliminary data published by the National Institute of Health 2023). This shows a 31% reduction in the number of maternal deaths entered into the National Public Health Surveillance and Vital Statistics System. The data also shows a significant reduction in the maternal mortality gap in the Indigenous population, going from a ratio of 288 to 104 per 100,000 births between 2015 and 2023.

Enhancing country ownership and supporting national priorities for greater impact: SDG3 GAP’s Improvement Cycle on Health

To ensure that SDG3 GAP support continues to be aligned with country-led priorities and approaches, the SDG3 GAP has established a monitoring framework which allows for Governments to assess the support of development partners and also provides a platform for Governments to make recommendations. Response by agencies to the feedback from Governments, including catalytic funding to further improve collaboration and documentation thereof for peer-to-peer learning, enable a continuous improvement cycle on health.

Following feedback provided by the Colombian Government in 2022 and due to significant successes in the initial years of implementation of the Interagency Strategy(see related case study from 2021 here), the collaboration among the UN agencies and the Colombian government was scaled up to include interventions aiming to tackle gender-based violence (GBV), malnutrition as well as road safety issues hence extending the coordination mechanism to help accelerate additional SDG targets (2.2, 3.1, 3.2, 3.6, 5.2) in line with the country’s health priorities and national strategies.

Among the feedback form the Colombian government was the recommendation to continue fostering collaborative work and to include the views of beneficiaries during the planning of interventions. Catalytic funds from the SDG3 GAP were thus used to strengthen the coordination and collaborative work between the UN agencies, civil society and local governments. The funding further supported capacity building of national and local authorities, health care providers and community leaders to improve maternal, neonatal and child health, nutritional health, GBV services and road safety measures. Community-based organisations and civil society were included in the planning of the interventions through a participative approach. 

For example, through a participative approach with community members, normalized phenomena related to harmful practices in women, girls and adolescents were identified which in turn enabled the development of practical tools for dignified and humanized care for populations that suffer or have suffered gender violence.

Gender violence has been an invisible phenomenon, affecting hundreds of women, girls and adolescents within indigenous communities in Colombia. Cases of gender violence continue to cause concern in the country: in 2023, 158,394 cases were reported, with women, adolescents and girls making up 80% of the victims. In indigenous communities, more than 4,332 cases were reported for 2023. In addition to physical, psychological and sexual violence, there are also the issues of child marriages and early unions, as well as female genital mutilation.

To address the challenges, the Interagency Strategy strengthened the capacities of health professionals with a training of trainers model on comprehensive, humanized and dignified response to GBV using the tools that were developed through the participative approach. The collaboration also enhanced institutional and community capacities in order to provide a comprehensive response to the phenomenon of violence. 

The United Nations Population Fund (UNFPA) emphasizes interagency collaboration in Colombia's prioritized areas as a vital strategy for advancing sexual and reproductive health among indigenous communities. This collaboration has strengthened advocacy with national and local health authorities, integrated indigenous perspectives into policies, improved intercultural adaptations of maternal health services, enhanced health professional capacities in SRH, and provided intercultural training for traditional birth attendants. These concerted efforts lead to the creation of inclusive, culturally sensitive, and effective SRH services, which are critical in reducing maternal morbidity and mortality among indigenous communities. Additionally, they help bridge the gap in guaranteeing sexual and reproductive rights and contribute to Colombia's progress towards achieving ZERO preventable maternal deaths.

What is the SDG3 GAP?

The Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development and humanitarian responses to help countries accelerate progress on the health-related SDG targets.  The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies.