Innovations in Supporting Local Health Systems for Global Women’s Health docx

Innovations in Supporting
Local Health Systems
for Global Women’s Health
Summary Report of the Wye River, MD Conference
Hosted b
y
R
ealizing Rights:
The Ethical Globalization Initiative
Council of Women World Leaders
Columbia Univ
ersit
y Mailman Sc
hool of P
ublic Health
Innovations in Supporting
Local Health Systems
for Global Women’s Health

SPONSORS
Realizing Rights: The Ethical Globalization Initiative (EGI) is a project
led by former P
resident of Ireland and United Nations High Commissioner
for Human Rights Mary Robinson, and is a partnership of the Aspen
Institute, Columbia University, and the International Council on Human
Rights Policy. EGI’s mission is to mobilize and influence political, economic
and civil society leaders in order to tackle global inequities by connecting
human security, human development and human rights.
The Council of Women World Leaders is a network of current and former
prime ministers, presidents and cabinet ministers whose mission is to mobilize
the highest–level women leaders globally for collective action on issues of

critical importance to women and equitable development. Through its networks,
summits, and partnerships, the Council promotes good governance and gen-
der equality, and enhances the experience of democracy globally by increasing
the number, effectiveness, and visibility of women who lead their countries.
Columbia University Mailman School of Public Health is the only accredited
school of public health in New York City and is among the first in the nation.
Its students and multidisciplinary faculty members engage in research, both
locally and globally, concentrating on biostatistics, environmental health sci-
ences, epidemiology, health policy and management, population and family
health, and sociomedical sciences. In the field of global health, the Mailman
School has played a leadership role in improving delivery of health services
through such programs as its Averting Maternal Death and Disability
( AMDD) program, its MTCT–Plus Initiative and other AIDS programs,
and through its involvement in the UN Millennium Project Task Forces on
child health and maternal health, HIV/AIDS, and malaria.
PHOT O CREDITS
Front cover
© Jeremy Hartley/Panos
Opposite page
© 20
02
WH
O/P. Virot
Page 4
© 20
02 WHO/P. Virot
Page 5 (top left)
© 2003 Julia Griner/CARE
Page 5 (bottom left) © 2003 Otto Guzman, Courtesy of Photoshare
Page 8 (bottom)

© 2001 Josh Estey/CARE
Page 10
© 2004 Karen Robinson/Panos
Page 13
© 2000 Kim Conger/CARE
Page 14 (left) © 2001 Josh Estey/CARE
Page 15 (right) © 2002 WHO/P. Virot
Page 16 (top) © Jeremy Horner/Panos
Page 18 (top) © 2002 WHO/P. Virot
Page 19 (left) © 1999 Martin Adler/Panos
Page 19 (right) © 2004 Jasmine, Courtesy of Photoshare
Photoshare images used in this material are for illustrative use.

On June 5–7, 2005, sixty leaders from around the world gather
ed at Wye
River, Maryland for a path breaking meeting entitled
“Innovations in Supporting
Local Health Systems for Global Women’s Health: A Leader’s Symposium.”
This diverse
group of participants, ranging from cabinet ministers to advocates, academics
to local practitioners, shared a common goal: to shine a bright spotlight on
urgent challenges in global women’s health and the critical need to pioneer
innovations in strengthening local health systems to address those challenges.
The diverse group focused on learning from one another and identifying
areas for further action with a particular focus on the role that political lead-
ers can play in creating positive change. Clear themes emerged and the ener-
gy and momentum generated in the meeting culminated in the
Wye River Call
to Action for Global Women’s Health

developed by the participants and subse-
quently endorsed by leaders the world over.
Co–hosted by Realizing Rights: The Ethical Globalization Initiative, the
Council of Women World Leaders, and the Columbia University Mailman
School of Public Health, the meeting addressed the most fundamental chal-
lenges facing women’s health. Participants shared their experiences of what
policies have proven successful in providing access to health care, and com-
mitted themselves to develop and promote leadership in implementing health
care policies that effectively provide fundamental services to women. They
discussed creative efforts to promote, manage, support and monitor local
health care systems in poor countries, with a particular focus on provision
of care to reduce maternal mortality and HIV/AIDS, and on reproductive
health services and rights.
This report extracts the key cross–cutting themes arising from the meeting’s
stimulating pr
esentations and rich discussions which together provided
the rationale for the
Wye River Call to Action. It draws out of the meeting
best practice examples and innovative and creative next steps that can be
tak
en. F
inally the report profiles a number of meeting participants, high-
lighting the important work for women’s health that is being carried
out today in every region of the world.
The Meeting
“This conference is
extraordinary because it
affirms what does work,
what can be done, and
now we just have to get

the right people to do it.”
— Marian Wright Edelman
President and Founder
Children’s Defense Fund
It is the hope of the sponsoring organizations that the meeting dialogue,
the
Wye River Call to Action for Global W
omen’s Health
, and the
examples of good practice provided in this report will support all levels of
leadership to recognize women’s basic right to health and the central role
of ensuring strong local health systems in fulfilling these rights. To add your
name or that of your institution to the Wye River Call to Action, please go
to www.realizingrights.org or send an email to peggy.clark
@
aspeninst.org
ACKNOWLEDGEMENTS
The conference organizers are deeply grateful to the following foundations
for their generous support of
“Innovations in Supporting Local Health Systems for
Global Women’s Health: A Leader’s Symposium.”
n
The Bill & Melinda Gates Foundation
n
The UN Foundation
n
The Rock
efeller Foundation
n
The David and Lucille P

ackar
d Foundation
This report was prepared by Helen de Pinho, Elizabeth Keller and
Gr
eg Behrman.
“Scaling up — ensuring
that health care is accessible
to and used by all those
who need it — also means
tackling the social, economic
and political context in
which people live and in
which health institutions
are embedded.”
— Lynn Freedman, et al, Who’s Got the Power?
Transforming Health Systems for Women and Children,
UN Millennium Project, Task Force Report
on Child Health and Maternal Health, 2005
We have the power to explore the planets and walk the moon. We have
the power to coax green from the deserts. We have the power to map
the human genome.
Yet in the year 2005, in millions of communities in every corner of the globe,
people are suffering because those with political power have failed to meet
their most basic responsibilities. That failure is seen in the crisis of local health
systems that do not work, that exclude the poor, abuse and marginalize women,
sow distrust and feed corruption. The result is societies marked by profound
insecurity, by deep and growing inequities, and by the unacceptable toll on
the health and well–being of girls and women.
Every minute of every day:
n

5 more women join the 20 million women currently living
with HIV/AIDS;
n
190 women conceive an unwanted or unplanned pregnancy;
n
One woman dies while giving birth; and
n
Countless women and girls suffer the health consequences of
malnutrition, chronic and communicable diseases that
disproportionately affect women, gender–based violence,
harmful traditional practices, and war and civil conflict.
As political and civil society leaders, we come together to express our outrage
at this carnage and to solidify our commitment to work together for change.
We call for a profound shift in the priorities that shape policies and
resource allocations globally, nationally and locally.
We call for universal access to health care:
n
Universal coverage of critical health interventions for women
and girls r
equir
es strong health systems that ensur
e access, equity,
and financial protection.
n
Health systems ar
e more than delivery systems for technical
interventions. They are core social institutions that lie at the heart
of the poverty r
eduction
agenda. They ar

e fundamental building
blocks of secure and democratic societies.
W
e call for systemic changes to build strong health systems:
n
F
unding of health systems must be incr
eased through pr
edictable,
sustained and long–term investments, nationally and globally.
n
User fees for primary health care must be abolished, financial barriers
to access eliminated, and systems to ensure financial protection implemented.
The Wye River Call to Action for
Global Women’s Health
June 7th 2005
n
Countries, rich and poor, must confront urgently the crisis of
human resources: increase training, ensure that mid–level cadres
of health workers are expanded and empowered, provide adequate
and fair compensation for all health workers, and take measures to
stem the exodus of scarce health workers from the public sector.
n
Countries must adopt and implement laws, regulations and policies
to strengthen health systems, improve women’s health, and establish
tolerance and respect for women’s decisions in all matters pertaining
to their health and well being.
n
HIV programs and policies must be oriented to the strengthening
of health systems and to the uncompromising protection of the health

and rights of women and girls.
We call for these priorities to be reflected in poverty reduction and
development strategies:
n
Political leaders must recognize the critical importance of women’s
health and empowerment, and of health systems to achieving the
Millennium Development Goals (MDGs), and
n
Countries must endorse the ICPD (International Conference on
Population and Development) target of universal access to
reproductive health by 2015 as an additional target to MDG 5.
These commitments are not optional.
Women have a human right to health and to access to health care.
Women are vital to the future development of their countries — as workers,
as car
egivers for their families, as stewar
ds of the environment, as technological
innovators, and as political leaders at all levels.
W
omen ar
e citizens with the right and responsibility to participate meaningfully
in the decisions that affect their lives and to demand accountability from the
people and institutions that have the duty to fulfill these rights.
W
omen ar
e entitled to no less.
Let us work for no less.
Madeleine K. Albright
Chair
Ministerial Initiativ

e of
the Council of Women
W
orld L
eaders
Mary Robinson
P
resident
R
ealizing Rights:
The Ethical
Globalization Initiativ
e
Allan Rosenfield
Dean
Columbia Univ
ersit
y
Mailman School of
P
ublic Health
05
We Call for Universal Access
to Health Care
Dr
.
P
ascoal Mocumbi
WHO Goodwill Ambassador for the
Commission on Social Determinants

for Health
High Representative, European & Developing
Countries Clinical T
rials
F
ormer P
rime Minister of Mozambique
As far back as he can remember, Pascoal
Mocumbi dreamed of being a physician.
Gro
wing up in then–colonial Mozambique,
Dr. Mocumbi could not have imagined
where his childhood yearning would
t
ak
e him.
After completing his medical training
and residency in Switzerland, Dr.
Mocumbi ret
urned to Mozambique in
1975, the year his native country would
finally achieve independence. The colo-
nial e
xperience would leave a legacy of
We Call for Universal Access
to Health Care
n
Universal coverage of critical health interventions for women and
girls requires strong health systems that ensure access, equity, and
financial protection.

n
Health systems are more than delivery systems for technical
interventions. They are core social institutions that lie at the heart
of the poverty reduction agenda. They are fundamental building
blocks of secure and democratic societies.
Wye River Call to Action for Global Women’s Health
In much of the developing world, health systems at the local level are
fundamentally failing to sustain and improve the lives of women.
In many
cases women are the last to receive adequate health care and are dying because
of it. Women are dying because they do not have access to emergency obstetric
care when they require it. Women are at risk because their nation, province
or village has not placed sufficient priority on ensuring that they are protected
from the threat of contracting HIV/AIDS. Women are suffering because they
must bear the burden when anyone in the household is sick, and there is no
doctor, nurse, or caregiver to turn to.
The statistics are well known and staggering. And yet, in many countries the
figures continue to worsen. Each year 500,000–600,000 women die in
pregnancy and childbirth. In some parts of Sub–Saharan Africa, 1 in 6
women die in child birth, while in United States the lifetime risk is as low
as 1 in 8400
1
. HIV/AIDS statistics tell an equally disturbing story of dis-
parity. In parts of Africa, over 35% of the adult population — 1 in 3 adults
— is infected with HIV
2
. The number of women contracting the disease is
also on the rise. For example, in Botswana, twice as many women as men,
ages 25 to 29, are living with AIDS
3

.
We know the interventions that can save most women’s lives. If every
woman had access to essential maternal care, 74% of maternal deaths could
be prevented
4
. If all women had access to self–controlled means of HIV/
AIDS protection and were in a position within society to use these methods,
millions of HIV/AIDS deaths could be prevented. Thus, we do not so much
need new technology, as we need to ensure
universal access, utilization and equity.
But ensuring universal access, utilization and equity means that our health
services cannot continue to function as “business as usual.” Fundamental
change is necessary. We must rethink the link between poverty and health
and understand the essential role that health systems play in society, in
poverty–reduction and in overall development.
Poverty is not just a state of want. Poverty is also fundamentally about
the relationships that people have with structures of power.
Health sys
-
tems are core social institutions that function as one of the most important
and pervasive structures of power in any society. Participatory poverty
assessments conducted in scor
es of countries around the world demonstr
ate
over and over again that neglect, abuse and exclusion by the health system
dislocation with profound repercussions
for the health of Mozambique’s state and
its people.
When Dr. Mocumbi returned, he
found all the Portuguese leaving the

country and only ten fully trained and
qualified local physicians for a nation
whose population numbered almost 10
million people. In 1
980, he was named
Minister of Health. In 1987, he was
appointed Foreign Minister and spent his
tenure trying to end a gruesome civil war.
He achieved peace in 1992 and, two
years later, Dr. Pascoal Mocumbi became
the Prime Minister of Mozambique.
P
eace allo
wed Dr. Mocumbi to usher
in a period of economic expansion, but it
also opened up Mozambique’s borders
and transport
ation cor
ridors, unobstructed
arteries in which HIV/AIDS would flourish.
In 1994, Mozambique’s adult infection
rate w
as 5 percent. Dr. Mocumbi esti-
mates that today it is 13.5 percent and
still on an upward trajectory. Together
with Malaria and
TB, HIV/AIDS is one of
the three communicable diseases that he
points to as Mozambique’s single great-
est health challenge. These three dis-

eases are increasing maternal mort
alit
y
and child mortality rates, and the burden
on women as primary caregivers is
becoming almost unimaginable.
During his tenure as Prime Minister,
Dr. Mocumbi gleaned a critical insight:
health is element
al to development. There
could be no economic advancement
Continues on page 09
“Access to health must be
regarded as a right and not
as charity.”
— Asa Cristina Laurell
Secretary of Health,
Mexico City Government, Mexico
07
has come to be part of the very experience of what it is to be poor in much
of the world today. Conversely, the ability to assert a right to health and to
health care and to have those rights fulfilled through access to a functioning,
responsive health system is an asset of citizenship
5,6
. Thus health systems are
fundamental building blocks of secure and democratic societies.
Conventional approaches to health in poor countries focus on disease–specific
interventions and their cost effectiveness, implemented via the path of least
resistance with a strong emphasis on short term results. The upshot is that sys-
temic problems which underlie poor health, failing health systems, and health

inequity are circumvented. Long–term, sustainable strategies are rarely devel-
oped or deployed. The crisis may change its spots, expressing itself in different
diseases, populations or geographic areas, but it essentially continues unabated.
The most fundamental challenge is to sustain the political pressure and
leadership required over the long term to strengthen and restore health
systems — health systems that will not only deliver technical interventions
effectively and equitably, but also promote democratic development and
poverty–reduction, and fulfill human rights. This means recognizing that:
n
Health and health systems are profoundly political. Poor health is
not a random event — it follows the fault lines of disadvantage in
access to power and resources in society
7, 8
.
n
The right to health is a fundamental value and an international
legal obligation that should shape the way decisions are taken and
policies developed. Over 70% of all nations have ratified the
International Covenant on Economic, Social and Cultural Rights
obligating governments to progressively realize the right to health.
n
The problem is global. It implicates not only issues of development
aid, but also global structural problems such as “brain drain,”
indebtedness, and intellectual property regimes.
n
Disease–specific programs are critical but do not work without
local–level problem solving, implementation, and attention to
sustainability. Conditions must be cr
eated to mak
e local–level

decision making and problem solving functional and legitimate.
Local political leaders must have and use tools of accountability
to ensur
e that local systems work for all.
There are no excuses — we need to assert broad vision, be bold and
take action.
08
Continued fr
om page 07
when those needed to work, to raise
f
amilies, to educate, to pass on v
alues
w
ere dying or sick in such large numbers.
Upon voluntarily leaving his seat of power
in February 2004, Dr. Mocumbi became
High Representative of the European
& Developing Countries Clinical Trials
Partnership Secret
ariat, a ne
w partnership
between Europe and Africa to advance
health in Africa.
W
ith international funding
, Dr
.
Mocumbi has already seen national lead
-

ership in pockets of Africa come together
to refine strategies to impro
v
e health, and
with local ingenuit
y
, he a
vers, much more
is possible. For example, an effort to train
non–ph
y
sicians to deliv
er care has the
potential, Dr
. Mocumbi belie
ves, to help
plug a gaping and deleterious hole in
human resources capacit
y
. Nurses with
more than fiv
e y
ears of experience and
medical assistants with more than three
y
ears of e
xperience, with additional train
-
ing
, will be able to dramatically increase

the medical and surgical services offered
to those in need in Mozambique.
It’
s a t
all order
, but with ingenuity,
partnership and adherence to what Dr.
P
ascoal Mocumbi holds a fundament
al
tr
uth — that health is a human right —
millions of lives may be saved.
The government of Mexico City, Mexico
believes that access to health care is a
human right, and should be universal and
free to those who cannot afford to pay.
In Mexico City the mayor has made health
care accessible to all, and has garnered
the broad support of the City’s leaders
and citizens for this unique effort
9
. When
the City’s popular mayor, Andres Manuel
López Obrador, came to power, he faced
two significant challenges to keeping his
campaign promise of free health care to
poorer families. First, the public health
system was fragmented. It covered only
60% of the population and was adminis-

tered b
y the central government. Second,
widespread political corruption had
undermined public services, undermining
public faith in the quality of the public
health system.
Mayor Obrador was able to keep his
campaign promise of removing economic
obstacles to health care and providing
social insurance by embracing the consti-
tutionally–protected right to health and
restructuring the existing, but deteriorat-
ing, health institutions. Mexico City’s
Secretary of Health, Asa Christina Laurell,
attributes much of the program’s success
to the strong political and financial com-
mitment. “You cannot have a rich govern-
ment and poor people,” she explains.
Indeed, financing for this program has
been sustained by cutting superfluous
government spending; all high govern-
ment officials accepted a 15% salary cut
and funding for unnecessary technologies
was slashed. This has created a savings
of $200 million in the first year and $300
million over the next three years. Further,
it has saved the poor — those who can
least afford to pay for medical services —
approximately $200 million.
The results of the program have been

tremendous. People living in Mexico City
now have better access to more expen-
sive services, and the poor, especially
women, have benefited the most from
the program. Importantly, despite the
City’s aging population, the mortality rate
there has decreased by 5% in the last
four years. And as of December 2004,
some 71
0,000 of the 900,000
low–income families that qualify for free
care had registered for the program.
Presented by:
Dr Asa Cristina Laurell
Secretary of Health, Mexico City
Government, Mexico
GOOD
PRACTICE
Ensuring Inclusive and
Equitable Health Services at
a Local Level — The Case
of Mexico City
We Call for
Systematic Changes
We Call for
Systematic Changes
n
Funding of health systems must be increased through predictable,
sustained and long–term investments, nationally and globally.
n

User fees for primary health care must be abolished, financial
barriers to access eliminated, and systems to ensure financial
protection implemented.
n
Countries, rich and poor, must confront urgently the crisis of
human resources: increase training, ensure that mid–level cadres
of health workers are expanded and empowered, provide adequate
and fair compensation for all health workers, and take measures
to stem the exodus of scarce health workers from the public sector.
n
Countries must adopt and implement laws, regulations and
policies to strengthen health systems, improve women’s health,
and establish tolerance and respect for women’s decisions in
all matters pertaining to their health and well being.
n
HIV programs and policies must be oriented to the strengthening
of health systems and to the uncompromising protection of the
health and rights of women and girls.
Wye River Call to Action for Global Women’s Health
The grim picture of women’s health, including maternal mortality and
HIV, has many causal factors, and solutions are to be found in multiple
sectors.
However, many of these solutions are mediated through and require
the presence of strong and effective local health systems. This level of care,
defined in many countries as the “district health system,” embraces the contin-
uum of care reaching from the household/community level up through the first
referral facility level, to the district hospital.
Despite their central importance in women’s health, local health care systems
throughout the developing world are plagued by insufficient funding, under-
staffing, inadequate drugs and supplies, poor infrastructure, inaccessibility of

services due to long distances, poor transport, and ill–functioning referral sys-
tems. Low salaries and poor incentive packages lead to demotivated, demoral-
ized health workers. These structural challenges are only heightened by
socio–economic constraints and lack of political support.
Addressing these problems requires systemic changes, rather than quick fix
solutions that are not sustainable in the long term and that fail to address the
underlying inequities that function to exclude marginalized groups, especially
poor women, from the system.
ENSURING PREDICTABLE, SUSTAINED AND LONG TERM FUNDING FOR HEALTH SYSTEMS
While there has been an increase in development assistance for health in
general, this aid is volatile — often driven by profits and politics.
Donor
governments are susceptible to the political agendas of their parliaments, plac-
ing a focus on short term results. Sustained health development does not fit
this profile.
Part of the solution lies in the harmonization or pooling of funds, focused
around a single country plan, that is flexible and includes funding for both
recurrent and capital expenditures. But this alone does not guarantee that the
funds will be used for strengthening local health systems or for improving
women’s health. Ministries of Health have to be supported to build a strong
case for ensuring that funds flow to the health sector. Collective experience
demonstr
ates that leaders armed with knowledge give gr
eater prioritization to
women's health in national policy and in resource allocation.
Experiences in Uganda, Nepal, and P
eru have shown that evidence–based
advocacy is the most effective means for motivating central government and
district leaders to implement a reproductive health policy.
National surveys

“Is there any reason why
in the 21st Century policy
makers still need convincing
on the need for more
resources to ensure women’s
access to reproductive
health services?”
— Vincent Orinda
Senior Project Officer,
UNICEF, Uganda
Marcela del Mar Suazo
Minister of the National Institute for
W
omen’s Affairs, Government of Honduras
When Marcela Suaz
o, a prominent educator
in Honduras, agreed to con
v
ene civil societ
y
leaders with then–presidential candidate
Ricardo Maduro, during the last P
residential
election 4 y
ears ago, it w
as on one condi
-
tion: that he wouldn’t ask her to work in the
go
v

ernment w
ere he to win.
Minister Suaz
o had done suc
h an effec-
tive job, that President Maduro decided his
pledge w
ould be too e
xpensiv
e to k
eep.
Upon winning
, he ask
ed her to become the
Minister of the Institute of Women’s Affairs
f
or Honduras.
T
he cabinet–le
v
el post put her
in c
harge of w
omen
’s affairs for the entire
country. After some prodding, she accepted.
“When do I see y
ou f
or instr
uctions,

” she
ask
ed the ne
w P
resident. “I’ll give them to
you right now,” President Maduro answered,
“B
e in y
our of
fice tomor
ro
w morning at
8 am.
”
That was it.
Minister Suazo had spent little time
thinking about gender issues, and had ne
v
er
heard the term
“gender equit
y.” But, as she
Continues on page 12
11
in Uganda highlighting gaps in the availability and quality of emergency
obstetric care resulted in mainstreaming of reproductive health and maternal
mortality issues into a Sector Wide Approach (SWAp) planning process.
Illustrating the problem and providing evidence for effective interventions
can dramatically raise the level of attention and resources policy makers
will give to this issue. Further, by sustaining the supply of sound data and

consistent policy recommendations to these leaders, health–advocacy
organizations will be more successful in mainstreaming reproductive health
into national policies.
ABOLISHING
USER FEES
Moving away from user fees is increasingly recognized as an important
step in ensuring universal access to health care.
In 2005, the World
Health Assembly, passed resolution WHA58.31 calling for policies that
facilitate “moving away from user fees”
10
. The UN Millennium Project
has also called for the removal of user fees.
Increasing evidence has shown that the introduction of user fees as a cost
recovery mechanism in many developing countries has not only failed, it
has also worsened inequity and reduced access to care, particularly for the
poor and most marginalized groups, including women. Likewise systems to
ensure waivers and exemptions have not been successful and are often
poorly targeted (the rich benefit more than the poor). In contrast, in
Uganda and South Africa, removal of user fees, especially at local level,
resulted in significant increase in utilization of health care services by
those groups previously excluded.
But “abolishing user fees” is not shorthand for “nobody pays anything.”
“User fees” refers to payments made at the time and point of service, a
factor that often discourages or prevents access when it is needed most.
Clearly, to function well, health systems must be adequately funded, through
development assistance and fair financing schemes. Out of pocket payments
for health care should be prepayments. They should be pooled (so as to
ensure that there is financial stability and risk sharing), and these pooled
pr

epayments should be set accor
ding to ability to pay. In extr
emely poor
countries, where a high proportion of people are not able to pay, prepayment
schemes will not be able to generate sufficient revenue, governments simply
do not have the capacity to fully finance health systems from the domestic
budget, and so international development aid will be r
equir
ed.
Continued fr
om page 11
immersed herself in the field, she found an
immense national c
hallenge and an issue
she w
ould become deeply passionate
about: sexual and reproductive rights for
women. It soon became clear that w
omen
were often deprived of access to appropri-
ate and needed health care, had little say
over the sort of care the
y receiv
ed, were
subject to domestic violence and/or sexual
abuse. Travelling from community to com-
munity, she heard repeated stories about
w
omen who needed maternit
y care, but

w
ould ha
v
e to travel 3 hours to the nearest
clinic to see a health worker. They would
then tell her she w
ould ha
v
e to go to the
district hospit
al, whic
h w
ould charge a con-
siderable fee, and would be another 4
hours a
w
a
y
.
T
he woman would then have to
go home and ask permission from her
husband not only for the funds to pay the
f
ee, but also f
or permission to receiv
e the
needed care.
Minister Suazo explains that last year,
30,0

0
0 cases of domestic violence w
ere
reported, but only 1
5% w
ere f
ollowed
through in the appropriate legal channels.
Domestic violence, gender inequit
y and
lac
k of access to basic maternal care f
or
women are all crises for Honduras’ women,
and societ
y at large. But Minister Suaz
o is
making strides. She recently put out the first
“Manual for Integral Attention for Women,”
whic
h outlines the appropriate procedures
f
or health w
orkers to take when women are
being deprived of appropriate care or subject
“This is not a time to be
polite — this is the time
to act.”
— Yasmine Fall
President of the African Women Millennium Initiative

on Poverty and Human Rights (AWOMI)
12

In Nepal, the presence of a skilled health
care worker able to undertake all the
functions required to manage obstetric
emergencies is regarded as the most
important factor affecting service
utilization. The decision to delegate basic
emergency obstetric care services to
nurses has increased coverage and utili-
zation of services countrywide. In addi-
tion participatory planning and review
meetings involving all health facility staff
and key community stakeholders have
established a dialogue between health
staff and communities. These meetings
have improved staff morale, increased
commitment, motivation and teamwork
and have improved quality of care. In addi-
tion, use of the UN process indicators has
f
acilitated effective program monitoring,
management and advocacy. All of these
lessons learnt have emerged through the
National Safe Motherhood Program, which
is supported by UNICEF, working in part-
nership with the National and district level
health authorities as well as global part-
ners including AMDD and DFID.

Presented by:
Dr Geetha Rana
Project Officer, Women’s Health,
UNICEF Nepal
GOOD
PRACTICE
Strengthening Human
Resources for Safe
Motherhood in Nepal
CARE is a humanitarian organization fight-
ing global poverty. With technical and
financial support from the Averting
Maternal Death and Disability (AMDD)
project at Columbia University, CARE initi-
ated the FEMME program, dedicated to
improving delivery of maternal health care
in Tajikistan, Tanzania, Peru, Rwanda, and
Ethiopia. By enhancing the capacity of
health facilities and their staff to effective-
ly manage obstetric complications, CARE
has made dramatic strides in meeting the
need for maternal health care. Most
notably, in the regions of Tanzania,
Rwanda and Ethiopia where CARE was
operating, case fatality rates decreased
b
y 50%; and in the
A
y
acuc

ho region of
Peru, the met need for emergency obstet-
ric care increased from 30% to 84% in
just five years. Much of CARE’s success
is due to the comprehensive,
rights–based approach it takes, combining
facility improvements with personnel
training, dissemination of best practices,
decentralization of administration for
maternal mortality programs and the
establishment of partnerships with
Ministries of Health and district health
bureaus.
Presented by:
Milly Kayongo
Technical Officer,
FEMME, CARE US
A
GOOD PRACTICE
Addressing Maternal
Mortality through
Strengthening Local
Health Systems
to domestic violence. In the past, caregiv
ers
simply did not kno
w what to do when suc
h
cases arose, and did not realize that specific
actions should be t

ak
en.
Still an educator
, Minister Suaz
o comple
-
ments this effort at systematic reform with
intensive communit
y–based education initia
-
tives and personal engagement on the local
level. The opportunity is what galvanizes her.
With reform, she asserts with con
viction, as
many as 70% of premat
ure deaths among
women may be prevented.
The removal of user fees has a triple purpose: it eliminates barriers to access
for those in need; it avoids catastrophic costs thereby reducing health care’s
contribution to inducing poverty; and it builds a financing system that is sus-
tainable, predictable and stable because it is pooled and prepaid. Ultimately,
the removal of user fees for primary health care is not just a technical
process, it is a bold political statement that signals a government’s commit-
ment to ensuring equity in access to care for all its citizens.
S
TRENGTHENING HUMAN RESOURCES FOR WOMEN
’S
HEALTH
Health services are labor intensive activities that depend upon the per-
formance of their workers.

Developing a cadre of motivated health workers,
who are appropriately skilled and deployed is central to the rebuilding of
local health systems and should not be treated simply as a one–time adminis-
trative task. It is a long term, fundamental concern.
Creative and innovative mechanisms are urgently required to address the
health worker crisis that now grips most developing countries. The migration
of health workers from poor to rich countries must be stemmed, and the
internal migration and “poaching” of health workers from the public to the
private sector must be tackled. Although part of the solution lies in address-
ing salary disparities, money alone will not ensure adequate health workers
required to improve women’s health.
There is a pressing need to expand the scope of practice for a variety of
health worker cadres.
Midlevel workers can be trained to take on duties that
would free up nurses and doctors to perform more complicated procedures,
or to provide services in those areas where there are no doctors. For example,
in order to ensure adequate coverage of health workers able to manage
obstetric emergencies, the Mozambique government trained non–physician
surgical technicians to perform basic surgical procedures including caesarean
sections. Studies have shown them to be as effective and safe as medical
officers. Similarly in some countries, nurses have been trained to provide
anaesthesia, and do so safely and effectively. One specific challenge ahead is
to br
eak the str
anglehold that medical professional societies sometimes exert
to prevent such expansion. In fact, medical professionals have sometimes
been champions of innovative strategies to develop new locally–based health
work
er positions that can dr
amatically help to addr

ess crisis level health chal
-
lenges such as HIV/ AIDS and maternal mortality.
14
Promise Mthembu
Global Advocacy Officer, Sexual and
Reproductive Rights
The International Community of Women
Living with HIV/AIDS
In 1
995, at 20 y
ears of age, P
romise
Mthembu learned something that w
ould
forever change the trajectory of her life.
She is HIV
–
positiv
e.
A
s a result of her positiv
e st
atus,
Promise Mthembu found that she had to
confront stigma and discrimination not
only from some of those in her communi
-
ty, but from those in the health system as
w

ell. During a visit to a health clinic a f
e
w
y
ears af
ter testing positive, a doctor
administered an injection that she did not
request. Later she learned that it w
as an
injection to pre
v
ent her from becoming
pregnant.
“It still haunts me,
” she sa
ys.
Charismatic and eloquent, Ms.
Mthembu t
urned to adv
ocacy
.
A
s a Global
A
dv
ocacy Of
ficer for the International
Community of Women Living with HIV,
residing in Durban, South
Africa, P

romise
Mthembu has become an international
leader in advocating for sexual and repro-
ductiv
e rights f
or w
omen living with
HIV/AIDS
. Her organization has members
in 100 countries and more than 5,000
members around the globe. But Ms.
The HIV/AIDS epidemic has resulted in an
enormous drain on many national health
budgets throughout the de
veloping world.
In Botswana, patients with AIDS and the
complications of AIDS take up 75% of the
hospital beds. But, with careful planning
and engagement of all levels of govern-
ment, it is possible to use the HIV epi-
demic to shape a health care system to
be responsive to women’s needs.
Expanding access to care and treatment
for HIV/AIDS can simultaneously strength-
en local health systems; build synergies
between treatment, prevention and pri-
mary health care services; and reach vul-
nerable groups. Effective management of
HIV/ AIDS through the health system
should aim to keep people healthy,

ensure continuity of care and establish
linkages across services and programs —
breaking the barriers and hierarchies that
exist in health facilities.
This approach to strengthening local
health systems is the model adopted by
the MTCT–Plus Initiative — aimed at the
prevention of mother to child transmis-
sion of HIV focusing not only on the child,
but also on the mother (and HIV infected
partners, children and household mem-
bers). Through building workforce skills,
developing new cadres of trained workers
or expanding their scope of activities,
forming partnerships with the community
and establishing specific indicators neces-
sary to monitor progress, the MTCT–Plus
Initiative has strengthened local health
services. These services are not only for
HIV positive women, but for all women
accessing care. For example when treat-
ment is linked to prevention of mother to
child transmission of HIV, provided
through maternal health services, the like-
lihood of women having enhanced access
to treatment, reduced social stigma and
strengthening general maternal health
services for all women is greater.
Presented by:
Wafaa El–Sadr

Director of the International Center for
AIDS Care and Treatment Programs
(ICAP), at the Mailman School of Public
Health and Professor of Clinical Medicine
and Epidemiology, Columbia University.
GOOD PRACTICE
HIV Care can Support
Building Local Health
Systems Responsive
to Women’s Needs:
the Case of the
MTCT–Plus Initiative
Mthembu describes her constit
uency as a
larger group: she fights f
or HIV–positiv
e
women aged 15 to 24 years old — the
f
astest gro
wing population of those
inf
ected with HIV — and all w
omen
infected with HIV around the world.
Promise Mthembu’
s mission: obt
ain
-
ing complete sexual and reproductiv

e
rights for women living with HIV/AIDS.
That means access to care, treatment f
or
all sexually transmit
ted illnesses, unquali-
fied discretion — “no ifs, ands, or buts”
— over all reproduction decisions, full
access to inf
ormation, an end to discrimi
-
nation and the right to reproduce saf
ely
.
Humble about what she has accom-
plished, she has spok
en to audiences
of thousands at eac
h of the past three
International AIDS Conferences; she
w
as the c
hief organiz
er of the first
marc
h f
or global access to care and
treatment in Durban, South Africa in
20
0

0 and is proudest of st
arting a ne
w
f
or
um, the Young Women’s Dialogue,
addressing HIV/AIDS with HIV–positive
y
oung w
omen.
When people speak about HIV/AIDS
,
the
y of
ten f
ocus on how to prevent future
infections, Ms. Mthembu explains. She
aims to mak
e sure the
y do not f
orget
about those who are already positiv
e, the
rights to which they are entitled, and the
contribution the
y are capable of making
.
T
o that end, P
romise Mthembu continues

to inspire — and to fight.
Meenakshi D
at
ta Ghosh
Principal Advisor and Secretary, Health,
Nutrition and Family Welfare
Planning Commission, Government of India
As the former Joint Secretary for the
Ministry of Health and Family Welfare,
Meenakshi Dat
t
a Ghosh was the key
architect of India’s National Population
Policy 2000, India’s first comprehensive,
and according to Ms Ghosh,
“humane,
”
population policy. The policy led to a new
program in population stabilization and
reproductiv
e health, promoting skill
up–gradation among India’s health work-
ers, technology transfers and widening
the bask
et of contraception choices. All of
this improved care and empowerment for
India’s women.
T
hough Meenakshi Ghosh can point to
progress in the last several years, India

now resides at a daunting epochal junc-
t
ure in whic
h it must grapple with what
she calls the “double burden of disease.”
Even as India’s public health establish-
ment fights e
xisting health challenges, it
also faces “the next agenda:” HIV/AIDS.
With approximately 5 million people
inf
ected, India is fast becoming the
n
Political leaders must recognize the critical importance of women’s
health and empowerment, and of health systems to achieving the
Millennium Development Goals (MDGs), and
n
Countries must endorse the ICPD (International Conference
on Population and Development) target of universal access to
reproductive health by 2015 as an additional target to MDG 5.
Wye River Call to Action for Global Women’s Health
We Call for These Priorities to
be Reflected in Poverty Reduction
& Development Strategies:
We Call for These Priorities to
be Reflected in Poverty Reduction
& Development Strategies:
Women’s health and women’s rights must be put at the top of the interna-
tional development agenda.
If it drops below first or second place — it is

likely that it will drop off the agenda all together. When women have the
knowledge and power to make their own social and economic choices, whole
societies benefit. The Millennium Development Goals, while not perfect, do
provide a unifying framework and focus for international development and
for the support of women’s health through the specific goals on improving
maternal health, combating HIV/AIDS and promoting gender equality.
The UN Millennium Project has also stressed that expanding access to
sexual and reproductive health information and services is a “quick win,”
a cost–effective action that can produce real results in combating poverty.
Continued leadership is needed to galvanize political support to implement
this quick win in all countries.
But it is at a national level, where policies and programs are developed,
implemented and budgets allocated where the difference is made.
It is at this level that women’s health must be incorporated into poverty
reduction strategies, country plans and national health policies. All too often
the mechanisms for developing these strategies are not transparent. There is
no public dialogue, no civil society participation. Instead, developing country
governments establish their priorities based on the conditions that interna-
tional donors place on their funding, including caps on funding for social
services and limitations on the nature of services that can be provided, espe-
cially related to reproductive health care.
Attention must be paid to how strategies are set, what voice is given to
those most in need, and what facilities exist for women to claim their
right to health care.
Where governments have committed to meeting
women’s health care needs, it is important to identify the mechanisms in
place to hold government accountable to these commitments. In
Mozambique, the support of strong social organizations, even at grass roots
level, ensured that the health goals set by the state were maintained despite
leadership changes. Women’s voices are vital. They must guide leaders to

allocate r
esour
ces to appropriate health services, and guide r
esearchers to
develop new health technologies that meet their needs.
“We know that poverty is
not just about lack of
money. it is also about
lack of choice. This is
particularly true for
women. Today, many
women cannot make their
own choices about preg-
nancy and childbearing.”
— Thoraya Obaid
UNFPA, Executive Director
UN Under–Secretary
countr
y with the most HIV/AIDS cases in
the w
orld, and some predict that the
infection toll may increase by several–fold
in the ne
xt 5 to 1
0 y
ears.
T
he st
ak
es are high. “Everyone knows

that AIDS must be fought and won in
India,” Ms Ghosh declares. Muc
h must be
done. Stigma and gender inequalit
y
remain rampant, and so education and
leadership, particularly regional leadership,
remains essential. F
oremost, though, India
must narrow its gaping deficit in human
capacit
y: the skilled doctors, nurses,
at
tendants and health w
ork
ers in India’s
health system. Or as Meenakshi Ghosh
prescribes, with greater specificit
y
, India
needs to
“bring in a blitzkrieg of training
.
”
Tackling the human capacity challenge
will strengthen India’
s health sy
stems at
large, enhancing care not only f
or

HIV/AIDS, but also for existing disease
c
hallenges and f
or reproductiv
e health,
where strides still must be made.
For Meenakshi Ghosh, women’s health
remains paramount, the bedroc
k f
or a
vibrant, productiv
e and humane societ
y:
“When women are attended to, homes
are happier
, communities are happier
,
economic productivit
y increases.
When
women are healthy life becomes sound
and rational.
T
here is greater jo
y
all–around, and,
” sa
ys Meenakshi Dotta
Ghosh, “that’s what drives me.”
17

WYE RIVER CALL TO ACTION
To endorse the Wye River Call to Action go to www.realizingrights.org
The challenge of strengthening local health systems to ensure women’s access
to healthcare is a complex and daunting task. Perhaps it seems insurmount-
able and unattainable. Yet, this report and the stories it tells reveal that
promising practice and policy innovations are happening across the globe in
communities, cities and at the national level. Progress is possible but political
will is a critical ingredient to achieving positive change. Hard experience tells
us that technical interventions, while critical, are never enough. Equitable
health systems require leadership with political vision, resources, social
mobilization skills, enormous dedication and even courage. Courage because
rebuilding health systems will mean hard political choices, setting priorities,
confronting entrenched power interests, and a steadfast commitment to
accountability.
The time has come to move beyond broad pronouncements of political
intent and to focus attention on what actually happens in a health system on
the ground, where the structures of government meet the hard reality of
women’s struggle for life and health. At the close of the Wye River meeting,
Madeleine Albright referred to the famous Margaret Mead quote about the
power of a small group of thoughtful and committed citizens. Secretary
Albright then went on to say, “The groups represented in this room are not
so small, but we are thoughtful, we are committed, and have no doubt, we
will change the world.”
Suzanne Aho
Minister of Health, Togo
On her w
a
y to Kara, a relativ
ely populous
cit

y in northern
T
ogo, Suzanne Aho spotted
a woman working in a field off of a dusty
countr
y road. Cultiv
ating crops, the w
oman
w
as accompanied b
y se
veral children.
Minister Aho told the driver to stop the car.
A
s is her custom, Minister
Aho got out of
the car and immediately began asking the
woman about her health status: was she
pregnant? e
xperiencing an
y sic
kness? had
she been v
accinated?
It turned out that the woman was in
good health, but that her 1
2–y
ear–old
daughter
, b

y her side, w
as pregnant.
Immediately, the Minister told the driver to
go and get the closest ph
y
sician, got her
things out of the car and sat b
y the side of
the road with the woman and her children
until the ph
y
sician ar
riv
ed and the girl
receiv
ed the needed care.
Such episodes are business as usual
f
or Suzanne
Aho,
T
ogo
’
s high profile and
hands–on Minister of Health. She is a st
un
-
ning example of how a determined leader
“A leader who is determined
to help women survive

will be guided by results,
not ideology, supporting
programs not because they
meet a political agenda,
but because they work…. A
leader who is determined to
make a difference in the lives
of women will inspire others
to take up the same cause.”
— Madeleine K. Albright
Chair, Ministerial Initiative of the Council
of Women World Leaders
18
In South Africa, where apartheid has left
tremendous health and economic dispari-
ties, Health S
ystems Trust, an NGO, is
working in communities to strengthen
access to health data and provide analy-
ses for leaders to improve health ser-
vices. The group has further implemented
pilot mechanisms whereby local commu-
nities can use the information to better
advocate for development of their health
service facilities and personnel.
The Trust’s effort to spread informa-
tion and best practices goes to the heart
of the inequities still plaguing South
Africa. The data have revealed that nearly
twice as much public money per capita is

spent on health care in the urban areas
than in the rest of the country, and most
of this money goes to facilities–develop-
ment and not to delivery of primary
health services. Further, though funding
for the private health sector vastly
exceeds funding for the public sector,
only 20% of the South African population
has access to private care.
In an effort to address these
inequities, South Africa has committed
itself to developing the district health
system, providing free primary health
care and free care for children and preg-
nant women at all levels of the system.
Funding allocation formulas to redress
past inequities across provinces have
been introduced and the Health Systems
Trust has played an important role in
monitoring progress towards this equity
goal, at both national and local levels.
Presented by:
Lilian Dudley
Chief Ex
ecutive Officer
,
Health Systems Trust
GOOD
PRACTICE
Monitoring Equity —

Supporting Health
Advocates and Leaders
with political will can mak
e a meaningful
dif
f
erence to the health of her nation.
A for-
mer social worker, Minister Aho can been
seen regularly on tele
vision, in ne
wspa
-
pers, or heard on radio, urging
T
ogolese
women to visit certified health clinics for
antenatal check–ups and deliv
er
y care.
Capacity is a challenge in Togo, but often
Minister Aho finds that misconceptions
about healthcare or pressure from local
customs lead women to unqualified
providers or to avoid care entirely. It is, for
Suzanne
Aho, perhaps
T
ogo
’

s greatest
health c
hallenge.
On one visit to a clinic, Minister Aho
f
ound a w
oman in the 1
4th hour of her
deliv
er
y
. She asked the “health” worker on
site for his certification papers. All he could
pro
vide w
ere papers certifying that he w
as
a registered mec
hanic. She r
ushed the
woman to a certified clinic, where she
deliv
ered saf
ely; then shut do
wn the illegal
f
acilit
y. In what Suzanne Aho has labeled a
“war” to get women appropriate health-
care, the Minister is making real progress.

When she became Minister of Health
three years ago, 4 percent of Togolese
households had bed nets to guard against
malaria, a national emergency and a
scourge for women and children’s health.
No
w
, 45 percent of households ha
v
e bed
nets, whic
h cost only dollars and reduce
the risk of malaria sharply. When national
leaders lea
v
e their of
fice, pic
k up a bullhorn
and demand action, Minister
Aho
’s exam-
ple illustrates, great strides are possible.
WYE RIVER PARTICIPANTS
ENDOR
SING THE CALL IN THEIR
PER
SONAL CAPACITY
Sono Aibe
Senior Program Manager
Population Program

The David and Lucile Packard Foundation
Alice P. Albright
Vice President and Chief Financial
and Investment Officer
The Vaccine Fund
Madeleine K. Albright
Chair
Ministerial Initiative of the Council of
Women World Leaders
Xu Baert
Communications, Advocacy and
Public Relations
Department of Making Pregnancy Safer
World Health Organization
Anurita Bains
Special Assistant
Office of the Special UN Envoy of the
Secretary–General for HIV/AIDS in Africa
Carmen Barroso
Regional Director
International Planned Parenthood /
Western Hemisphere Region
Gr
eg Behrman
Henry Kissinger Fellow
The Aspen Institute
Patricia Caffrey
Project Director
Parliamentarians for Women’s
Health, International Center for

Research on Women
Peggy Clark
Managing Director
Realizing Rights: The Ethical
Globalization Initiative
Barbara B. Crane
Executive Vice President
Ipas
Nils Daulaire
P
resident and CEO
Global Health Council
Helen de Pinho
Policy Advisor
UN Millennium Project Task Force on Child
Health and Maternal Health
Isabelle de Zoysa
Senior Adviser for HIV/AIDS
Office of the Assistant Director–General
for Family and Community Health
World Health Organization
Clementine Dehwe
Global Union HIV/AIDS Campaign
Coordinator
International Confederation of Free
Trade Unions
Zimbabwe
Marcela del Mar Suazo
Minister of the National Institute for
Women’s Affairs

National Institute for Women’s Affairs
Government of Honduras
Linda Distlerath
Vice President
Global Health Policy
Merck & Co., Inc.
Paula Donovan
Senior Advisor
Women’s and Children’s Issues
Office of the Special UN Envoy for AIDS
in Africa
Beverly Draper
Project Director
Department of Health of the
W
estern Cape
& Department of Public Health and Family
Medicine, University of Cape Town
Lilian Dudley
Chief Executive Officer
Health S
ystems Trust, SA
Marian Wright Edelman
P
resident and Founder
Children’s Defense Fund
Wafaa El–Sadr
Director, The International Center for
AIDS Care and Treatment Programs (ICAP)
Professor, Clinical Medicine and

Epidemiology
Columbia University Mailman School
of Public Health
SIGNATORIES TO THE WYE RIVER CALL TO ACTION
The Wye River Call to Action for Global Women’s Health was developed
by participants to the
“Innovations in Supporting Local Health Systems
for Global Women’s Health: A Leaders Symposium,”
Aspen Wye River
Conference Center, Maryland, USA, 5th – 7th June 2005.
REFERENCES
Note: All presentations from the
meeting are available on the EGI website
www.realizingrights.org
1. UNFPA, “Maternal Deaths Disproportionately
High in Developing Countries,” October 20,
2003, at
/>pdf_2003printable.pdf
2. See UNAIDS, “Sub–Saharan Africa,” at
/>by+region/sub–saharan+africa.asp
(last accessed July 19, 2005)
3. See id. (“[r]ecent population–based studies
suggest that there are on av
erage 36 young
women living with HIV f
or every 10 young
men in sub–Saharan Africa.”); UNAIDS,
“Botswana,” at />geographical+area/by+country/botswana.asp
(last accessed July 19, 2005)
4. Wagstaff, A, and M Claeson. 2003.

The Millennium Development Goals for
health: Rising to the Challenges. The World
Bank. Washington, DC
5. Mackintosh, M. 2001. "Do health care systems
contribute to inequalities?" In D. A. Leon and
G. Walt, eds., Poverty, inequality and health:
an international perspective. Oxford: Oxford
University Press
6. Gilson, L. 2005. “Editorial: building trust and
value in health systems in low– and
middle–income countries” Social Science &
Medicine (61) 1381–1384
7. Link, B , and J Phelan 1995. “Social
conditions as fundamental causes of disease.”
Journal of Health and Social Behavior:80–94
8. Braveman, P, and S Gruskin. 2003. “Defining
equity in health.” Journal of Epidemiology and
Community Health 57:254–258
9. For more information, please visit the website
for the Mexico City Ministry of Health:

10. WORLD HEALTH ASSEMBLY WHA58.31:
Working towards universal coverage of
maternal, newborn and child health interven-
tions, Agenda item 13.2 25 May 2005
20
Yassine Fall
President of the African Women
Millennium Initiative on Poverty and
Human Rights (AWOMI)

Senior Policy Advisor, UN
Millennium Project
Senior Economic Advisor, UNIFEM
Lynn Freedman
Director
Averting Maternal Death and
Disability Program
Columbia University Mailman School
of Public Health
Adrienne Germain
President
International Women’s Health Coalition
Meenakshi Datta Ghosh
Principal Advisor (Health, Nutrition,
and Family Welfare) and Secretary
Planning Commission
Government of India
Heather Grady
Director, Policy and Partnerships
Realizing Rights: The Ethical Globalization
Initiative
Liisa Hyssälä
Minister of Health and Social Services
Ministry of Social Affairs and Health,
Finland
Lydia Johnson
Chairperson, Health Committee
KwaZulu–Natal Parliament
Milly Kayongo
Technical Officer

FEMME
CARE USA
Arzumand Banu Khan
General Medical Private Practitioner
F
amily Medical Centre
F
ormer National Coordinator
, National
AIDS Coordinating Agency, Ministry of
State President, Botswana
Betty King
Senior Advisor to the Chief
Executive Officer
California Endowment
Former U.S. Ambassador to the
UN Economic and Social Council
Michelle Kouletio
Senior Health Advisor
Concern Worldwide, Inc.
Asa Christina Laurell
Secretary of Health
Mexico City Government, Mexico
Mary Ann Leeper
President and COO
The Female Health Company
Laura Liswood
Secretary–General
The Council of Women World Leaders
Jessica Longwe

South Africa Representative
European Parliamentarians for Africa
Michelle McMurry
Director
Health, Biomedical Science and
Society Initiative
The Aspen Institute
Tapani Melkas
Director, Health Department
Ministry of Social Affairs and Health
Government of Finland
Pascoal Mocumbi
WHO Goodwill Ambassador for the
Commission on Social Determinants
for Health
High Representative
European & Developing Countries
Clinical Trials Partnership Secretariat
Promise Mthembu
Global Advocacy Officer
Sexual and Reproductive Rights
The International Community of
Women Living with HIV/AIDS
Liisa Ollila
Office of the Honorable Liisa Hysala
Ministry of Health and Social Services,
Finland
Vincent Orinda
Senior Project Officer, Health,
Nutrition and WES

UNICEF Kampala, Uganda
Nina Puri
P
resident
International Planned Parenthood
Federation
Geetha Rana
Project Officer, Women’s Health
UNICEF Nepal
Susan Rich
Director
Women and Population
United Nations Foundation
Mary Robinson
President
Realizing Rights: The Ethical Globalization
Initiative
Zeda Rosenberg
CEO
International Partnership for Microbicides
Allan Rosenfield
Dean
Columbia University
Mailman School of Public Health
Nafis Sadik
Special Envoy of the Secretary–General
for HIV/AIDS in Asia and the Pacific
United Nations
Suomi Sakai
Representative

UNICEF Nepal
Terttu Savolainen
Secretary of State for Health
Ministry of Social Affairs and Health
Government of Finland
Brooke Shearer
Senior Advisor
Global Health Strategies
Jill W. Sheffield
President
Family Care International
Julie Sullivan
President and Chief Executive Officer
International Foundation for Education
and Self–Help
Marja Tallavaara
Special Adviser to the Minister of
Social Affairs and Health
Government of Finland
Dunia Tomé
National Institute for Women’s Affairs
Government of Honduras
Mirna Valladares
National Institute for Women’s Affairs
Go
vernment of Honduras
Wim Van Lerberghe
Editor in Chief,
World Health Report 2005
Coordinator, Health P

olicy and
Strategic Planning
Department of Health System Policies
and Operations
Evidence and Information for Policy,
World Health Organization
Asunta Wagura
Executive Director
Kenya Network of Women with AIDS
As of the date of publication of this report,
36 new signatories have added their names
to the Wye River Call to Action.
Realizing Rights:
The Ethical Globalization Initiative
271 Madison Avenue
Suite 1007
New York, NY 10016
www.realizingrights.org
Council of Women
World Leaders
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www.womenworldleaders.org
Columbia University
Mailman School of Public Health
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