1. Mothers Matter program in the Andes (Poder Ser) Bolivia, Ecuador and Peru An avoidable maternal death is a violation of human rights

2. Global Mothers Matter Strategy EMPOWERED COMMUNITIES POLICY ACTION RESPONSIVE HEALTH SYSTEMS maternal mortality reduction

3. Sexual & Reproductive Health (SHR) Service Package Access to Family Planning Prenatal Care Delivery Attention, postpartum Emergency Obstetric Care (EmOC) STD and HIV/AIDS prevention Newborn care Counseling services on SRH Health Promotion and Prevention on SRH and Safe Motherhood Cancer Detection

4. Objective Contribute to reduce maternal mortality, improving access to safe and secure maternity and birth services for 1.6 million indigenous women from Bolivia, Ecuador and Peru

5. Components of Strategy 1.(building) Regional Commitment 2. Advocacy 3. Quality Health Services 4. Women and Communities Empowered

6. Regional Commitment Advocacy to key actors (Andean Regional Level-The Community of Andean Nations, Pan American Health Organization, facilitating cooperation between MOHs) Learning: Local, National and Regional

7. Advocacy MOH and MOE to finance and implement innovative strategies based on evidence and adapted to a local contexts-Advocacy on public budgeting and donor funding and implementation Advocacy on creation, modification and implementation of public policies Participatory monitoring of the quality of services Advocacy to raise political support and visibility of Maternal Mortality Networking and support/capacity building of alliances

8. To scale up (LIFT UP) strategies based on evidence, gender equity, interculturality, RBA and dignity: –Emergency obstetric Care (FEMME model Peru) –Vertical transmission prevention (UNIVIDA Ecuador, Global Fund Peru) –Four Delays (CARE Ecuador) –Friendly services for youth and adolescents (CARE Ecuador) Define and validate (jointly with MOH and other key players) cultural adapted models Quality Services (capacity to solve local needs, accessibility, use, availability, and acceptability)

9. Women and Community empowered Community control and consensus about quality of Maternal services Community participation in design and implementation of public policies Demand-side strengthening, including IEC about rights and responsibilities Piloting models on gender inequities and 4 delays, involving men (masculinities) Work with youth and adolescents on Sexual and RH issues and masculinities (with health and education sectors).

10. Geographical Areas Bolivia: –La Paz/El Alto, Potosí & Oruro (3 departments) –165,658 women of reproductive age –Also 171,395 women of reproductive age in 10 networks in east (Beni, Santa Cruz, Tarija and Chuquisaca) Ecuador: –Tungurahua, Chimborazo, Cotopaxi, Imbabura, Esmeraldas –266,873 women of reproductive age Peru: –Ancash, Ayacucho, Cajamarca, Huancavelica & Puno –1,192,806 women of reproductive age

11. Advances Working sub regionally in the Andes and leveraging CARE Peru’s and Ecuador’s experience The Bolivian Ministry of Health, has bought into the Femme model as developed successfully in Peru with the support of CARE Peru. CARE Peru seen by Bolivian MOH and USAID as key to supporting the transfer of the model successfully to Bolivia....adapting it to the Bolivian context. Advocacy successes in Peru (national model for EmOC with detailed “how to” guide, newborn health, manual for health volunteers, health rights laws, social control models) and Ecuador (educational materials, norms, policies and curricula on SRH) New GBV project in Bolivia (abortions, maternal deaths, particularly in adolescents)

12. BOLIVIAECUADORPERU Existing Maternal Health projects Community Health (USAID)LIFT UP DFID IIMMHR – No woman behind CARE UK PPA – Participatory Voices Antamina EmOC LIFT UP New funding for Mothers Matter REDES CONE (USAID - $1.2m – 12 months) UNFPA ($70k – 3 months) EC Social control (EUR 328,500– 3 years) UNFPA consultancy on social control by indigenous women - $8k Mothers Matter components in existing/new projects GBV (USDoS $600k 2 yrs) Global Fund HIV UNIVIDA EC HIV Global Fund HIV Masculinities (BGE) Relationship to CO Programs Large part of one of three CO programs ("Maternal and newborn Mortality“) Part of Social program (education and health) Large part of health program

13. How staff responding Staff who enjoy working in teams and in a participatory approach are very happy about the program shift. Staff with a strategic mindsets are more likely to see the advantage of the approach, staff who want to keep their power and work in isolation have major problems coping with the approach. Learn by doing – inductive approach, building on what we have…

14. Challenges Struggling to find short term and long term funding – and hard to get regional funding, for whole program or large parts LAC lower priority with most donors (and many CI members) Time to focus on design and regional coordination, given multiple other demands -Workload – program agenda is much broader and more ambitious than project agendas, but often do not have enough staff or resources Focus is as much on influencing funds of others, as getting CARE projects funded – donors or government – needs flexible funding to cover core costs (Peru with big advantage here) Institutional position on controversial issues – e.g. abortion

15. Lessons Evidence of impact is key – and visits by decision makers to successful experiences (e.g. MoH and USAID Bolivia to Peru) Focus design opportunities on the strategy and incorporate the strategy (or parts) in all new design opportunities Small amounts of funding ($20-30K) can support key elements of a program strategy, initiatives traditional donors might not support….this is why it is critical to get UNR numbers up Positive support from CARE USA Mothers Matter team – worked with us to design a program that fits our realities, within global framework, but from bottom up…including changing the name (women who are not mothers also matter…chose a name that stresses power, rather than traditional roles – key for engaging the women´s movement)