PMNCH Knowledge Summaries: #12 - Deliver on promises
Publisher: The Partnership for Maternal, Newborn and Child Health
Publication date: 2011
Language: English only
Note: Full text and all graphs, tables and references for each Knowledge Summary are available only on the PDF version.
Women and children have a right to quality health care and to survival-fundamental rights that should be respected and protected.The aim is "Every pregnancy wanted, every birth safe, every newborn and chifd healthy". A well-coordinated and integrated approach can help realize this, based on advocacy for policy, services and financial resources; action; and accountability.
Accountability holds the key to progress.Women and children – whose health and lives are at stake – have a right to know what their governments are doing and achieving. Global, national and local communities have to get involved in supporting this basic right and in helping women and children live healthy lives.
What do we know?
Funding for reproductive, maternal, newborn and child health (RMNCH) has been a low priority for many years, despite the availability of proven and cost-effective strategies. As a result, 10 million lives are lost every year. However, progress is possible when countries make RMNCH a political priority.
In 2010, RMNCH has featured prominently on political and policy-making agendas. The United Nations General Assembly, the G8, and the African Union have prioritized RMNCH. The media has played a major role in advocating change and insisting on political accountability, and provided a platform for public education, debate and generation of demand. 3 The Partnership for Maternal, Newborn & Child Health (PMNCH) and its partners are building on this recent momentum to mobilize greater resources, action and accountability.
What will make it work?
Women’s and children’s education and participation
Women and children are the primary stakeholders in their own health.There have been few systematic reviews of the evidence, but individual field-based studies have emphasized the importance of women’s and children’s participation, empowerment and community mobilization. Such efforts have led to better outcomes where they have been tried and implemented, although scale-up has proven much more difficult. Local and sub-national initiatives have also contributed to better outcomes where they have involved women in identifying their own health problems (for example, in rural Malawi) or facilitated improvements in their interactions with the local health system (for example, in Nepal).
Children’s participation in national parliaments and at UN General Assembly and G8 special sessions has influenced policy-making on a range of issues, including poverty, health, education and the environment. Children and adolescents also effectively use new social media to make their voices heard.
The primary responsibility for ensuring good quality RMNCH services lies with national governments, but several other stakeholders also have a significant influence. Bilateral and multilateral donors, the UN, civil society organizations, parliamentarians, the media, private sector organizations, academics and healthcare providers all have a role to play.
Global health initiatives – such as GAVI, the Global Fund and others – have successfully galvanized support for tackling major diseases. These multi-stakeholder partnerships have helped improve access and equity as well as the quality of specific health services. Joint planning by these global initiatives could ensure that their strategies and resources are better aligned to country priorities across the continuum of care.
Putting knowledge into action
The knowledge of what works in RMNCH is available, but there is a gap between knowledge and its use in policy and practice. Awareness of scientific evidence tends to stay within the scientific community. In practical terms, this could result in low uptake of proven interventions and, in turn, poor outcomes. This could be overcome if RMNCH policy networks can bring knowledge into the mainstream, using innovative ways of generating and applying evidence. The SUPPORT Tools – which include summaries of systematic reviews in RMNCH – are one example of a positive step in this direction.
Budgets are a reflection of stakeholders’ priorities. Civil society organizations have begun tracking national budgets to assess governments’ priorities and funding commitments (see Box 2). However, data on domestic expenditure on the MDGs and RMNCH are not easily available.Tracking international funds faces similar challenges.
The Countdown to 2015 calculated that international funding for MNCH in 2008 accounted for 34% of all development assistance for health. Though this proportion represents a 15% increase in funding for MNCH between 2007 and 2008, the spending is still insufficient and is not always targeted to the countries in most need. The commitments made at the MDG Summit in September 2010, included quantified targets on increased funding, improvements in the health workforce, reductions in maternal and newborn deaths, improvements in child health and other related measures. Better costing, budgeting and tracking of RMNCH funding is needed to improve actions and accountability (see Knowledge Summary 3).
Political, managerial and social accountability will encourage implementation of commitments to RMNCH. For example, maternal death reviews help ministries of health to ensure a chain of accountability. South Africa’s National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) has provided invaluable information on avoidable causes of maternal and perinatal mortality. It revealed that weak health systems and HIV/AIDS are responsible for lack of progress in reducing deaths. This enquiry process has encouraged leaders to set priorities and act.
The Committee on the Rights of the Child (CRC) requires all governments to submit regular reports on their progress towards implementing children’s rights. Civil society organizations and international agencies participate in the process, thus promoting mutual accountability.
Accountability depends on the ability to measure results
Accountability requires accurate information on the health of women adolescent girls, newborns and children. However, vital registration and monitoring systems are weak in many of the poorest countries, due to insufficient political will, lack of resources and poor staff motivation or training. Alternative sources of information are demographic surveys, sentinel surveillance systems and hospital records. Several initiatives – such as the Health Metrics Network – are working with countries to strengthen information systems.
The Global Strategy calls for the World Health Organization to “chair a process to determine the most effective international institutional arrangements for global reporting, oversight and accountability on women’s and children’s health”. The PMNCH is supporting this effort across its range of partners, for example by engaging with parliamentarians through the Inter-Parliamentary Union and by supporting the Countdown to 2015 work on monitoring RMNCH funding, coverage, equity and outcomes.
Governments and many other partners have acknowledged the global disgrace of mothers, newborns and children dying needlessly. All partners have to come together at this juncture, to take action. Knowledge of what works has to translate into effective policies and programs. Now is the time.