Full document: Global Strategy for Women's and Children's health
More health for the money
We must maximize the impact of investment by integrating efforts across diseases and sectors, by using innovative, cost-effective and evidence-based tools and approaches, and by making financing channels more effective
Increasing effectiveness through integration
The conditions in which women and children are born, grow up, live and work have a major impact on their health. Efforts to improve health must be closely linked to those intended to tackle poverty and malnutrition, improve access to education, ensure gender equity and empowerment, tackle major diseases, and improve access to safe drinking water, adequate sanitation and a clean, safe environment. Integrating the care of women and children with other services is an efficient and cost-effective route to success. For example, investing in family planning in addition to maternal and newborn services can save US$1.5 billion while achieving the same outcomes.12
Egypt is one of the few countries on track to achieve both MDGs 4 and 5, which it has achieved by integrating child health and family planning programs, upgrading facilities to strengthen safe motherhood programs, combining oral rehydration programs with the expansion of water and sanitation systems, and training health-care workers in parallel with community outreach programs.13
Meanwhile, maternal mortality has fallen by 75% in two indigenous communities in La Paz, Bolivia, because women’s groups have implemented education and empowerment programs, educated men about gender equality and reproductive health, and trained community health workers.14
Using innovation to increase efficiency and impact
Some of the poorest countries have significantly reduced maternal and newborn mortality and improved women’s and children’s health. Innovative approaches can achieve even more, eliminating barriers to health and producing better outcomes. These approaches need to be applied to all activities: leadership, financing (including incentives to achieve better performance and results), tools and interventions, service delivery, monitoring and evaluation.15
Innovation and mobile phones – unprecedented potential
There are nearly 5 billion mobile phones in the world, and the UN estimates that by 2012 half the people living in remote areas will have one.18 More than 100 countries are now exploring the use of mobile phones to achieve better health. In Ghana, for instance, nurse midwives use mobile phones to discuss complex cases with their colleagues and supervisors. In India, mDhil sends text messages giving information about various rarely discussed health topics and supporting prevention and patient self-management efforts. Rwanda uses a system of rapid SMS alerts, through which community health workers inform health centers about emergency obstetric and infant cases, enabling the centers to offer advice or call for an ambulance if needed.
Innovative leadership is also vital, and in several places dynamic national leadership at the cabinet level, exercised through parliament, is holding local governments accountable for their results. In Rwanda, for example, government ministries must include women-centered actions in their plans and introduce gender budgeting. At a local level, delegations of community leaders conduct investigations into each woman who dies of a pregnancy-related cause, which the government then monitors. This bold, outcome-focused leadership has led to the rapid development of health systems, often through innovative programs to train and retain new health workers.
Innovative financing mechanisms can tap the enormous potential of the broader global community and increase the flow of money to women’s and children’s health. For example, UNITAID has negotiated a levy on all flights departing from partner countries, raising nearly US$1 billion, and UNICEF’s “Check Out For Children” has raised US$22 million from hotel guests who donate US$1 at check-out.
Results-based financing – the provision of cash or goods conditional on measurable action being taken or a defined performance target being achieved – can improve health service utilization, improve the quality and efficiency of services and enhance equity. In India, for example, the Janani Suraksha scheme provides cash to health workers and pregnant women living in poverty if the woman gives birth in a public-health facility or an accredited private-sector facility.16 Between 2006 and 2008 there was a ten-fold increase in the number of people benefiting from this program.17
Innovative service delivery has also resulted in efficiency savings. “Child Health Days” and “Child Health Weeks” have helped to deliver a range of low-cost, high-impact interventions such as vitamin A, immunizations and insecticide-treated bed nets for preventing malaria. In targeted areas of Ethiopia, Madagascar, Mali, Mozambique, Tanzania, Zambia, Nigeria and Niger, these interventions have reached more than 80% of children under five. Meanwhile, in many countries, information and communication technology is being used to enhance health literacy, provide health information, improve care and strengthen monitoring and evaluation, and it will no doubt develop rapidly in the coming years.
Public-private partnerships make good use of the private sector’s willingness to innovate and take risks, to provide information and improve the quality of services, and to accelerate the development of new vaccines, drugs and technologies. The public sector and private sector can work together to better address the challenges faced by billions of people in emerging economies. In China for example, Goodbaby, a company providing baby products, uses 1,000 trained health professionals to give phone consultations to parents, and runs a website that receives over three million hits per day. In Tanzania, the Food and Drug Authority has created an innovative regulatory system for pharmaceuticals, through a network of retail drug dispensing outlets (ADDOs) that provide affordable, quality drugs and services in rural areas where pharmacies are rare.
Technological innovations can also play a critical role. First, they can simplify expensive, hard-to-use technologies, such as ventilators and tools for administering treatments, making them more affordable and usable in the home or community, where most babies are born. Healthcare businesses should look at their product lines (analyzing the number of units they manufacture, their ease of use, pricing, and integration with distribution networks) and make sure they can be used in a home or community environment. Secondly, new interventions and tools can tackle challenges such as pre-term births and creating vaccines for AIDS and other diseases.
Monitoring and evaluation can also benefit from innovation.19 In Peru and Nicaragua, new methods of online data collection have made monthly reporting possible, leading to rapid improvements in health outcomes. Similar approaches can be used to monitor maternal deaths and identify contributory factors.
Making funding channels more efficient
A number of international and regional taskforces have emphasized the importance of long-term, predictable and harmonized financing.20 Yet funding is often unpredictable, making it impossible for countries to scale up and plan ahead. Commitments and disbursements often fail to reach countries, and when funding does arrive, it is often earmarked for narrow uses. Some donors fund similar initiatives in the same country instead of coordinating their activities. Countries without a unified national health plan may not have clearly articulated health priorities that can guide the use of funds and may not be disbursing all the money they have budgeted.
Countries and donors have agreed a set of principles around aid effectiveness to address these challenges.21 Countries will work to develop national health plans and donors will align their aid accordingly. They will also harmonize their budgets, providing separate health budget lines, with all public spending and donor financing included. Already, countries and donors are using the International Health Partnership (IHP+) to improve and harmonize their activities, reduce fragmentation and ensure that more funding flows rapidly to those who need it.
Today, funds for women’s and children’s health reach countries through many channels, including traditional bilateral funding and multilateral channels. One mechanism to better channel new and existing funds for health systems strengthening is the Health Systems Funding Platform. This commits the World Bank, the GAVI Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, with the facilitation of WHO, to coordinate and align their funding for broad health systems support with countries’ priorities, plans, timelines and processes. The Platform is being introduced in several countries and is open to other funders. Through it, over US$1 billion22 of new money will be channeled to countries.23 Nepal is one example of a country moving ahead with the Platform as a way to align partners’ programs and grants with its national health plan.