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The PMNCH 2011 Report: Analysing Commitments to Advance the Global Strategy for Women's and Children's Health

Executive Summary

In September 2010, the United Nations Secretary-General Ban Ki-moon launched the Global Strategy for Women’s and Children’s Health, aiming to save 16 million lives in the world’s 49 poorest countries by 2015. The Global Strategy sets out six key areas where action is urgently required to enhance financing, strengthen policy and improve service-delivery:

• Support to country-led health plans, supported by increased, predictable and sustainable investment.
• Integrated delivery of health services and life-saving interventions – so women and their children can access prevention, treatment and care when and where they need them.
• Stronger health systems, with sufficient skilled health workers at their core.
• Innovative approaches to financing, product development and the efficient delivery of health services.
• Promoting human rights, equity and gender empowerment.
• Improved monitoring and evaluation to ensure the accountability of all actors for resources and results.

The Global Strategy put women’s and children’s health at the top of the political agenda. Almost 130 stakeholders from a variety of constituency groups made financial, policy and service-delivery commitments. Commitments addressed areas ranging from human rights, technical guidelines and gender and economic empowerment, to citizen participation, accountability and governance.

Stakeholders reported a wide variety of reasons for engaging with the Global Strategy. They wanted to be part of an unprecedented global movement for women’s and children’s health, and many wanted to make fresh commitments to help fill the gaps in global funding and resources. Others were keen to showcase their existing work, and found that a commitment gave it visibility. And others recognized an opportunity to link with partners who could provide technical and financial support. Finally, they wanted to ensure that their work for women’s and children’s health was prioritized by their own organizations and national leaders.

This report’s objective

The overall objective of this report is to present an introductory analysis of the commitments to inform discussion and action on the following topics:

• Accomplishments of the Global Strategy and the Every Woman, Every Child effort, in terms of the commitments to date;
• Opportunities and challenges in advancing Global Strategy commitments;
• Stakeholders’ perceptions about the added value of the Global Strategy; and
• Next steps to strengthen advocacy, action and accountability, taking forward the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health.

Unprecedented commitments

The Global Strategy resulted in a remarkable set of commitments.

• 127 stakeholders made commitments to advance the Global Strategy, collectively worth more than US$40 billion. This only includes monetized commitments, and therefore underestimate the total value, as extensive policy and service-delivery commitments were also made.
• Low-income countries made the highest number of commitments overall, including financial commitments valued at US$10 billion. In addition, 24 governments committed to expand access to family planning, 18 to expand access to skilled birth attendance and 23 to reduce financial barriers to health-care.
• More than 100 stakeholders made policy commitments, including removing user fees, improving access to high-quality health- care and promoting gender empowerment.
• Of the 127 stakeholders, 99 (78%) made commitments to strengthening health systems and service-delivery. These included specific pledges to improve health services and incorporate innovative approaches to expand utilization, for example by using mobile phones to raise awareness and promote healthy behaviours.
• Of the 127 stakeholders, 66 (52%) made commitments to building human resource capacities for health. These included pledges to increase the number of health workers (by more than 45 000), with 35% of these commitments focused on skilled birth attendants and 23% on midwives.
• Of the 127 stakeholders, 87 (69%) made commitments that promote some dimensions of human rights. For example, to address equity by using mobile clinics to reach remote areas and women and children in greatest need, to reduce the costs of medicines by negotiating royalty-free licences from pharmaceutical companies, and to address accountability by working with local communities to establish maternal death audits.
• Of the 477 references to countries in commitments and interviews, 70% focused on the 49 low-income countries, ensuring that women’s and children’s health in these countries is now a joint global responsibility.

Opportunities and challenges in advancing Global Strategy commitments

The analysis in this report indicated a number of opportunities to further advance the Global Strategy.

• Stakeholders identified funding shortfalls as the most important constraint to implementation, and many also pointed out that there is insufficient clarity on how and when the funds already committed can be accessed.
• More than 95% of commitments are from stakeholders in the health sector. However, improving the health of women and children also requires the involvement of many other sectors, including education, nutrition, water and sanitation, agriculture and infrastructure.
• Of the 127 stakeholders making commitments, only 14 are from the business community and five from middle-income countries – both these groups can play a much more significant role, including in the lowest-income countries.
• The Commission on Information and Accountability recommends the use of innovation, particularly in the field of information and communication technologies, to strengthen vital registration and health information systems that underpin accountability for women’s and children’s health.

Next steps for stakeholders

Stakeholders can build on their existing work to achieve more in six focus areas of the Global Strategy. In particular, they can:

• Prioritize implementation, guided by how their commitments contribute to the ultimate goal of saving 16 million lives by 2015. The Commission follow-up will focus on what is actually being done to achieve the desired impact. Its 11 indicators will allow stakeholders to know whether or not they are on track, and how to either consolidate successes or change course if needed.
• Focus on all low-income countries. Korea PDR attracted no commitments, and seven countries attracted only one. By contrast, 15 countries attracted more than 10 commitments each.
• Link commitments to needs, addressing gaps in the coverage of key life-saving interventions. Along the continuum of care, some interventions received fewer commitments, such as postnatal care for mothers, insecticide-treated bed nets and nutrition.
• Invest in innovation to speed up progress. Although 50 stakeholders expressed an interest in innovation, only nine commitments refer to using it to catalyse progress in areas such as leadership and policy, product development and financing
• Develop a common understanding of what a “commitment” is. For example, some stakeholders have based their commitments on new and additional activities, policies and/or financing. Others chose to package a selection of their existing and ongoing RMNCH-related efforts to emphasize their support for the campaign. Some also viewed the commitment-making process as an opportunity to set out intended activities and policies, should future support be available for implementation. Developing a common approach to commitment-making will facilitate better targeting of priorities identified by the Global Strategy.
• Harmonize efforts to avoid duplication and facilitate more efficient use of resources. This will also help address issues that are beyond the capacities of any single country or partner, such as cross-border health emergencies and human rights violations.
• Address structural barriers to, and social determinants of, women’s and children’s health, focusing on gender equality and empowerment. This requires the engagement of many players across sectors working to achieve the Millennium Development Goals and to realize human rights.
• Ensure that future commitments promote health and human rights literacy and health-seeking behaviour. Less than 10% of the commitments have addressed the need to promote health and human rights literacy, and education, so that individuals and communities can have the information they need to make decisions about their health, claim their rights and demand accountability.
• Do more to strengthen community systems and participation, recognizing the essential role communities play in providing health- care, facilitating access to health services, promoting citizen participation and empowerment, advocating for essential interventions and addressing structural barriers to health. Women and children, and their families and communities, cannot be viewed as passive recipients of services. They must be active participants in the realization of their rights.

This report is a first step towards unpacking the commitments made to advance the Global Strategy. While the approach and methods need to be discussed and improved, it is hoped that the report’s findings, and the challenges it identifies, will inform the accountability process, as well as more targeted action and advocacy. It should also help identify areas that can be addressed by the independent Expert Review Group set up to take forward the recommendations of the Commission on Information and Accountability.