Message from the Chair: The iERG: an innovation in accountability
Source: The Global Campaign for the Health Millennium Development Goals – Report 2013
January 22, 2013
As the era of the Millennium Development Goals draws to an end, it is right that countries and the global community compose a balance sheet of credit and debit. To proceed with confidence beyond 2015, towards sustainable development, we need to understand what has worked and what has not in our efforts to defeat diseases of poverty.
Undoubtedly, progress has been achieved in many areas. Spectacular reductions in under-five child mortality show what can be achieved when the global community displays political will, a commitment to translate research evidence into practice and an ability to scale up interventions for effective and equitable coverage.
But not all spheres of global health have shown similar progress. Reductions in maternal mortality have taken place but are hampered by persistent weaknesses in struggling health systems. In recognition of the need to hold all partners accountable for their promises to make progress, the Commission on Information and Accountability for Women's and Children's Health established (in 2011) an independent Expert Review Group (iERG) to monitor progress, to review successes and obstacles to success, and to offer remedies to overcome those obstacles. The iERG published its first report in 2012.
The iERG, co-chaired by Joy Phumaphi and myself, Richard Horton, made six recommendations to accelerate improvements in reproductive, maternal, newborn and child health.
First, the welcome proliferation of initiatives around MDGs 4 and 5 mean that global governance frameworks for women's and children's health must be strengthened to avoid fragmentation, duplication and inefficiency.
Second, to take advantage of commitments already made, a global investment framework for women's and children's health should be devised. This framework will identify the most cost-effective interventions, as well as critical enablers, to ensure that interventions are fully and effectively delivered.
Third, to speed up progress in countries, clearer country-specific strategic priorities need to be set, including testing innovative mechanisms for delivering these priorities.
Fourth, countries, with the help of partners, can make further progress by accelerating the uptake of eHealth and mHealth technologies – e.g. to strengthen civil registration and vital statistics systems.
Fifth, all partners must strengthen human rights tools and frameworks to achieve better health and accountability for women and children. Finally, there needs to be a far greater commitment to evaluation. Unless we know what works and why it works, we will be condemned to repeat failures and to miss opportunities to translate reliable evidence into the service of women and children.
In their second report, to be published at the United Nations General Assembly in 2013, the iERG will review the progress made on these recommendations. They will also focus on two new areas: adolescent health and country accountability. The iERG is a time-bound accountability mechanism, ending in 2015. It is an experiment. But if the value of the iERG can be proven to partners, perhaps the notion of independent accountability could be strengthened further in future arrangements for global health.