Accountability for Women’s and Children’s Health

The iERG 2012 report

iERG recommendations

In their first 2012 report, the iERG make six recommendations for improving the effectiveness of the accoutnability framework developed by the Accoutnability Commission:

Strengthen the global governance framework for women’s and children’s health.

To maximise the impact of multiple initiatives in women’s and children’s health, and to ensure coordination and coherence in their implementation, we recommend that a more formal global governance (or guidance) framework for women’s and children’s health be established. At present, there is a governance gap that must be filled by a mechanism inclusive of partner countries, multilateral agencies, donors, non-governmental organisations, health professionals, researchers, foundations, and the private sector. We advocate a renewed effort to promote effective interaction and cooperation between all partners dedicated to improving women’s and children’s health.

Devise a global investment framework for women’s and children’s health.

The case for stronger accountability mechanisms to track resources for women’s and children’s health was one of the main conclusions of the Commission on Information and Accountability. But how will the needs for priority countries be fully costed and met? The likelihood is that a financing facility for women’s and children’s health will be established in the near future. The creation of a financing facility without a clearer idea of country needs and priorities would be a mistake. We recommend the creation of a global investment framework, taking account of national investments and allocations, to guide a more targeted and strategic approach to supporting women’s and children’s health. The success of the investment framework that exists for AIDS provides one possible model for doing so.

Set clearer country-specific strategic priorities for implementing the Global Strategy and test innovative mechanisms for delivering those priorities.

Priorities across the continuum of care need to be sharpened during the 3 years remaining until the MDG target date of 2015. We make recommendations for reproductive health (contraceptive information and services, sexual health, and safe abortion services); maternal health (skilled birth attendants, facility-based delivery, emergency obstetric care, and postpartum care); stillbirths (addressing the complications of childbirth, maternal infections and diseases, and maternal undernutrition); newborn health (addressing the complications of preterm birth); child health (targeting pneumonia, diarrhoea, and malaria); and adolescent health (sexuality education and universal access to reproductive health services). We also recommend innovative approaches to scaling up coverage through equity-focused initiatives, community mobilisation, integration of services (especially with AIDS programmes), using the mass media, and poverty alleviation (such as conditional cash transfer schemes).

Accelerate the uptake and evaluation of eHealth and mHealth technologies.

The potential for digital technology to accelerate improvements in women’s and children’s health is great—notably, in supporting country civil registration and vital statistics systems. Although eHealth and mHealth have generated much attention, the evidence on which to base decisions about implementation and scale up are weak or nonexistent. We urge partners to assist countries with the development and implementation of national eHealth plans, to focus on sustainable long-term investments in eHealth, to encourage coordination between providers, and to support evaluation.

Strengthen human rights tools and frameworks to achieve better health and accountability for women and children.

Human-rights based approaches have a crucial, but neglected, part to play in the delivery of the Global Strategy. A human-rights based approach provides not only a goal but also a process to reach that goal. In 2011, the Committee on the Elimination of Discrimination against Women became the first UN human rights body to state that countries have an obligation to guarantee, and take responsibility for, women’s timely and non-discriminatory access to maternal health services. They wrote: “The right to health means the availability, accessibility, acceptability, and quality of health care, as well as tackling the underlying determinants of health. Women and children have the right to hold States accountable for the health care they provide”. This decision was an important turning point in strengthening accountability for women’s health. We recommend that human rights treaty bodies that interface with health routinely incorporate the health of women and children into their work.

Expand the commitment and capacity to evaluate initiatives for women’s and children’s health.

Evaluation is a key component of accountability. We recommend that partners accelerate their work to establish a global research network to support the Global Strategy. Without reliable evidence, openly and freely accessible, to inform what works for women and children (and what does not), results will fall short of expectations and resources will be wasted. We also urge research funders to invest more in women’s and children’s health. Research itself can be a powerful accountability tool. We see evaluation—the relentless pursuit of results—becoming one of the foundations of effective independent accountability.