Governments, foundations, businesses, multilateral organizations, non-governmental organizations and health care professional associations have publicly pledged more than $ 40 billion* to improve maternal and child health and save million of lives this year.
How do you ensure that they will live up to these commitments?
One way is to bring all of the stakeholders together -- from government to civil society to academia to health professionals to the UN -- to develop concrete strategies for action on financing, policies and service delivery.
This is the goal of a "Pledges to Action" meeting to be held in New Delhi this weekend, 13-14 November, a global meeting of The Partnership for Maternal, Newborn & Child Health (PMNCH), representing all of key stakeholder groups
PMNCH is an independent alliance of 350 partner-organizations based at the World Health Organization in Geneva. It brings together six different constituency groups from governments and civil society to foundations and academic institutions.
The Delhi meeting, hosted by the Government of India, follows closely from the launch of the Global Strategy for Women's and Children's Health by the UN Secretary-General Ban Ki-moon at the UN General Assembly in September.
This outreach has generated $40 billion in commitments towards meeting the Millennium Development Goals -- a landmark achievement for women and children's health.
* For list of commitments, please go to the Hoffman & Hoffman Worldwide website: http://www.hoffmanpr.com/world/PMNCH/Commitments/
PMNCH has been central in developing both the content of the Global Strategy and in mobilizing financial commitments. PMNCH members will now play a critical role in following up, including further development of commitments and encouraging accountability for those pledges made.
"These commitments have been a critical turning point in the fight to save millions of lives of women and children," says Flavia Bustreo, MD, Director of PMNCH.
"For the first time, we have had significant sums of money pledged to women's and children's health from a broad range of partners. It's a great sign of faith in the progress that countries are making towards achieving the MDGs. Now, the task for PMNCH is to spur a drive from these commitments to action. The first task is to support a common approach in the accountability process, so everyone is doing, looking at, and measuring the same things."
Countdown to 2015: key mechanism for tracking progress
One of the key mechanisms for tracking progress on women's and children's health is Countdown to 2015, a global movement of academics, governments, UN agencies, foundations, health care associations and nongovernmental organizations formed in 2005 to track progress and analyzes data from the 68 countries that account for more than 95 percent of maternal and child deaths.
Countdown to 2015 adds value by forging a clear, evidence-based consensus on priority interventions and coverage indicators, and by providing a mechanism for holding countries and their partners accountable for results.
The Countdown to 2015 Decade Report (2000-2010) was released in June, offering country-by-country indicators of progress in meeting women's and children's health goals. Countdown co-chair Zulfiqar Bhutta, MD, of Aga Khan University, Pakistan, will give a keynote address at the Delhi meeting highlighting the critical role of evidence-based advocacy in accelerating action for women's and children's health.
Many countries are on the way to meeting their goals, but a substantial number of countries, especially in Sub-Saharan Africa and South Asia, have made insufficient progress, according to 2010 Countdown report.
India, however, has made steady recent progress in advancing towards its MDG goals, aided in part by innovative policies that support poor women in seeking professional care during pregnancy and childbirth. As a result, newborn deaths have decreased and facility-based deliveries have risen substantially over the past five years.
Says India's Minister of Health and Family Welfare Ghulam Nabi Azad: "The Partners Forum meeting is both important and timely as we approach 2015 - the target year for achieving the Millennium Development Goals. This conference can provide further momentum in making more rapid progress towards the MDGs. Considering the tremendous contribution The Partnership is making towards maternal and child health, we look forward to closer engagements with it, this year and beyond."
Mobilizing action and accountability
A breakdown of the $40.3 billion pledged by stakeholders at the September launch of the Global Strategy shows that $17.3 billion came from upper and middle-income countries; $8.6 billion from the 49 lowest-income countries; $6 billion from non-government organizations and charities; $5 billion from the UN and other multilateral organizations; $2.3 billion from global philanthropic organizations; $1 billion from the business community; and $31 million from health care professional associations.
PMNCH's constituency groups have been instrumental in this process.
Civil society members of PMNCH, non-governmental organizations and other charitable groups, pledged more than $6 billion to the Global Strategy. This figure includes commitments to develop and evaluate innovative approaches to delivering health and social services for all; strengthen local capabilities to scale-up implementation of proven interventions; educate and engage communities; track progress and encourage stakeholder accountability; and advocate for increased attention to women's and children's health.
Ann Starrs, co-chair of PMNCH and president of Family Care International, was instrumental in facilitating these commitments on behalf of her community. Says Starrs: "NGOs helped shape the Global Strategy as it was being written, and we pledged more than 15 percent of the total announced in September. Moving forward we will play an equally central role in implementing the Global Strategy. The Partners' Forum in Delhi presents a critical opportunity to foster consensus and develop plans among global, regional and country partners for immediate action."
Several of PMNCH's constituency groups will hold meetings in Delhi in conjunction with the Partners' Forum. This will include health professional associations, convened by Dr. Andre Lalonde of the Society of Obstetricians and Gynecologists of Canada and Bridget Lynch, President of the International Confederation of Midwives.
Academic and training institution members of PMNCH, will be convened by Prof. Vinod Paul, MD, of the All India Institute of Medical Sciences (AIIMS) and Jane Schaller, President of the International Pediatric Association.
Professor Paul, a world-renowned neonatologist, is a co-chair of PMNCH as well as Chair of the Pledges to Action programme committee. He will give the opening remarks at the meeting, which begins on Saturday 13 November.
2010 Global Campaign Report
Another highlight at the Partners' Forum will be the release of the 2010 Report of the Global Campaign for the Health MDGs by the Network of Global Leaders who are working to improve maternal and child health.
At the launch of The Global Strategy for Women's and Children's Health at the UN in September, the world's 49 lowest-income countries accounted for more than one-third of the financial commitments pledged by governments. The Global Campaign Report focuses on translating commitments into action. This year's report features statements by a group of world leaders who explain how they plan to implement their commitments and their approach to holding themselves and others accountable for making progress. The report points out that accountability is essential to meeting the MDGs, for accountability "ensures that promises made become promises kept."
Effective accountability must involve all stakeholders—governments, donors, multilateral agencies, philanthropic institutions, NGOs, the private sector, and health care professionals—and should meet three principles, according to the report:
- Accountability must be tied to measuring results, especially outcomes and impact.
- Because accountability requires national leadership and ownership, MNCH accountability should be tied to national health strategies and national monitoring and evaluation efforts.
- Existing country- and global-level accountability mechanisms and processes should be built on, enhanced, and strengthened.
The 2010 Global Campaign Reports emphasizes the need for accurate reporting of births and deaths, which currently does not exist in many low and middle-income countries. Accurate statistics on births, deaths, and causes of deaths are needed to provide evidence for any improvements in health and to measure progress toward meeting the MDGs.
Innovation in information technology, including deeper penetration of broadband access, provides new opportunities to improve civil registration systems in countries through on-line health records and public health information. The challenge will continue to be to ensure that such efforts are driven by need rather than technology alone.
Dr. Richard Sezibera, Minister of Health of Rwanda, will be attending the Delhi meeting to participate in a special working lunch of health ministers, and to represent the Accountability Working Group of the Global Strategy, which Rwanda co-chairs with the Government of Canada and the World Health Organization.
Rwanda is a global leader in the use of mobile technology for strengthening health systems, implementing a real-time alert SMS system for tracking the maternal and neonatal life cycles. Critical points are documented, and sent electronically to a central database, with an auto-response alert of each critical event sent to the nearest health centre. Maternal deaths, for instance, trigger alerts in the system that then automatically prompt the supervising health facility to initiate a maternal death audit.
Says Dr Sezibera: "These innovative community health-care systems ensure that an ever-increasing number of people will have access to affordable health services."
Forging a working partnership
Another Partnership Forum goal is to reaffirm the principles of partnership so that all partners recognize the need to engage, so that the "Global Strategy" becomes a true partnership of all members, and not solely a United Nations process.
"We need to harmonize our efforts to support countries in making progress on maternal and child health, while seeking to reduce the burden they currently face in reporting to donors on multiple indicators in multiple formats," says PMNCH Chair Julio Frenk, MD, Dean of the Harvard School of Public Health. "This is a multi-stakeholder process and we need to ensure mutual accountability."
The Global Strategy tasks the World Health Organization with convening a process with partners to identify the most effective way forward in global reporting, oversight, and accountability on women's and children's health.
Immediate next steps will be to develop a high-level process to address all aspects of accountability for the health of women and children. Recommendations arising from this process will be brought to the attention of ministers of health during the World Health Assembly in May 2011, with final recommendations and action points provided to the G8 Summit in June 2011 and the UN General Assembly meeting in September 2011.
Upholding goals of the Global Strategy
Among those topics to be addressed at the Partners Forum will be how best to monitor the ambitious health goals set out in the Global Strategy to be achieved in 2015 alone:
- Number of new users of family planning. The goal is 43 million new users;
- Number of new mothers supported by a skilled birth attendant. The goal is 19 million more women;
- Number of additional treatments for neonatal infections. The goal is 2.2 million more treatments;
- Number of newborns exclusively breastfed for the first six months of life. The goal is 21.9 million more infants.
- Number of children under 5 who receive vitamin A supplements. The goal is 117 million more children;
- Number of children protected from pneumonia. The goal is 40 million more children;
- Number of new health facilities, including heath centers, and district and regional hospitals. The goal is 85,000 additional health facilities;
- Number of additional health workers. The goal is between 2.5 and 3.5 million new workers, including nurses, midwives, physicians, technicians, community health workers, and administrative staff.
In addition to tracking health indicators and outcomes, it also important to monitor key inputs to this process, such as financial investments, supportive policies and laws, and health system service delivery, which enable such outcomes to be achieved.
An impressive gathering of partners
More than 700 partners from 35 countries have registered for the conference, where UN Secretary-General Ban Ki-moon will deliver a welcome message.
Other featured speakers include Pratibha Devisingh Patil, President of India; Margaret Chan, Director-General of the World Health Organization; Bience Gawanas, Social Affairs Commissioner of the African Union; Jose Angel Cordova Villalobos, Minister of Health of Mexico; and Purnima Mane, Deputy Executive Director at UNFPA, speaking on behalf of the four agencies that make up the "Health 4, or H4", i.e., WHO, UNICEF, UNFPA and the World Bank.
PMNCH Director Flavia Bustreo will introduce the Global Strategy and Julio Frenk, Chair of PMNCH, will offer next steps to be taken toward meeting the goals.
The Partners Forum follows closely the mHealth Summit in Washington, DC, where the use of mobile technologies, even basic cell phones, to help meet the MDGs is being considered. A pre-Forum session will also explore how mobile technology can help advance women and children's health.
In addition, an "Innovation Showcase" at the Forum will demonstrate recent innovations from many parts of the world that have potential to improve women's and children's health.
The 15 featured innovations include: an SMS Sex Education program from Indonesia; pocket-sized mobile ultrasound scanners; an inexpensive incubator for premature and/or low birth-weight babies that works without electricity; and the Life Straw, which removes 99.9 percent of waterborne bacteria and 98.7 percent of waterborne viruses and is powered only by suction.
Norwegian Prime Minister Jens Stoltenberg launched the Global Campaign for the Health MDGs in 2007 with the specific goal of increasing and sustaining the financial and political commitments made for the health MDGs. The Network of Global Leaders, including the Presidents of Mozambique, Tanzania, Brazil, Liberia, Senegal, Indonesia, Prime Minister Stoltenberg and Graça Machel, Founder and President of the Foundation for Community Development in Mozambique, guides the campaign, providing political support and advocacy for the health MDGs.
Because the leaders consider 2010 a turning point for improving maternal and child health, the 2010 Global Campaign Report focuses on commitments made and the need for accountability. For the report, a group of leaders state how their countries or organizations will honor their commitments and hold themselves accountable for progress.
In addition to the financial pledges, the report also highlights other types of commitments, including:
- Intel, by working with local governments, NGOs and telecom providers, is offering internet access to Bangladeshi women in remote villages;
- The UK is creating an Independent Commission for Aid Impact to monitor the use of its aid resources and will publish information online;
- The Bill and Melinda Gates Foundation and the governments of he UK, Australia and US have formed an alliance to support the efforts of high-need countries to reduce unintended pregnancies, maternal and newborn mortality.
Looking forward, the report lays out a 2011 roadmap of regional and global events that offer opportunities to focus world attention on the health of women and children and support efforts for all countries to meet the health MDGs, culminating with the September UN General Assembly where the recommendations and action points of the WHO-convened high-level process for accountability will be presented.