Commitments to women’s and children’s health come under the spotlight

In a previous blog post I wrote that I had been helping to review a report written by the Partnership on Maternal, Newborn and Child Health (PMNCH).

Today the report – Analysing Commitments to Advance the Global Strategy for Women’s and Children’s Health – is being released at the UN General Assembly in New York and here is my analysis of some of the most interesting findings.

The report  is the first real attempt to evaluate what has actually been promised by governments and other stakeholders over the past 12 months as part of the UN Global Strategy for Women’s and Children’s Health

Greater accountability

Making this information available, PMNCH believes, will help encourage greater accountability and faster action to meet the Global Strategy goal of preventing 16 million deaths in the 49 poorest countries by 2015.

A total of 127 governments and organisations (see them all here) have made commitments to advance the Global Strategy.

Collectively, these commitments are said to be worth more than US$41 billion – almost half the total amount of the US$88 billion needed to implement the Global Strategy.

Priority for health workers

As well as financial commitments, there was a diverse range of commitments to introduce new policies or to scale up access to reproductive, maternal, newborn and child health interventions.

Over half of the stakeholders (66 out of 127) made commitments to increase the number, or build the capacity of health workers.

This focus is welcome because more and better trained health workers, particularly those with midwifery skills, are essential for improving women’s and children’s health (see our new report for more information).

Need to close the gap

Where specific targets were included, the report shows that an additional 45,000 additional health workers are set to be trained as a result of the Global Strategy.

 On first glance, this looks significant. However 30,000 of these health workers will be in just two countries: Kenya and Nepal.

To close the global health worker gap of more than 3.5 million more developing countries must set ambitious targets to increase their health workforce and donors must agree to support countries with more resources and technical assistance.

Improving equity

One of the questions that stakeholders were asked when contributing to this report was whether their commitment made provisions to improve equity of access and outcomes or to reach the poorest and most vulnerable.

PMNCH argue that it is critical to ensure that interventions are targeted to reach those women and children in greatest need, so that the poorest and most vulnerable do not miss out.

Some Global Strategy commitments did specifically address equity and a few interesting examples are illustrated in the report.

Abolishing user fees

Among the most significant are the commitments made by 23 developing countries to abolish user fees for healthcare or to provide some new form of income protection for targeted, poorer and vulnerable groups.

Many developing countries identified funding shortfalls as the most important constraint to the implementation of their commitments.

If countries are to successfully deliver on their commitments to remove user fees and provide social safety nets to the poorest then they must look to increase the proportion of their national budget that is allocated to health and donors must provide more long-term and predictable aid.

Insufficient focus on nutrition

PMNCH plotted commitments along the continuum of care for reproductive, maternal, newborn and child health to see whether commitments were in line with need and designed to address gaps in the coverage of different interventions. They found that a number of key life-saving interventions with the largest coverage gaps received fewer commitments.

For example, there were only three specific references to postnatal care for mothers and newborns and only seven references to exclusive breastfeeding.

There were also relatively few references to nutrition-related interventions. PMNCH note this as surprising given that under-nutrition is an underlying cause of one third of child deaths.

And maternal nutritional status is increasingly recognised as an underlying determinant of not just newborn health but also subsequent adult health.

Next steps

This report is a first step towards unpacking the commitments made to advance the Global Strategy. 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.

2015 is fast approaching and implementation of commitments needs to be supported and prioritised by all stakeholders.

Delivery

In one year’s time stakeholders will be expected to provide more information on what they are actually doing to deliver on their commitments and achieve the desired impact.

To have the maximum impact by 2015, resources need to be allocated and health workers need to be trained sooner rather than later.

If fully implemented, the 127 commitments made will make a significant contribution towards improving the health and well-being of women and children in the poorest countries. However, as the report has noted, there are still some considerable gaps to be filled.

Working together

All stakeholders must work together to more closely link commitments to needs. This will require addressing gaps in the coverage of key life-saving interventions such as nutrition and also ensuring that interventions are equitably distributed to benefit the poorest and most marginalised.

Those stakeholders, particularly governments, who have not yet made their commitment need to do so. Those who have should consider whether their commitment can be expanded and strengthened.

For example, at the UN this week, Save the Children and more that 300 other organisations have been calling for further commitments to close the global health worker gap.

To view the full report and see individual responses from stakeholders (including Save the Children) visit the PMNCH website.