CIS Team

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Keeping promises to women and children
Measuring results on MDGs 4 5 The role of
parliamentarians
Dr Flavia Bustreo Assistant Director General
Family, Women and Children's Health
Cluster World Health Organization
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Outline

1. The MDGs, progress towards MDGs 45
2. The Global Strategy on women's and children's
   health
3. Accountability for women's and children's health
4. Implementation of commitments to the Global
   Strategy
5. The role of Parliamentarians in advancing the
   implementation of the Global Strategy and holding
   stakeholders to account

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The MDGs and women's and children's health
MDG 3 Promote Gender Equality and Empower
Women
MDG 4 Reduce Child Mortality Reduce by 2/3 the
under 5 mortality rate, between 1990 and 2015
MDG 5 Improve maternal health 5.A Reduce
maternal mortality by 75 from between 1990 and
2015 5.B Achieve, by 2015, universal access to
reproductive health
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A great challenge

• EVERY YEAR
• 7.6 million children die before their 5th
  birthday
• 3.2 million newborn babies in the first month of
  life
• 2.4 million infants between 1 12 months
• 356,000 women die due to complications of
  pregnancy and childbirth
• 3 million stillbirths

These are silent tragedies that have to be
prevented
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We know where children die

• About 49 of all child deaths occurred in Africa
  and 33 in South-east Asia
• More than 50 of all child deaths were
  concentrated in just six countries India,
  Nigeria, DR Congo, Pakistan, China and Ethiopia

Sources (1) Levels and Trends in Child
Mortality, UN-IGME Report 2011 (2) Figure
Black et al. Child Survival Series. Lancet, 2003
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We know why children die
Causes of deaths in children under 5 years (7.6
million deaths every year/ around 21,000
preventable deaths every day)
Figures adapted from Countdown to 2015, Decade
report. 2010.
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We know where maternal mortality is highest
Source Estimates of maternal mortality levels
and trends 1990-2008. WHO/UNICEF/UNFPA/World
Bank, 2010
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and causes of maternal deaths
Causes of maternal deaths (350 deaths every
year/around 1000 preventable deaths every day)
Figures adapted from Countdown to 2015, Decade
report. 2010.
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Effective interventions are available

• Preventive interventions
• Family planning
• Antenatal care
• Skilled care at birth
• Postnatal care, mother and baby
• Early initiation and exclusive breastfeeding for
  6 months
• Complementary feeding
• Immunization
• Insecticide treated bed-nets
• Prevention of mother to child transmission of HIV

• Treatment interventions
• Emergency Obstetric Care
• Neonatal resuscitation
• Care of LBW babies and sick newborns
• ORT and zinc for diarrhoea
• Antibiotics for dysentery
• Antibiotics for pneumonia
• Anti-malarials
• Treatment of STIs and Antiretroviral treatment
  for HIV

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But coverage is low
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Inequities are great
Poorest quintile
Richest quintile
Access to services
Source 42 countdown countries, survey data
2000-2009.
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Use of contraception is lowest among poorest
women,those with less education, and living in
rural areas
Source UN MDG Report, 2010
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Regional trends and variationin adolescent birth
rate
Adolescents are particularly vulnerable
Particularly in the poorest countries
(Source United Nations, World Contraceptive Use
2005 2006)
(Source United Nations Population Division 2010)
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The good news

• 19 of 68 Countdown countries on track to achieve
  MDG4
• 17 countries have reduced child mortality by at
  least 50
• 47 countries have accelerated progress since 2000

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The good news

• 5 Countdown countries are on track to achieve MDG
  5 and 32 countries are making progress
• However, progress is insufficient especially in
  sub-Saharan Africa
• For every woman who dies there are 20 who suffer
  injuries, infection and disability

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The promises

• Adoption of the Millennium Declaration - 189
  countries endorsing 8 Millennium Development
  Goals (2000)
• 2005 Start of Countdown to 2015 Tracking
  progress in maternal, newborn and child survival
  Launch of the Partnership for Maternal, Newborn
  Child Health (PMNCH)
• G8 Muskoka initiative - commitment of US 7.3
  billion in new and additional funding for MDGs 4
  and 5 (2008)
• UN Secretary General's Global Strategy for
  Women's and Children's Health (2010)
• Commitments to implement the strategy of over US
  40 billion
• Commission on Information and Accountability for
  Women's and Children's Health - 10
  recommendations and global oversight (2011)

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and the way forward

• By 2015
• Saving 16 million lives of women and children
• Preventing 33 million unwanted pregnancies
• Protecting 88 million children from stunting
• Protecting 120 million children from pneumonia

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Together we must make a decisive move, now,
to improve the health of women and children
around the world. We know what works"
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Renewed commitments
93 commitments made in 2010 amounting to over US
40 billion 39 Low-income countries 21 NGOs 15
high income countries 14 foundations 14
business community
Many new commitments were announced at the Every
Woman Every Child first year anniversary. 29
Low-income countries 4 high income countries 12
UN and partnerships 2 philanthropic
institutions 40 NGOs civil society 15
business community 11 HCW and academic
institutions
Graphs of commitments http//www.who.int/pmnch/to
pics/part_publications/2011_pmnch_report/en/index4
.html
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But uneven attention for 49 countries in need

• 15 countries (31) attracted more than 10
  commitments
• 8 countries attracted only one or no commitment
• India attracted 24 commitments

Geographical distribution of commitments with
respect to progress on MDGs 4 5a
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Key areas where action is urgently needed

1. Support to country-led health plans
2. Integrated delivery of quality health services
   and life-saving interventions
3. Stronger health systems, with sufficient skilled
   health workers at their core
4. Innovative approaches to financing, product
   development and the efficient delivery of health
   services
5. Promoting human rights, equity and gender
   empowerment
6. Improved monitoring and evaluation to ensure the
   accountability of all actors for resources and
   results

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Driving progress The continuum of care
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Accountability

• Commission established by UN Secretary General in
  Jan 11
• Co-chaired by President of Tanzania and Prime
  Minister of Canada
• Supported by 2 working groups results and
  resources
• Commission's report advance release in May 2011
• Ten recommendations to monitor results and track
  resources

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Accountability

• Recommendations discussed in high level meetings
  - G8, World Health Assembly - resolution WHA
  64.12, Busan
• Agreement to focus follow-up on 74 countries - 49
  lowest income countries (Global Strategy) 25
  additional high burden countries (Countdown)
• Commission's report officially released by Dr Ban
  Ki-Moon, September 20, 2011
• Independent expert group announced

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Measuring results

• Vital events By 2015, all countries have taken
  significant steps to establish a system for
  registration of births, deaths and causes
• Health indicators By 2012, the same 11
  indicators across the continuum of care
  reproductive, maternal, newborn and child health,
  including HIV
• Innovation By 2015, all countries have
  integrated the use of Information and
  Communication Technologies

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Tracking resources

• Resource tracking By 2015, all 74 countries
  where 98 of maternal and child deaths take place
  are tracking and reporting, at a minimum, two
  aggregate resource indicators
• Country Compacts By 2012, in order to facilitate
  resource tracking, compacts between country
  governments and all major development partners
• Reaching women and children By 2015, all
  governments have the capacity to regularly review
  health spending

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Better oversight

• National oversight By 2012, all countries have
  established national accountability mechanisms
  that are transparent, that are inclusive of all
  stakeholders, and that recommend remedial action,
  as required.
• Transparency By 2013, all stakeholders are
  publicly sharing information on commitments,
  resources provided and results achieved annually,
  at both national and international levels.

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Putting recommendations into action

• Multi-stakeholder work plan developed through
  consultative process with all interested
  partiesCosts US 88 million
• Roles and responsibilities for many partners
  H4, global health partnerships (PMNCH, HMN,
  GAVI, others), Parliamentarians, civil society
  organizations, academics and researchers, country
  representatives, private sector
• Funding commitments for implementation made by
  Norway, Canada and United Kingdom

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Key steps in follow-up at country level

• Development of national plan to augment
  information and accountability
• Monitoring 11 core results indicators HMIS,
  surveys, use of ICT
• Strengthening registration of births and deaths
• Quality assessments maternal and perinatal
  deaths reviews, quality of care surveys
• Tracking financial resources domestic and
  external commitments, expenditures
• Development of a national digital health strategy
  
• Annual review and action with all relevant
  stakeholders incl. human rights bodies
• Advocacy National Countdown conferences,
  parliamentarians, community participation

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All have a role to play
Parliamentarians
Govt / Policy makers
UN agencies
Women and children
Health care workers
Business community
Academic /research institutions
Donors
Civil society
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Role of Parliaments and Parliamentarians

• Through core functions
• Representing the voice of women and children
• Women's and children's health caucus
• Advocating for MDGs 4 and 5, nationally and
  internationally
• Legislating to ensure universal access to
  essential care
• harmonization of legislation with international
  human rights standards
• Removal of user fees, implement social health
  insurance, address discrimination, etc
• Budgeting for maternal, newborn and child health
• Gender and human rights sensitive budgeting
• Budget lines for women's and children's health
• Holding the government to account for
  implementing policies
• Public hearings and systems for redress
• Collaboration with civil society

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Case study Mexico Parliamentarians taking action
Ensuring accountability for maternal health by
tracking public spending

• Analysis of how maternal and child health is
  reflected in public budgets by independent
  organization (Fundar)
• Selected findings
• Not enough focus on the birth and neonatal period
• Delivery of services did not sufficiently target
  high-risk groups such as indigenous rural women
• Not enough investment in infrastructure
• Dissemination to public and dialogue with
  parliamentarians has helped make maternal
  mortality a high-profile political issue
• EmOC now included in package of services offered
  by national health insurance program

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Case study Vietnam Parliamentarians taking action
Removing financial barriers to child health care
through legislation

• Implementation of 2002 Health Care Fund for the
  Poor supported through legal protection
• Law on Child Protection, Care and Education
  (2004) Art. 15 all children under 6 legally
  entitled to free health care
• National Health Insurance Law (2009)
• Parliamentarians critical in
• ensuring multi-sectoral and participatory legal
  drafting process
• monitoring through (1) regular consultation with
  central level government (2) monitoring missions
  at provincial, district and local levels (3)
  regular reporting to Parliament by MoH

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Case study Cambodia Parliamentarians taking
action
Parliamentarians raise awareness of women's and
children's health

• National Assembly and Senate caucused on women's
  and children's issues
• Improving children's health and addressing child
  labour
• Determined that most important challenge is
  maternal mortality, conducting joint field
  missions to inform dialogue and action in
  parliament

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Parliamentarians can take action now

• For every woman and every child to realize their
  right to health and health care