cpa, uk: international parliamentary conference on the millennium development goals. 30 november...

CPA, UK: International Parliamentary Conference on the Millennium Development Goals. 30 November 2011

Keeping promises to women and children Measuring results on

MDGs 4 & 5

The role of parliamentariansDr Flavia Bustreo

Assistant Director General

Family, Women and Children's Health Cluster

World Health Organization


Outline

1. The MDGs, progress towards MDGs 4&5

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


The MDGs and women's and children's health

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

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


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


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


We know why children die …

Figures adapted from Countdown to 2015, Decade report. 2010.

Causes of deaths in children under 5 years(7.6 million deaths every year/ around 21,000 preventable deaths every

day)


Source: Estimates of maternal mortality levels and trends 1990-2008. WHO/UNICEF/UNFPA/World Bank, 2010

We know where maternal mortality is highest …


Figures adapted from Countdown to 2015, Decade report. 2010.

Causes of maternal deaths(350 deaths every year/around 1000 preventable deaths every day)

… and causes of maternal deaths


Effective interventions are available …

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

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


But coverage is low…


Inequities are great

0% 20% 40% 60% 80% 100%

ANC 1+

ANC 4+

SBA

BCG

Measles

DPT3

ORT

Pneumonia care

Family planning

Poorest quintile

Richest quintile

Access to services

Source: 42 countdown countries, survey data 2000-2009.


0

5

10

15

20

25

30

35

40

45

rural urban noeducation

primaryeducation

secondaryeducationor more

poorest20%

second20%

middle20%

fourth 20% richest20%

%

1994-2003

1999-2008

Use of contraception is lowest among poorest women,Use of contraception is lowest among poorest women,those with less education, and living in rural areasthose with less education, and living in rural areas

Source: UN MDG Report, 2010Source: UN MDG Report, 2010


(Source: United Nations, World Contraceptive Use 2005; 2006)

0

20

40

60

80

100

120

140

1990 2000 2007

Ad

ole

sc

en

t B

irth

Ra

te

Developed regions Northern AfricaSub-Saharan Africa Latin America and the CaribbeanEastern Asia Southern AsiaSouth-eastern Asia Western Asia

Regional trends and variationRegional trends and variationin adolescent birth ratein adolescent birth rate

(Source: United Nations Population Division 2010)(Source: United Nations Population Division 2010)

Adolescents are particularly vulnerable

Particularly in the poorest countries


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


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

The good news …


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)


… 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


“Together we must make a decisive

move, now, to improve the health of

women and children around the

world. We know what works…"


Renewed commitments

Graphs of commitments:http://www.who.int/pmnch/topics/part_publications/2011_pmnch_report/en/index4.html

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


• 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

But uneven attention for 49 countries in need


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

Key areas where action is urgently needed


Driving progress: The continuum of care


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


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

Accountability


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 …

Measuring results


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 …

Tracking resources


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.

Better oversight


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

Putting recommendations into action


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


Women and

children

Academic /research institution

s

Health care

workers

Civil society

Govt / Policy

makers

Donors

UN agencies

Business communit

y

All have a role to play

Parliamentarians


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


Ensuring accountability for maternal health by tracking

public spending

Case study Mexico: Parliamentarians taking action

• 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


Removing financial barriers to child health care through legislation

Case study Vietnam: Parliamentarians taking action

• 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


Parliamentarians raise awareness of women's and children's health

Case study Cambodia: Parliamentarians taking action

• 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


Parliamentarians can take action now

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

cpa, uk: international parliamentary conference on the millennium development goals. 30 november...

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