07 November 2014

Setting The Foundation for Post-2015

Dr Marie Paule Kieny of the World Health Organization opened the first day of the meeting by sharing how the accountability work has moved from a path-finding exercise when it first started to a place where 65 countries are now implementing accountability frameworks. “Accountability is recognised as being central to discussions on maternal, newborn and child health, but also to health in general” she said, urging all partners to continue this work.

Co-conveners Diane Jacovella from the Canadian government and Tore Godal, Special Advisor to the Norwegian Prime Minister on Global Health, echoed this sentiment. Both Canada and Norway announced significant funding for women’s and children’s health at the UN General Assembly’s announcement of a new Global Financing Facility in support of Every Woman Every Child in September in New York, part of a final push towards achieving the MDGs before the end of 2015, and to buoy the momentum thereafter.

Ms Jacovella spoke of the financing mechanism and reflected on the new Sustainable Development Goals (SDGs): “Women and children are lost in the draft SDGs and we owe it to them to maintain dedication and commitment.” She explained that the new Global Strategy along with the Global Financing Facility presented an opportunity to make a difference and said, “We have a financial mechanism and it is up to us to make sure this mechanism gives us what we want”.

Dr Godal stressed the importance of investing in innovations that can be game changers, as well as the critical role that women play in their countries’ development. Using the Norwegian experience as an example he said, “The role of women in development is amazing and in Norway they are more important to the economy than oil.” All co-conveners stressed that while the new development goals – the SDGs – will address a broader set of issues, it is important not to lose sight of the unfinished business of the MDGs as it refers to maternal and child health.

Moving the agenda beyond 2015

Dr Flavia Bustreo of the World Health Organization provided an overview of the progress made in reducing maternal and child deaths but cautioned that despite the encouraging gains, the MDG targets have not yet been achieved. She pointed out the changing causes of maternal deaths, now being linked to non-communicable diseases, and underlined the need to start looking at health more broadly, and work across sectors to find solutions that go beyond what the health sector alone can achieve.

H.E. Dr Shirin Sharmin Chaudhury, Speaker of the Parliament of Bangladesh and Dr Pedro Crocco, the Director, of Disease Prevention and Control for the Chilean Ministry of Health shared progress in their respective countries as well as challenges they are still facing. H.E. Dr Chaudhury explained that her country was able to make improvements and is on track in the reduction of maternal mortality rates because Bangladesh “identified causes that led to maternal deaths and tried to address them .”

She also emphasized the catalytic role of CoIA funding in helping to improve women’s and children’s health and the role of parliamentarians in ensuring that promises made by the government are being implemented. She pointed out that gender equality, social safety net protection and an integrated approach to health continue to be crucial in reducing maternal and child deaths.

Chile’s approach has been showcased as a successful one in improving maternal and child health outcomes – the country went from being at the bottom of the Latin American region in terms of health indicators to one of the best performers. Dr Crocco emphasized that universal access to health services is the most important step that countries can take to improve outcomes for mothers and children. He also noted that increased political participation by women makes an enormous difference for women’s and children’s health, and development more broadly.

According to Dr Crocco, however, the lack of health workers continues to be a challenge, with public and private health providers in the country competing for limited resources. He highlighted the importance of education, infrastructure, water and sanitation in improving health outcomes in Chile and insisted that a country “cannot have a good health program if you do not involve the community.”

Princess Sarah Zeid put conflicts and other humanitarian emergencies squarely on the agenda, reminding participants that 56% of all maternal deaths take place in fragile states. “This is not unfinished business,” she said, “it is a battle for survival.” She said that across conflict and emergency situations “success is measured in lives saved,” and that support for frontline health workers, birth registration and innovation were imperative in saving lives. She also echoed other participants in urging the audience to move beyond the paradigm of survival to one of “survival and thrival.”

The final speaker was Joy Phumaphi, co-Chair of iERG, who set out the unfinished agenda for women and children naming newborns, stillbirths, sexual and reproductive health and rights, nutrition and health workers as areas that still required focus. Looking beyond 2015, she implored the global community to pay more attention to addressing the social determinants of health as well as inequities. In closing, Ms Phumaphi said that we must “go beyond the continuum of care and appreciate that there is no better framework in which to position ourselves than that of human rights.”

Discussions around the scope and content of the renewed Global Strategy looked at how to ensure that the unfinished MDG agenda is central and that there is a vision that takes us to 2030 that is closely aligned with the SDGs, that goes beyond survival, and that is well integrated with other sectors as currently envisaged in the SDG framework. Participants had an opportunity to discuss all these ideas in working groups. The main outcomes and agreement were collected in a presentation (available from the links on the right).

The session on lessons from accountability included representatives from Government of Cambodia, the OECD, the Inter-Parliamentarian Union and the Centre for Economic Governance and AIDS in Africa. The session concluded with the lessons on accountability from the iERG and from the ‘Every Woman Every Child’ review of accountability mechanisms. Panelists shared important progress in their respective countries and highlighted the need to strengthen the links between global and country accountability processes as accountability work moves forward as a central piece of the efforts to and beyond 2015.

The importance of country leadership was emphasized by Dr Georgina Msemo, Assistant Director of Reproductive and Child Health from Tanzanian Ministry of Health, who showcased how the personal involvement of President Kikwete in the Commission on Information and Accountability has been crucial to prioritizing political and technical support to advance women’s and children’s health in the country.

Financing for the ‘grand convergence’

The session on the new Global Financing Facility (GFF) for women’s and children’s health was equally rich. Dr Tore Godal underscored that aid for health must be systematically linked to national financing, and that country ownership is absolutely critical for achieving sustainable results. This point was reiterated throughout the session, notably by Dr Tim Evans of the World Bank and Ethiopian State Minister of Health, Dr Amir Aman Hagos.

Dr Evans said that in the design of the GFF we need to plan for both the short term and the long term, and the latter involves planning for how countries transition to sustainable domestic financing, gradually covering a larger portion of their health budgets. Dr Evans said that the evolving fiscal reality of countries must be considered very closely, and that, given its close working relationships with Ministers of Finance, the World Bank can add value by helping them to understand “the health sector as an investment, not a drain.”

Minister Hagos described how the Ethiopian government currently finances 16% of the national health budget, but is actively exploring ways to increase this percentage, including through taxation and public-private partnerships, as part of their 20 year health care transformation plan. He also emphasized the importance of global public goods, stressing that a greater share of the research and innovation agenda needs to focus on how to successfully scale up existing innovations.

Anuradha Gupta, Deputy CEO of Gavi (The Vaccine Alliance) also noted the “huge investment deficit” when it comes to “much neglected public goods.” She spoke of some of Gavi’s successes in pooling demand, leveraging volumes, and working with industry as a key stakeholder to drive down prices. She expressed Gavi’s strong support for the GFF saying that it presented an opportunity to address adolescent health, fragmentation of funding, and to lower transaction costs for countries as they streamline their investments for women’s and children’s health, and health systems more broadly. “Verticality,” she said, “is an Achilles heel and we have all been wanting to address this but have failed miserably to do so.”

At the close of the two-day meeting, co-conveners Diane Jacovella, Dr Tore Godal and Dr Flavia Bustreo presented participants with a timeline and concise summary of the discussions. The co-conveners also committed to establishing work streams by the end of November to advance the renewal of the Global Strategy, and to reconvene the larger stakeholder group for another consultation at the end of February.

It is envisioned that the renewed Global Strategy will present a common vision for 2030 and will be launched jointly with the first five-year implementation plan at the UN General Assembly in September 2015, aligning with the adoption of the SDGs. There is a significant amount of work to be done between now and then but all partners agreed with Joy Phumaphi who said that “we are the privileged ones because we have an opportunity to end preventable deaths among women, children, newborns and adolescents for the first time in the history of mankind.”

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