13 July 2020

IAP2020: Interview with Joy Phumaphi

Today, the Independent Accountability Panel for Every Woman Every Child (IAP) launched its 2020 report—“Caught in the COVID-19 storm: progress and accountability for women’s, children’s and adolescents’ health in the context of UHC and SDGs.” The IAP report evaluates the impact of COVID-19 on the health of these vulnerable groups—and, crucially, offers suggestions for how to build back better. To celebrate the report, Every Woman Every Child interviewed IAP co-chair Joy Phumaphi. 

1. Why is the IAP—and this report—so important when it comes to helping women, children, and adolescents and achieving the SDGS? 

A focus on accountability is critically important for delivery of effective health services. The IAP offers  an independent, objective, legitimate and credible review of progress in delivering these services to women children and adolescents.

It offers an opportunity  to assess accountability of states at the national level,  hold accountable stakeholders, including other states and non-state actors, for their transnational commitments to development, such as SDG17. 

With “the commitment to an ongoing public, transparent process of assessment, change and reassessment”, the IAP’s  view is granted credibility, authority and legitimacy by its appointment by the UNSG’s office; as well as the  independence of its review.

This independent review is not a finger-wagging exercise. Rather, it is a constructive, learning process that involves recognizing success and drawing attention to good practice, identifying shortcomings and, as required, recommending remedy and action. The review provides expert evaluation about progress, promises and commitments.

2. The report states that progress was lacking even before the COVID-19 virus spread. Prior to the pandemic, what were the big-picture reasons for a lack of progress, and how will the pandemic affect those gains? 

Unfortunately, most countries were inadequately  protecting Mothers, newborns, children  and adolescents before Covid 19, primarily because for decades, governments and stakeholders have been making inadequate and/ or the wrong type of investments in health and the social determinants of health.

There has been poor governance of health to the extent that globally,  countries are loosing  2 trillion US Dollars per year to inefficiencies and corruption.

We have included 5 case studies in this report, that share some lessons. Each one focuses one  aspect of a major driver of exclusion.

  1. The Kenya case study focuses on health financing and the extent to which out of pocket payments disadvantages and/or excludes the poor
  2. The Papua New Guinea case study demonstrates the importance of engaging communities in the design, delivery, management and assessment of health services 
  3. The Guatemala Case study underscores the importance of removing barriers to accessibility, affordability and culturally acceptable care
  4. The Georgia case study underscores the importance of effective public private partnerships 
  5. The Ethiopia case study demonstrates the importance of community engagements, community based care and use of community health workers in institutionalizing accountability at community level.

Before the pandemic hit, many of our countries were already lagging behind in the health SDGs, and now, with Covid 19; mothers,  newborns, children and adolescent are loosing 20 % of their health and social services.

  • There have been shutdowns of sexual and reproductive health services and attempts  to push retrogressive laws.
  • There has been a stoppage of mass immunization campaigns which has  led to 13.5 million children not being protected against disabling and life threatening diseases.
  • With school closures, 370 million children are missing much needed school meals; and the social isolation is leading to metal health issues, particularly in adolescents.

As the pandemic continues, the situation will be even more critical.

  • We could see a big rise in deaths among pregnant women and young children, by 10 or even up to 50 % due to the disruption in essential services and supplies.
  • For every three months of lockdown, 15million more cases  of gender based violence are anticipated
  • An estimated 42-66 million people could be pushed into extreme poverty, with women children and adolescents disproportionately affected and lacking both financial and social protection.
  • With more women delivering without midwives or post natal care and without access to emergency obstetric care, an additional 168,000 newborn deaths and 24,400 maternal deaths are estimated.
  • With disruptions in under 5 years child health care, over 400,000 additional deaths due to COVID 19 related disruptions are estimated.

3. One of the report findings is that countries with similar resources achieve different results. Broadly speaking, what are some of the main reasons for these disparities?

There is evidence that how countries  invest in health, and the choices they make, for example on evidence- and rights-based laws and policies, investments, and implementation; determine results.

Pre-COVID-19, some countries in the same income category, with lower per capital spending on health; were performing better than others to improve women’s, children’s and adolescents’ health and rights and ensure universal health coverage (UHC). 

For example, the US spends more than twice as much on health than either Japan or France, yet children in the US are more likely to die before their fifth birthday  and women are more than twice as likely to die in childbirth. Nigeria spends around double per capita on health than Tanzania and has similar service coverage (around 40 on the UHC service coverage index). But Nigeria has over double the child mortality rate as Tanzania (120 and 53 deaths per 1000 live births respectively) due in part to sub-national inequalities, and critical gaps in health and multi sectorial service delivery and financial protection.

Progress on the SDGs and UHC has been lagging behind for women, children, and adolescents, for several reasons. There has been insufficient evidence based investments in health systems, to make them robust enough to deliver the results women children and adolescents deserve; or resilient enough to withstand shocks such as the COVID 19 pandemic. Though in the past decade the Every Woman Every child movement has led to the reduction of under five mortality in even the poorest countries; many births of children go unrecorded, making them invisible to planning and resource allocation. Many deaths of women, children, and adolescents go unrecorded, making the problems that lead to their mortality invisible to policy makers and resource allocation and service delivery.

This “blind” development has contributed to:

  • Underinvestment in common goods for health such as legislation, regulation, health surveillance, information and population services, and communication 
  • Only between one third and one half of the worlds population being covered by essential health services including investments for women children and adolescents. More than 900 million people experienced catastrophic health expenditure last year, driving poor people deeper into poverty.
  • 3 billion people still lacking access to basic water, sanction and hygiene facilities. The UN warns that the risk of disruption to the existing services from lockdown endangers health, especially from water borne diseases and the containment of COVID 19.
  • Huge inequities between countries and within countries. There are gaping gaps between the rich and the poor, racial discrimination, ethnic and religious divides, geographical factors that limit access to services. These inequities are worsening with the COVID 19 pandemic, compounded by lack of resources and financial protection.

4. The report highlights the harm that COVID-19 can cause, but also provides three major suggestions: invest in country data systems, institutionalize accountability functions, and democratize accountability. How were these recommendations chosen? 

The IAP has identified the lack of  accountability as the key driver of the failure to deliver on the goals set for  the health and well being of women children and adolescents.  In view of  this, the IAP report sets out an accountability framework with four pillars: Commit, Justify, Implement, Progress. All these pillars must be present for effective accountability: 

Commit: all those who have a responsibility to act must commit to their obligations. 

Justify: actions must be explained on the basis of evidence, rights and the rule of law. 

Implement: core accountability functions of Monitor-Review-Remedy-Act must be implemented. 

Progress: continuous progress towards agreed goals must be ensured, justifying any reversals – the principle of ‘progressive realization’. 

Guided by the above framework, the  actions that governments can take now that will not only mitigate, but help limit further deterioration;  and promote the attainment of the goals for women children and adolescents’ health and well being are as follows:

First, governments should invest in data systems. They must ensure, for example, that all births and deaths are registered, they must monitor the coverage, quality and equity of service coverage.  

Next, accountability must be institutionalized, with a formal relationship between, on the one hand, monitoring, review and recommendations, and, on the other, remedy and action. 

Finally, accountability must be democratized, so that the voices of people and communities are heard and acted upon.