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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
The MDGs and women's and children's health
MDG 3:
Promote Gender Equality
and Empower Women
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
(1) Levels
CPA,Sources:
UK: International
and Trends in Child Mortality, UN-IGME Report 2011;
et al. Child Survival Series. Lancet, 2003
Parliamentary Conference
on the
(2) Figure:
Black
Millennium Development Goals.
30 November 2011
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)
adapted
CPA,Figures
UK: International
from Countdown to 2015, Decade report. 2010.
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
We know where maternal mortality is highest …
Source: Estimates of maternal mortality levels and trends
1990-2008. WHO/UNICEF/UNFPA/World Bank, 2010
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
… and causes of maternal deaths
Causes of maternal deaths
(350 deaths every year/around 1000 preventable deaths every day)
adapted
CPA,Figures
UK: International
from Countdown to 2015, Decade report. 2010.
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
Treatment interventions
 Emergency Obstetric Care
 Neonatal resuscitation
 Care of LBW babies and sick
newborns
 ORT and zinc for diarrhoea
 Complementary feeding
 Antibiotics for dysentery
 Immunization
 Antibiotics for pneumonia
 Insecticide treated bed-nets
 Prevention of mother to child
transmission of HIV
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
 Anti-malarials
 Treatment of STIs and
Antiretroviral treatment for HIV
But coverage is low…
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
Inequities are great
Poorest
quintile
Richest
quintile
Family planning
Pneumonia care
ORT
DPT3
Measles
BCG
SBA
ANC 4+
ANC 1+
0%
20%
40%
60%
Access to services
42 countdown
CPA,Source:
UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
countries, survey data 2000-2009.
80%
100%
Use of contraception is lowest among poorest women,
those with less education, and living in rural areas
% 45
40
35
30
25
20
15
10
5
0
rural
1994-2003
1999-2008
urban
no
primary secondary poorest
education education education
20%
or more
second
20%
middle
20%
fourth 20%
Source: UN MDG Report, 2010
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
richest
20%
Adolescents are particularly vulnerable
Regional trends and variation
in adolescent birth rate
140
Particularly in
the poorest
countries
Adolescent Birth Rate
120
100
80
60
40
20
0
1990
Developed regions
Sub-Saharan Africa
Eastern Asia
South-eastern Asia
(Source: United Nations Population Division 2010)
CPA, UK: International
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Millennium Development Goals.
30 November 2011
2000
2007
Northern Africa
Latin America and the Caribbean
Southern Asia
Western Asia
(Source: United Nations, World Contraceptive Use 2005; 2006)
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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)
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
“Together we must make a decisive
move, now, to improve the health of
women and children around the
world. We know what works…"
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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/topics/part_publications/2011_pmnch_report/en/index4.html
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
Driving progress: The continuum of care
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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 …
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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 …
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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.
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
Putting recommendations into action
 Multi-stakeholder work plan developed
through consultative process with all
interested parties
Costs: 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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
All have a role to play
UN
agencies
Health care
workers
Academic
/research
institutions
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
Govt /
Policy
makers
Women
and
children
Parliamentarians
Business
community
Donors
Civil
society
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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:
–
–
•
Parliamentarians critical in:
–
–
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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)
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
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
CPA, UK: International
Parliamentary Conference on the
Millennium Development Goals.
30 November 2011
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 2011