Keeping promises to women and children Measuring results on MDGs 4 & 5

1. 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

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

3. 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

4. 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

5. 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 We know where children die … Sources: (1) Levels and Trends in Child Mortality, UN-IGME Report 2011; (2) Figure: Black et al. Child Survival Series. Lancet, 2003

6. 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.

7. We know where maternal mortality is highest … Source: Estimates of maternal mortality levels and trends 1990-2008. WHO/UNICEF/UNFPA/World Bank, 2010

8. … 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.

9. 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

10. But coverage is low…

11. Inequities are great Poorest quintile Richest quintile Access to services Source: 42 countdown countries, survey data 2000-2009.

12. Use of contraception is lowest among poorest women,those with less education, and living in rural areas Source: UN MDG Report, 2010

13. 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)

14. 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

15. 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 …

16. 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)

17. 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 … and the way forward

18. “Together we must make a decisive move, now, to improve the health of women and children around the world. We know what works…"

19. 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

20. 15 countries (31%) attracted more than 10 commitments 8 countries attracted only one or no commitment India attracted 24 commitments But uneven attention for 49 countries in need Geographical distribution of commitments with respect to progress on MDGs 4 & 5a

21. Key areas where action is urgently needed Support to country-led health plans Integrated delivery of quality health services and life-saving interventions Stronger health systems, with sufficient skilled health workers at their core Innovative approaches to financing, product development and the efficient delivery of health services Promoting human rights, equity and gender empowerment Improved monitoring and evaluation to ensure the accountability of all actors for resources and results

22. Driving progress: The continuum of care

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Parliamentarians can take action now For every woman and every child to realize their right to health and health care