Against the backdrop of slow progress towards the Millennium Development Goals concerning maternal and child health, the need for an urgent, global coordinated response has prompted several agencies and international organizations to join forces and create partnerships for maternal, newborn and child health. Over the past few decades, it has become clear that the support required for the development of a resource-constrained country is so multifaceted and complex, that it cannot be successfully taken on by one agency or one Non-Governmental Organization (NGO), alone. The recently established Partnership for Safe Motherhood and Newborn Health aims to strengthen and expand maternal and newborn health efforts. The Healthy Newborn Partnership has been established to promote awareness and attention to newborn health, exchange information, and improve communication and collaboration among organizations beginning to work in newborn health. The first function of these partnerships is to stimulate and sustain the political will to keep the maternal, newborn and child health agenda as a central priority. They do so through dialogue at the highest level of government. The partnerships can also assist in bridging the gap between knowledge and action by facilitating the interaction between policy-makers, researchers, donors and other stakeholders who can influence the uptake of research findings - and orient research towards solving the operational and systemic constraints that hold back the scaling up of effective interventions. Finally, the partnerships can help bring together the various parties involved in maternal, newborn and child health (ministries of health, finance and planning, national non-governmental organizations (NGOs), health professional groups, donor agencies, United Nations agencies, faith-based groups and others), or provide technical support to existing coordination mechanisms. This creates national partnerships through which funding, planning and implementation of national and sub-national maternal, newborn and child health plans can be accelerated.
The requirement for countries to formulate Poverty Reduction Strategy Papers (PRSPs) as a precursor to debt relief and the shared commitment to the Millennium Development Goals have cemented the links between pro-poor policy and maternal, newborn and child health priorities. The shared recognition by both donors and recipient governments of the need for coordination of resources was a critical factor in the early acceptance of sector-wide approach. In many countries NGOs actively engage in maternal and child health, but usually have only limited access to these mechanisms. Building the district health systems required for maternal, newborn and child health, let alone their equivalent in more pluralistic settings, supposes a reasonable degree of macroeconomic and political stability and a reasonable degree of budget predictability. The responsibility for quickly restoring acceptable standards of health services falls on under-resourced ministries of health. In such circumstances the expansion of the network to cover remote areas is far slower and more expensive than would usually be expected. If recurrent costs are underestimated when investment decisions are made, this undermines the sector's long-term sustainability. Providing universal access requires a viable and effective health workforce. Yet, as demand has increased and as more ways of delivering effective treatment and prevention have become available to respond to increasing needs and demand, the size, skills and infrastructure of the workforce have not kept pace. Along with the shortages, it appears that many countries have also witnessed a deterioration in the effectiveness of their workforce. The public expects skills, knowledge and competencies in maternal, newborn and child health care that health workers often lack, putting lives at risk.
The World Health Report 2005 - Make every mother and child count, published by the World Health Organization, examines why these deaths continue to occur on such a scale, and how the annual toll can be reduced. To put an end to widespread exclusion, countries have to guarantee access to care for each and every mother and child - through a continuum that extends from pregnancy through childbirth, the neonatal period and childhood. Universal access for mothers and children requires health systems to be able to respond to the needs and demands of the population, and to offer them protection against the financial hardship that results from ill-health. To make these possible, investments in health systems and in the human resources for health need to be stepped up. The maternal, newborn and child health should constitute the core of the health entitlements protected and funded through public funds and social health insurance systems.
Poverty Reduction Strategy Papers (PRSPs):
Poverty Reduction Strategy Papers (PRSPs) are national planning frameworks for low-income countries. All countries wishing to access concessional loans through the Poverty Reduction Growth Facility (PRGF) or wishing to benefit from debt relief under the Highly Indebted Poor Countries (HIPC) initiative are required to produce a PRSP. It is potentially a very important instrument for the health sector. It is an important entry point for tackling poverty-health challenges in low-income countries. The potential benefits of the PRSP process - or any multisectoral planning process - is that it could provide an opportunity for different sectors to come together, discuss synergies and common challenges, and undertake joint planning of cross-sectoral activities. PRSPs fairly consistently reflect the goals of MDGs, but they do not necessarily reflect the quantifiable targets. One of the key components of the health strategy is to consolidate and develop health services in poor regions. The majority of health strategies presented in PRSPs represent a strengthening of basic health care. It is important to point out that the level of detail varies considerably between PRSPs - in some cases the role of non-government service providers (for-profit and not-for-profit) is rarely discussed. By bringing a poverty reduction lens to the health sector, PRSPs could catalyze a more pro-poor analysis of the health challenges that low-income countries face, including an examination of why existing polices are failing to reach vulnerable groups.
One way forward is to improve links between the PRSP and other processes which can help improve the poverty focus of the health component. Another such process is the development of Health Investment Plans, proposed as part of the follow-up to the Child and Maternal Health (CMH) process. They could provide an important source of information, as well as political momentum, for the creation of health strategies with a greater poverty focus. Greater support from health development partners, links with other processes, and continuing advocacy with higher levels of government, remain essential to achieve MDGs 4 & 5 (reduce child mortality & improve maternal health).
Strengthening links between the analytical work and guidance and capacity-building: World Health Organization (WHO) is one of the key players for health, needs to better link the information and insights from the PRSP desk review with support for PRSP design and implementation at country level. WHO does need to accelerate work on developing tools and guidance which are useful at country level, including tools which countries can use to monitor progress in the implementation of PRSPs. Such guidance should look beyond health to other sectors (education, transport, water etc.) and be linked to existing and MDGs and work to build an evidence-base on health and poverty determinants at country level. Tools and guidance should be linked to capacity-building and advocacy at country level. Moving forward on this issue within the health sector could help to strengthen collaboration across sectors. There is also a substantial amount of literature exists on the ongoing work to frame and monitor PRSPs from a human rights perspective and in many civil society organizations. In the short term to provide technical input the tasks are:
- Providing input on the next draft of the framework.
- Identifying countries for follow-up case study work.
- Helping to establish stronger collaboration between World Health Organization (WHO), the International Monetary Fund (IMF), and other donor groups and organizations doing similar work on financial monitoring of PRSPs.
- Establishing mechanisms to improve sharing of data and resources.
- Exploring the issue of how to define pro-poor health spending.
Poverty Reduction Strategy Papers (PRSPs) should prioritize those health interventions most likely to improve the health of the poor(est) and help to reduce poverty. The World Bank emphasizes that PRSPs should be written and produced by countries themselves, and should go beyond macroeconomics stabilization and liberalization to address issues of poverty and equitable growth. However, PRSPs must also be approved by the Boards of the World Bank and the International Monetary Fund (IMF) before access to debt relief and concessional lending is granted. Moreover, Bank and Fund consultants often assist in the drafting of PRSPs. This suggests - and country experience confirms - that to a certain extent PRSPs must conform to Bank/Fund interpretations of "sound economic policy".
Poverty, maternal mortality/morbidity and child mortality cannot be eradicated without gender equality and women's empowerment, and this would require a change of traditional and cultural gender norms. Nothing illustrates the disastrous effects of gender discrimination more starkly than the maternal mortality/morbidity and HIV/AIDS pandemic in the developing countries. Women need action, resources and Governments that protect and advance their human rights effectively. The critical areas of concern are even more complex and intertwined, but the major dimensions of gender equality and women's empowerment remain economic empowerment, well-being and decision-making. Equal pay and women's integration in non-traditional sectors are still an exception to the rule. In the new millennium, transnational corporations have enormous power. Only by investing in the world's women we can expect to achieve Millennium Development Goals (MDGs) by 2015.
The Commission on the Status of Women, at its forty-ninth session in March 2005, adopted wide-ranging resolutions on improving women's status, including gender mainstreaming in national policies and programs. While the gender gap in education has narrowed, severe gaps in the quality of education remain especially for indigenous populations. Despite progress in basic education, girls and women still face inequality, particularly as far as access to higher education. Other problems are related to school dropout, high illiteracy rates, and gender stereotyping. Laws can influence allocation of resources, and progressive Women's Healthcare Legislation is more than just care and treatment.
The wide acceptance of the Millennium Development Goals (MDGs) by the international community confirms the central role of human development, including health and nutrition, in combating poverty. As countries develop and implement their Poverty Reduction Strategies (PRS), one of the key challenges is to identify actions that will have the greatest impact on poverty and improve the lives of poor. The challenge is compounded by the fact that poverty has many dimensions, cuts across many sectors, and is experienced differently by women and by men. In no region of the developing world are women equal to men in legal, social and economic rights. Gender gaps are widespread in access to and control of resources, in economic opportunities, in power and political voice. Gender equality is a development objective on its own - it also makes good business sense as it is central to economic growth and sustainable development.
Safe Motherhood is back at the top of the global health agenda. Today the interventions already exist to transform the lives of millions of mothers and children and to prevent millions of tragically premature deaths and disabilities. With the increasing integration of the world economy, issues of research and development in health sector has assumed a global dimension. Working towards universal coverage of maternal, newborn and child health interventions is our mission. People want and societies need mothers and children to be healthy. That is why every mother and every child counts so much in our ambitions for a better tomorrow. This work is important and must continue. We tend to collect, analyze and spread the evidence that investing in health is one major avenue towards poverty alleviation. The diverse interests of a big project/program guarantee the liberty of all. Opportunity entails responsibility. Working together we have the opportunity to transform lives now debilitated by disease and fear of economic ruin into lives filled realistic hope. Those of us who commit our lives to improving health can help to make sure that hope will predominate over uncertainty in the century to come.
- The WHO, ICM, FIGO Pledge
Making Pregnancy Safer: The Critical Role of the Skilled Attendant (pdf)
- World Health Organization
PRSPs: Their Significance for Health: Second Synthesis Report (pdf)
- World Health Organization and World Bank
BUILDING STRATEGIC PARTNERSHIPS IN EDUCATION AND HEALTH IN AFRICA (pdf)
- International Monetary Fund (IMF)
Debt Relief Initiative & The IMF
- United Nations Commission on the Status of Women
Department of Economic and Social Affairs
Women's Health and Education Center (WHEC)