Driving accountability for progress on maternal and child health
A message from Plan Canada's CEO
August, 2011 – Last year at this time, we were reflecting on the successes of the Muskoka G8 Summit in June – with its focus on preventing millions of pregnant women, new mothers, and their young children from dying needlessly every year – and anticipating further progress to come at a meeting of the United Nations member states in September. So many catastrophic events have seized the world's attention since then – from famines, to earthquakes and floods, to violent uprisings and debt crises – that maternal and child health has not made headline news. But we at Plan Canada have been pleasantly surprised by how much is actually moving forward on this front. We are especially encouraged by how seriously the Government of Canada is taking its commitments.
The birth of the Muskoka Initiative
As you'll recall, Plan was one of a consortium of international development organizations that promoted the selection of maternal and child health as the summit's signature issue. Despite the grim statistics, we were and are convinced that this is an area in which real progress can be made. We know what must be done. We know the right mix of simple, low-cost actions – from pre-birth care to effective treatment of common childhood diseases – will deliver measurable results. We celebrated the $7.3 billion pledged by G8 nations to the "Muskoka Initiative" as a promising beginning, while stressing that much more would be required.
But will they follow through?
The theme of accountability for following through and delivering results was front and centre when UN members met last fall. A key outcome of that session was the Global Strategy for Women's and Children's Health. Its goal: to save 16 million lives by 2015 in the world's 49 poorest countries. Financial commitments in the order of $40 billion have now been mobilized in support of this work.
Accountability Commission indicators of maternal, newborn and child health
||Maternal deaths per 100,000 live births
||Under-five child mortality – newborn deaths per 100,000 live births
||Percentage of children under five who are stunted (measured by WHO height-for-age standards)
||Contraception needs met
||Prenatal care provided by a skilled health provider (at least four times during pregnancy)
||Methods in place to prevent HIV transmission; therapy available for HIV-positive mothers-to-be
||Skilled attendant present at births
||Postnatal care provided within two days of childbirth
||Exclusive breastfeeding for infants in their first six months
||Three doses of diphtheria, pertussis and tetanus vaccine for infants between 12-23 months
||Antibiotic treatment for suspected cases of childhood pneumonia
But we are all aware that in the past many such commitments have not been fully honoured or have failed to achieve the expected positive impact on people's lives. The clear message from the September session was, "This is not acceptable." To signal the UN's intent to drive change, the Secretary-General struck a Commission on Information and Accountability for Women's and Children's Health, co-chaired by Jakaya Kikwete, president of Tanzania, and Prime Minister Stephen Harper.
Keeping promises, measuring results
Their report – Keeping promises, measuring results – was released in May. The ten practical actions it recommends are grounded in the principle that national governments are responsible both to their own people and to the global community. The Commission's focus is on creating a system to track whether money earmarked for maternal and child health is in fact being used for this purpose, whether resources are being spent wisely, and whether the expected results are being achieved.
They cite lack of data as a major barrier to planning sound investments and giving donors confidence that funds are being used appropriately. The countries with the poorest records on women's and children's health tend also to have the weakest systems for registering births, deaths and causes of death. This is the "scandal of invisibility": How can you scope the problem, make wise decisions and measure improvement if the vast majority of births and deaths go unrecorded?
On the positive side, the report notes the potential of communication technology to enable a great leap forward in collecting and analyzing critical information. In Senegal, for example, community health workers are using hand-held devices to record data in the field and send to a centralized repository for analysis and use by decision-makers. One district reported data that took two weeks to collect on paper is now recorded and transmitted in one hour.
The Commission urges countries to monitor eleven indicators of reproductive, maternal and child health using consistent definitions and reporting practices (see box). Only then can the world see a clear picture of progress being made overall, learn where there are successes to emulate, and identify countries most in need of assistance.
Accelerating action on the Canadian front
The report's direction is completely aligned with work Plan has been part of driving here in Canada. In November, International Cooperation Minister Bev Oda invited some 30 international development NGOs and medical associations to a roundtable session. The purpose was to share what we're doing to move the Muskoka agenda forward, and to plan for ongoing information exchange and collaboration.
Out of that was born the Canadian Network on Maternal, Newborn and Child Health, which I have the privilege of co-chairing with Dr. Dorothy Shaw, Vice President, Medical Affairs at BC Women's Hospital. One of the goals the network has been working towards is a common set of metrics – aligned with the Accountability Commission indicators – and a mechanism for tracking the results our collective efforts. While that may sound very tactical and far removed from the realities of pregnant mothers in difficult circumstances, our vision is of a rich knowledge base on what truly makes a difference in improving their chances of survival and the fate of their newborn children. It's part of holding all our organizations accountable for wise spending of public and donor money.
We have also recommended that Canada's contribution be focused on front-line community health care, rather than thinly spread across national health systems. While urban medical centres clearly play an important role in saving lives, the majority of people access services at the community level – particularly the poor, vulnerable and hard-to-reach populations who suffer the greatest burden of disease. In Bangladesh, for example, which has one of the highest rates of maternal mortality, 95% of babies are delivered at home. We believe investing in community health will deliver the greatest short-term results, while contributing to long-term strengthening of national health systems.
The Canadian government, through the Canadian International Development Agency (CIDA), has begun to deliver on the financial commitments announced in Muskoka, selecting a variety of Canadian agencies to execute projects. Plan's program portfolio in this sector has grown to over $54 million, with our donors' commitment of almost $10 million leveraging more than four times as much in CIDA contributions.
Projects in seven countries – Ghana, Mali, Ethiopia, Bangladesh, Zimbabwe, Tanzania and Bolivia – are expected to directly benefit some 1.2 million women of child-bearing age and over a million children. Looking ahead, I see more working sessions on the horizon aimed at accelerating efforts and continuing to drive accountability – a follow-up UN meeting in September, and a meeting of the Canadian network with Minister Oda and the president of CIDA in November. I look forward to reflecting back next year at this time and reporting continued progress in this drive to stop easily preventable deaths.
Read Rosemary's past CEO Notebook entries.