UNITED NATIONS – For years, progress on the Millennium Development Goal of improving maternal health was painfully slow. Now, MDG 5 has become the cornerstone of a new global health strategy which is expected to be the engine that propels progress toward all eight goals.
The three-day MDG summit will culminate with the launch of U.N. Secretary-General Ban Ki-moon’s “Global Strategy on Women and Children’s Health” on Wednesday (Sept. 22).
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Ban will be joined by a host of public and private sector leaders - including Chinese Premier Wen Jiabao, U.S. Secretary of State Hillary Clinton and philanthropist Melinda Gates - at the unveiling of this health initiative and pledge financial, service and policy commitments that will focus on women around the world, who are increasingly seen as key to international development.
Donor nations are expected to announce billions of dollars in pledges, and private sector groups will commit money and services toward achieving MDGs 4 and 5. Although the target of $26 billion in funding, including $12 billion in new money, set earlier this year by the World Bank, won’t be reached that day, health officials are optimistic about the renewed commitment to maternal and child health.
Ban’s health strategy urges developing countries to take charge and create national health plans that will guide domestic reform and strengthen alliances with international donors and partner organizations.
These country plans may end up curbing donor pet projects, boost partnerships with nonprofits and among governments, and result in more sustainable health systems that focus on women’s needs and promote gender equality.
At the same time, these plans could engender short-lived, underfunded health initiatives that have little effect on the current state of affairs.
Elevating the status of women’s health
In the years following the Millennium Declaration, women’s health did not figure prominently in the global health debate. HIV/AIDS dominated headlines and funding talks. The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002, followed two years later by the U.S. President’s Emergency Plan for AIDS Relief. Malaria eventually got the attention of the Bill & Melinda Gates Foundation, which launched its Nothing But Nets campaign in 2006.
This past year, however, women’s health – and maternal health in particular – was front and center on the international circuit, including the G-8 gathering in Canada last June and the African Union summit in Uganda in July. The renewed focus was partly propelled by a realization that a majority of developing countries may not be able to meet MDG 5 targets, achieve universal access to reproductive health and reduce the maternal mortality ratio by three quarters between 1990 and 2015.
The United Nations estimates that approximately 358,000 women continue to die every year from preventable complications in pregnancy and childbirth – a 34 percent decrease in total deaths but, considering population growth, only a 2.3 percent decrease overall.
Ban’s strategy is expected to save 16 million lives by 2015 and grant 43 million people access to family planning.
The renewed focus on women and children’s health effectively elevates MDGs 4 and 5 to a status of driving all other MDGs, from the reduction of poverty and HIV/AIDS to the improvement of gender equality and primary education.
>> G8 Launches Maternal and Child Health Initiative
This week’s U.N. High-Level Plenary Meeting on the Millennium Development Goals is marking a “crescendo” that will reverberate for the foreseeable future, said Flavia Bustreo, director of the World Health Organization’s Partnership for Maternal, Newborn and Child Health.
“We’ve seen a huge push by inspiring leaders for women’s rights and maternal health, and that is going to carry us at this summit and beyond,” Bustreo explained. “The strategy needs to be around that reflection of how do we get the best results with the money that already exists. Considering what countries and relevant partners are already investing in health, how do we get the best of it?”
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John McArthur, chief executive officer of Millennium Promise, a nonprofit organization committed to supporting the achievement of the MDGs, noted that the creation of sustainable health systems – with a focus on maternal health – had rare bipartisan support in the U.S. Congress.
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While appreciating the momentum on maternal health, Jeffrey Sachs, economist and special advisor to the U.N. secretary-general, cautioned against a narrow focus on maternal health this month.
“We need to give equal importance to all goals and focus on all,” he told reporters in New York.
National health plans and policy commitments
All U.N. member nations are expected to sign off on the strategy. But the strategy will have particular significance for the 25 high-burden countries identified by the United Nations Population Fund, UNICEF, the World Bank and the World Health Organization. Several of these have been drafting national health strategies in the past few months and are expected to commit to domestic health reforms at the Sept. 22 event in New York.
Each national health plan will look different – and each may have a different degree of donor buy-in. But common themes have emerged.
Some countries will pledge to devote more existing domestic resources to health care, or commit to making birth control options, obstetric care and comprehensive emergency care more accessible. Others will seek to widen health insurance coverage for women, increase the number of midwives, or provide free immunizations to children and free health services to pregnant women. Policy shifts may focus on educating adolescents about reproductive health, strengthening commitments to combat HIV/AIDS, and seeking bans on child marriage.
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“A broad scope on innovative approaches towards maternal, newborn and child health is critical to reduce mortality rates,” Tore Godal, special adviser on global health to Prime Minister Jens Stoltenberg of Norway, told Devex in a written statement. “Country-led as well as global innovations can achieve further reductions, enabling health services to produce better outcomes at the same or lower cost. These range from paying women as well as health services for results, to innovative use of mobile phones and other communication tools.”
Norway and the United Kingdom have taken a leadership role in boosting global efforts to improve maternal health.
Toward integrated national health services
Two ideas are key to Ban’s strategy: integrate maternal, newborn and child health services with other, related programs like HIV/AIDS prevention and access to clean water and sanitation, and tap into services people are already accessing regularly, like mobile phones.
International organizations have been honing in on the idea of creating integrated health services.
“We’re really looking at using these three diseases – tuberculosis, malaria and HIV/AIDS – as an entry to improve maternal and child health,” said Anurita Bains, a Global Fund senior advisor. “It isn’t about just preventing the infection to the newborn. It really calls for countries to look for integrated approaches through these diseases and those discussions have been happening at country levels this past summer.”
Building local capacity and connecting health workers and at-risk people in rural areas via mobile phones was at the heart of the planning process for Ban’s global health strategy, which brought the private sector, governments, multilateral and bilateral organizations and a variety of other stakeholders together.
To what degree these ideas will be incorporated into national health plans remains to be seen. But the corporate and nonprofit worlds appear ready to help.
“We’re seeing the private sector engaged and excited in a way that I haven’t seen before,” said Rachel Wilson, director of policy and advocacy for PATH, an international public health organization. “We’re having conversations about this in a way that hasn’t happened before, and there’s now a space for that. This plan is reaching out to a wide range of donors, recipients, private sector, academics and fostering some new and exciting partnerships.”
Wilson served on the strategy’s innovations technical working group. The other working groups focused on the action plan, accountability, finance and advocacy.
>> List of technical working groups and partners
>> Nonprofits Pledge Funding for Maternal, Child Health
Monitoring and evaluation
The strategy’s formal introduction will signal “the landmark year for women,” according to Kimberly Hunter, spokesperson for ONE, an international advocacy group. However, although a system for tracking financial pledges will likely be in place, the question of who will oversee this monitoring mechanism has yet to be answered.
The World Health Organization appears likely to play a key role in monitoring, but civil society groups have indicated that they will set up parallel monitoring mechanisms at the grassroots level.
Donors have already been tightening monitoring mechanisms. The World Bank, for instance, recently adopted an “achievement-based approach” to improve tracking the implementation of field projects, noted Sadia Chowdhury, the bank’s senior health specialist.
“One of the things we hope we could see much more of a focus on is not what the program will achieve, but a focus on results,” Chowdhury explained. “Rather than how many hospitals you have built, we are talking about looking at it in a different way, of how many women have you helped in this institution and in making the choice in terms of having contraceptives?”
Within developing countries, one area of focus will be the establishment of strong data systems, such as birth and death registries in countries, in order to improve “imprecise methods” of measuring progress, Bustreo said.
“More money has to go toward ensuring better statistics,” she argued. “It’s very clear to me that we can only improve on this when countries are better able to analyze their own statistics.”
Next step: More meetings
Despite the policy commitments expected from leaders within the developing world, full implementation of Ban’s global health strategy and individual country health plans will depend largely on donor funding. The Partnership on Maternal, Newborn and Child Health estimates the funding gap for maternal and child health to be at USD26 billion in 2011 alone.
“This strategy is a very important piece of advocacy, but the next step is to see that it turns into something concrete and meaningful,” said Anurita Bains, a senior advisor for the Global Fund to Fight AIDS, Tuberculosis and Malaria. “For me, much of that is having to deliver on what we say the gaps are and to prevent unnecessary preventable deaths among women and children. That really requires the funding and it also requires the political will.”
The first big test for donor commitments will be in October, at the Global Fund’s donor conference. The organization is seeking USD17 billion to USD20 billion in funding for a three-year period. ONE is advocating for the U.S. to commit USD6 billion to the government’s Global Health Initiative.
The Partnership for Maternal, Newborn and Child Health will be organizing a high-level partner’s forum in New Delhi, India, Nov. 12-14 to consolidate commitments and accelerate progress toward MDGs 4 and 5. Around 700 health ministers, U.N. officials and civil society representatives will “recap commitments pledged throughout this important year and provide a platform for developing strategies and networks that promote accountability for those pledges,” according to the event’s website. The coalition will also push for maternal health’s prominence in the G-20’s agenda at the summit in Seoul, South Korea, this November.
“We’re not just going to do something in September and then let it die,” Bustreo said. “This is a major landmark, but not the end of the road. Civil society organizations have a tremendous role over the next few years for keeping governments’ feet to the fire and seeing that they honor commitments they lay out.”
Rolf Rosenkranz contributed to this report.
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