Posted by Caroline Green <http://www.globalhealthcheck.org/?author=12> on Dec 6th, 2011 in Maternal and Child Health
As 2011 draws to a close, it’s time to take stock of the global action on maternal and child health this year. With a woman dying from pregnancy or childbirth every two minutes in the developing world, turning the tide on this global scandal can’t come soon enough.
Most notably, this September marked the one year anniversary of the United Nations Secretary General’s initiative to drive action on maternal and child health. The initiative, *Every Woman Every Child*, called on a range of stakeholders to accelerate action on MDGs 4 and 5 ahead of the looming 2015 deadline. Its birthday party was a moment to celebrate the additional pledges that have trickled in over the past 12 months: 33 more governments signed up – both donor and developing countries, along with 12 multilaterals and partnerships, 40 NGOs and 15 members of the business community. With an $88 billion funding gap[1] to meet MDGs 4 and 5 by 2015, commitments to promote women’s and children’s health are not just welcome; they are vital.
But what policies will ensure that every woman and every child is able to access lifesaving care? How should money be invested to meet the needs of poor women and children for generations to come?
The truth is that there is tons of evidence of what works. Many players, including the World Health Organisation, rightly argue that governments invest in public health systems in order to ensure quality care to women and children. Evidence also illustrates that free access to health care is vital in ensuring the poorest women don’t end up with catastrophic bills they cannot pay. Oxfam’s Blind Optimism Report argues that previous cutbacks in public health provision and increasing reliance on the private sector in many countries have been associated with an increase in unattended home deliveries as well as women and children delaying care due to the high costs involved. This is particularly important in societies where the subordinate position of women and girls translates into little control over the purse strings. Back in 2009, Amnesty International found that high costs for care in Sierra Leone balanced against the low priority women were given around the allocation of scare resources within the family, meant they did not seek or obtain care when they needed it. That’s why it’s great news that the Government of Sierra Leone has since worked to remove fees for pregnant women and children under five.
As part of the *Every Woman, Every Child *initiative, lots of governments committed to increase overall spending on health care in 2010, and more signed up over 2011. It was encouraging to see Senegal’s commitment to increase recruitment of state health workers. And this year many more governments have pledged free health care provision through the removal of certain user fees in their contribution to the initiative – including Cameroon, Chad, Cote d’Ivoire, Gambia, Guinea, Kyrgyzstan and South Sudan. Now donors must step up the resources to help implement these policies by providing the budget support desperately needed.
But looking back at the initiative as a whole, many policy commitments are too vague to be translated to real changes for poor women and children. It’s time for governments, and donors, to set out clear plans on how they will strengthen public provision of health services, ensure women have access to them and support countries in removing user fees. A report produced by the Partnership for Maternal Newborn and Child Health<http://www.who.int/pmnch/topics/part_publications/2011_pmnch_report/en/index1.html>\(PMNCH\) points to the general lack of clarity in many commitments and encouraged governments (and other stakeholders) to publish their commitments in greater detail.
<http://www.who.int/pmnch/topics/part_publications/2011_pmnch_report/en/index5.html>More governments now need to specify these details.
The PMNCH also identified that as we move forward with the initiative, stakeholders must do more to address the barriers to gender equality that restrict women’s access to quality health care. Women should be enabled to be active in planning and implementing services. Moreover, interventions for women’s health need to be broad in scope: last year, part of Niger’s commitment to the initiative was to introduce legislation to increase the legal age of marriage to 18 and improve female literacy. Congo committed to pass a law to ensure equal representation of Congolese women in political, elected and administrative positions. This year Guyana committed to work on gender based violence and teen mother initiatives. Transformative changes in women’s health will require coordinated action to empower women and raise their voices across multiple sectors.
There have also been high-profile private sector contributions to the *Every Woman, Every Child *initiative. But generous contributions from companies like Merck and Johnson and Johnson must be measured against stark realities; for example they are two of only three companies holding patents for HIV medicines that have not yet entered formal negotiations with the Medicines Patent Pool.
There’s something to be said for the real momentum and range of parties signed up to the *Every Woman Every Child* initiative. Let’s just make sure in 2012 that all energies are used to help the poorest women and children today and into the future.
*Caroline Green works for Oxfam GB as a Gender Policy Advisor*
[1] In 2010 the Global Strategy for Women’s and Children’s health identified the additional funding required in 2011-2015 in 49 low-income, high-burden countries to improve access to essential interventions as US$88bn (including the direct and health systems costs of programmes targeting women and children)