Keeping promises, Measuring results: The Global Strategy and Accountability for Women's and Children's Health Bernadette Daelmans Family, Women and Children's Health Cluster World Health Organization

The Global Strategy (2010) 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

Commitments made Graphs of 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

Commission on Information and Accountability Called at the request of the UN Secretary-General as an integral part of the UN Global Strategy for Women's and Children's Health Commission's Report (advanced) released during the World Health Assembly, May 2011 Recommendations discussed in high level meetings –World Health Assembly - resolution WHA –G8 meeting 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 – Carmen Barroso, Zulfikar Bhutta, Richard Horton, Dean Jamison, Joy Phumaphi, Marleen Temmerman, Miriam Were 3

Key principles National leadership and ownership of results Strengthen countries’ capacity to monitor and evaluate Reduce the reporting burden by aligning efforts with the systems countries use to monitor and evaluate their national health strategies Strengthen and harmonize existing international mechanisms to track progress on all commitments made Founded on the fundamental human right of every woman and child to the highest attainable standard of health, and on achieving equity in health 5

10 Recommendations Holding all stakeholders accountable Recommendations 1-3: Better information for better results Recommendations 4-6: Better tracking of resources for women's and children's health Recommendations 7-10: Better oversight of results and resources: nationally and globally 6

Measuring results 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 …

Indicators for results 8 Eleven indicators Three tracer indicators: –maternal mortality ratio –under-5 child mortality (with the proportion of newborn deaths) –children under 5 who are stunted Eight coverage indicators: –met need for contraception –antenatal care coverage –antiretroviral prophylaxis among HIV positive pregnant women to prevent mother-to-child transmission of HIV –skilled attendant at birth –postnatal care (within 48 hours of childbirth) for mother and child –breastfeeding exclusively for 6 months –three doses of the combined diphtheria, pertussis and tetanus vaccine –children with suspected pneumonia receiving antibiotics.

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 -total health expenditure by financing source, per capita; and -total reproductive, maternal, newborn and child health expenditure by financing source, per capita. 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

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

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

Putting recommendations into action Multi-stakeholder work plan developed through consultative process with all interested parties Costs: US$ 88 million Roles and responsibilities for many partners: H4+, global health partnerships (PMNCH, HMN, GAVI, others), IPU, civil society organizations, academics and researchers, country representatives, private sector Funding commitments for implementation made by Norway, Canada and United Kingdom

Hosting the ERG secretariat Facilitating the implementation of the workplan and mobilizing resources Coordinating technical support to each of the recommendations – roll out in countries Building partnership and capitalizing on partner' strengths Promoting and supporting innovation Role of WHO and UN partners

Action can be taken now Strengthen health systems and improve quality of health services Improve measurement and use of data Use innovation and technology to disseminate and share information