Maternal, newborn, child and adolescent health at the sixty-ninth session of the UN General Assembly

Ministers, ambassadors, senior public officials, and civil society representatives gathered on 21 September 2014 in New York to discuss maternal, newborn, child and adolescent health.

The WHO co-hosted a breakfast event with Countdown to 2015, the independent Expert Review Group (iERG) and The Partnership for Maternal Newborn & Child Health (PMNCH). This fourth annual event will bring together stakeholders, to take stock of evidence on progress, identify models of success, and agree on the priority actions and processes essential to developing robust accountability structures which will also be relevant in the post 2015 era.

Important new data and evidence were highlighted from two new reports — the 2014 PMNCH Report on Commitments to the Global Strategy for Women and Children’s Health and the third report from iERG, which focuses on a vision for women’s and children’s health in the post-2015 era. The findings of the Countdown to 2015 report, Fulfilling the Health Agenda for Women and Children, were also presented at the breakfast. Key findings and recommendations from each of these reports show both the progress that has been made and the continued and intensified effort that is still needed for women and children. With under 500 days left until the end of the Millennium Development Goals (MDGs), and with one year left to shape the sustainable development goals, these reports show that stakeholders are at critical junction for women’s and children’s health, a position laid bare during the discussions on Sunday.

A key theme throughout the event was that of sustainability and strengthening health systems. Dr Margaret Chan, Director-General, WHO, stressed that while progress has been made for women and children, the Ebola crisis in West Africa is a reminder “that even excellent progress can be so fragile.” She, along with other speakers including Julia Duncan-Cassell, the Liberian Minister of Gender and Development, emphasized the importance of building and strengthening health systems to withstand crises and ensure that results are sustainable. Minister Duncan-Cassell also noted that women make up nearly 75% of Ebola fatalities in her country, because it is often women and girls who care for the ill and wash the bodies of the deceased. In addition, the collapse of the health system has grave implications for maternal health, as women are unable or unwilling to give birth in health facilities with skilled birth attendants.

The importance of strengthening health systems, as well as of determining factors for health such as poverty reduction and female education, was reinforced by Dr. Luis Huicho, who presented preliminary findings of a Countdown to 2015 in-depth Country Case Study that he is leading in Peru. This study seeks to understand and explain Peru’s success in reducing its rates of maternal, newborn and child mortality between 2000 and 2012. Also presented at the breakfast was new Countdown analysis of financial flows for reproductive, maternal, newborn and child health (RMNCH), which showed that, while aid for RMNCH increased during 2011-2012, continued increases in both official development aid and in-country investments are needed in order to accelerate progress towards MDGs 4 and 5.

Bob Orr, Assistant-Secretary General of the UN and a key leader of the Every Woman Every Child movement, emphasized UN Secretary-General Ban Ki-Moon’s commitment to women’s and children’s health and his conviction that women and children have to be “at the front of the queue, not at the back of the MDG train.”

Top of mind for all participants was how women’s and children’s health will feature in the post-2015 development landscape and the global health architecture to support it. For the first time in a public forum, panelists and attendees discussed the current plans to develop a Global Financing Facility (GFF), hosted by the World Bank, to better coordinate and leverage financial resources for reproductive, maternal, newborn, child and adolescent health in the 2015-2030 period. Speaking on behalf of the World Bank, Dr Tim Evans briefly described the proposed facility, and expressed great optimism saying, “We have a historic opportunity to bend the curve and eliminate preventable child and maternal deaths within a generation.” While not the only solution, he suggested that the GFF would accelerate progress by pooling funding, leveraging other financial tools and mechanisms, and simplifying and streamlining the global RMNCH landscape to reduce the application and reporting burden on countries.

Agnes Binagwaho, Minister of Health of Rwanda, joined the panel on financing for greater accountability and equity to make a powerful demand from the donor community to respect country leadership in planning, to reduce the burden in reporting requirements of countries, and to work together to invest in national health systems in a more holistic manner. 'Ask us what we need and we will tell you; don't go and speculate: We have a good plan and we know our needs ... the global community must be more accountable on coordination. We are disrupted by you in our work.'

Richard Horton, Editor in Chief of the Lancet, provided an overview of the iERG’s Every Woman Every Child: Post-2015 Vision report along with a proposed new framework for a sustainable approach to improving women and children’s health. He warned that “the landscape for women’s and children’s health is about to undergo a seismic shift” calling for action not paralysis in the face of uncertainty. He told participants that “sustainability is about paying as much attention to the future as we do to the present… it is about the value we put on our lives and on the lives of our children.” Stakeholders this week in New York, will indeed pay heed to these words as they look to help shape a set of sustainable development goals, which leave no woman, child or adolescent behind.

An update on the process for developing the PMNCH post-2015 Strategic Framework.

The Partnership for Mother, Newborn & Child Health (PMNCH) joins reproductive, maternal, newborn and child health communities into an alliance of more than 500 members, across seven constituencies: academic, research and teaching institutions; donors and foundations; health-care professionals; multilateral agencies; non-governmental organisations; partner countries; and the private sector. Working together our goal is a world in which all women, newborns, children and adolescents not only are healthy, but thrive.

At its July 2014 meeting in Johannesburg, the PMNCH Board mandated the Secretariat to begin a process that would result in the development of a PMNCH Post-2015 Strategic Framework.

This new PMNCH strategic framework will build on its ongoing work, as set out in the existing PMNCH 2012 to 2015 Strategic Framework. The decision to develop the next framework is also in line with the views of the majority of members, as reflected in the recommendations from the independent external evaluation of PMNCH, which was recently completed and which will be published shortly.

The Executive Committee agreed that the process for developing the PMNCH post-2015 Strategic Framework would broadly be as follows:

• September/ October, 2014: Procuring external consultants to facilitate the strategic framework development process (in progress), and agreeing a set of issues and questions that would underpin the stakeholder discussions and consultations on the framework development process.

• October/ November, 2014: Ongoing consultations, development of scenarios, and preparations for Board retreat.

• December, 2014: Board retreat to discuss the emerging conclusions and directions for the strategic framework development.

• January to April, 2015: Implementation of Board retreat conclusions, further consultations, and finalisation of the PMNCH Post-2015 Strategic Framework.

To read more about PMNCH, please click here.

Human Rights and Volunteering in Health Care

Health is a in fact a human right. Internationally, it was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”[i]

The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living (art. 25). The right to health was again recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights.

Since then, other international human rights treaties have recognized or referred to the right to health or to elements of it, such as the right to medical care. The right to health is relevant to all States: every State has ratified at least one international human rights treaty recognizing the right to health. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation and policies, and at international conferences.[ii]

Despite the fact that health is a human right, there are many worldwide that do not have access to adequate health care due to fragile health systems. 

The volunteering force may bring the needed strength to fragile health systems. But how exactly do we ensure that we volunteer in a way that supports the heath system in the best way possible? 

Photo: Health Aid Plus

Volunteering can be defined as any activity that involves spending time, unpaid, doing something that aims to benefit the environment or someone (individuals or groups) other than, or in addition to, close relatives. Central to this definition is the fact that volunteering must be a choice freely made by each individual. This can include formal activity undertaken through public, private and voluntary organisations as well as informal community participation.[iii]

The United Nations describes the three key defining characteristics of volunteering as:

First the activity should not be undertaken primarily for financial reward, although the reimbursement of expenses and some token payment may be allowed.

Second, the activity should be undertaken voluntarily, according to an individual’s own free-will, although there are grey areas here too, such as school community service schemes which encourage, and sometimes require, students to get involved in voluntary work and Food for Work programmes, where there is an explicit exchange between community involvement and food assistance.

Third, the activity should be of benefit to someone other than the volunteer, or to society at large, although it is recognised that volunteering brings significant benefit to the volunteer as well.[iv]

There is no doubt that we ourselves benefit from volunteering. Volunteering is the perfect vehicle to discover something you like doing and developing a new skill. It is never too late to learn new skills and no reason why you should stop adding to your knowledge just because you are in employment or have finished education. However, how can we be sure that our volunteering is actually beneficial to those we seek to help? And how do we ensure that our volunteering promotes health care whilst promoting the human rights of those we seek to help?

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[i] WHO (1945) 'WHO Constitution.' (Geneva: WHO Press)

[ii] WHO (2001) 'The Right to Health.' (Geneva: WHO Press)

[iii] Hawkins, S. Restall, M. (2006)'Volunteers across the NHS.' (London: Volunteering England Press) 

[iv] United Nations Volunteers Report, prepared for the UN General Assembly Special Session on Social Development, Geneva, February 2001

UNFPA - The Maternal Health Thematic Fund

In 2008, UNFPA launched the Maternal Health Thematic Fund to accelerate progress towards making safe motherhood a reality in some of the poorest countries in the world. It is one response to the fact that improving maternal health is the Millennium Development Goal target lagging farthest behind. 

Experience from countries such as Egypt, Guatemala and Sri Lanka shows that maternal mortality in developing countries can be reduced rapidly if adequate political and financial support is in place and effective approaches employed. The thematic fund aims to jump-start progress in countries where far too many women continue to die from preventable complications of pregnancy.

Photo: UNFPA

Support from the Maternal Health Thematic Fund is provided to national governments in close coordination with UNFPA’s Global Programme on Reproductive Health Commodity Security. This fosters a strengthened and streamlined approach towards accelerating progress towards MDG5 and ensuring that every pregnancy is wanted and every birth safe.

The Maternal Health Thematic Fund focuses on high-priority countries that have maternal mortality ratios of over 300 deaths per 100,000 live births. The approach revolves around strengthening national health systems, rather than creating parallel structures, and in helping governments overcome obstacles that prevent their own maternal health plans from succeeding.

Key components of the Maternal Health Thematic Fund's work include supporting programmes that build up human resources for maternal health and needs assessments that provide countries with up-to-date data in the area of obstetric care.

Data show that fewer than two thirds of women in developing countries receive assistance from a skilled health worker when giving birth. The State of the World’s Midwifery Report found that at least 112,000 health workers with midwifery skills are missing from 38 countries with the highest burden of maternal death. As long as women continue to give birth without skilled care, the number of women dying in childbirth will remain stagnant. UNFPA has partnered with the International Confederation of Midwives to address this critical gap. The Midwifery Program is now operational in some 30 Maternal Health Thematic Fund supported countries, with a focus on improving and expanding midwifery training and strengthening national midwifery associations.

Read more here

Pakistan Initiative for Mothers and Newborns (PAIMAN)

Pakistan's maternal and newborn mortality rates are some of the highest in the subcontinent. Every 20 minutes, a Pakistani woman dies due to complications of pregnancy. More than 60% of newborn deaths occur within the first week of life. The majority of these maternal and newborn deaths occur at home. 

The Pakistan Initiative for Mothers and Newborns (PAIMAN) was a six-year project that raised awareness about health care for mothers and newborns. 

PAIMAN worked in 24 districts across all four provinces, which has reached more than 5.7 million beneficiaries - women, their families, and the health care providers who serve them.

PAIMAN created a film as well as a TV series, which has reached more than 8 million women of reproductive age. 

Read more here