With an objective of planning for a post-2015 development agenda, the Third summit of Partner’s forum was organized at Johannesburg, South Africa. The summit was also considered as an unique opportunity to envisage the world we want by 2030 and take stock of progress in women’s and children’s health.
PMNCH (Partnership for Maternal, New born and Child Health) joins the reproductive, maternal, newborn and child health (RMNCH) 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 organizations; partner countries; and the private sector.
The Partnership is governed by a Board, and administered by a Secretariat hosted at the World Health Organization in Geneva, Switzerland. It has been established with a vision, ‘The achievement of the United Nations Millennium Development Goals (MDGs) 4 and 5, to reduce child mortality and improve maternal health, with women and children enabled to realize their right to the highest attainable standard of health in the years to 2015 and beyond.’
1. Eradicate extreme poverty and hunger 2. Achieve universal primary education • Ensure that all boys and girls complete a full course of primary schooling. 3. Promote gender equality and empower women • Eliminate gender disparity in primary and secondary education preferably by 2005, and in all levels of education no later than 2015. 4. Reduce child mortality • Reduce by two thirds the mortality of children under five. 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development
Millennium Development Goals
Millennium Development Goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
• Ensure that all boys and girls complete a full course of primary schooling.
3. Promote gender equality and empower women
• Eliminate gender disparity in primary and secondary education preferably by 2005, and in all levels of education no later than 2015.
4. Reduce child mortality
• Reduce by two thirds the mortality of children under five.
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
It has held two previous Partners’ Forums. The first, in Dar es Salaam in 2007, marked the emergence of PMNCH as the first dedicated partnership focused on maternal and child health and the pursuit of MDGs 4 and 5. The second Forum, in New Delhi in November 2010, aimed to develop joint approaches and strategies to operationalize the UN Secretary General’s Global Strategy for Women’s and Children’s Health to accelerate progress towards the MDGs by 2015. This meeting, the third, was organized to prioritize discussion on joint action and accountability across sectors in anticipation of the post-2015 development goals.
The two new key reports were launched at the Forum: The Countdown to 2015: 2014 Report; and The Every Newborn Action Plan, a landmark report on ending preventable newborn deaths.
Progress story of 10 ‘Fast-track’ countries
At the beginning of the forum, the growth stories of various countries in women and child health sector was discussed. The importance of multisectoral investments, coordination and “close collaboration between sectors” to improve women’s and children’s health was common across countries. Strategies for poverty reduction and infrastructural development in Peru, gender equity in Lao PDR, free universal education in Bangladesh and a multisectoral approach to nutrition in Viet Nam were among those highlighted.
The experience of these countries showed the importance of political will and leadership to drive the maternal and child health agenda, and as one panelist reinforced, to “translate it into reality at the service delivery level”.
The panelists stressed the importance of investing in high impact and evidence-based maternal and child health interventions, such as family planning, immunization and quality care at birth. The programme to Reduce Maternal Mortality and Eliminate Neonatal Tetanus in China, Egypt’s Healthy Mother/Healthy Child Programme, Ethiopia’s “home-grown and indigenous” community-based Health Extension Worker programme, and the use of cash incentives in Nepal to improve access to maternal care, were among the health strategies highlighted. Demand creation and community ownership, combined with targeting underserved communities also contributed to countries’ success.
In the session “Building a Future Where Children Survive and Thrive”, need was expressed for intervention in early childhood, like protecting child to the maximum extent possible, which will reduce the child mortality significantly. The evidence from Guatemala, Jamaica and Brazil showing how early childhood interventions can have long term benefits in LMICs (Low and Middle Income Countries).
It was also highlighted how Cambodia invested in key sectors such as education and nutrition to complement health sector investments which has dramatically improved childhood outcomes in the country. Using examples from Zambia and Cambodia, Rebecca Fishman, Director, WASH Advocates (water, sanitation, and hygiene) pointed out how shared advocacy and integrated programs should be central to the post-2015 development agenda, and that WASH is not just an infrastructure issue but is also a health and human rights issue. She quoted a new study coming out in the International Journal of Public Health which identified financial barriers and lack of coordination as major impediments to cross-sect oral collaboration. Strong country leadership and incentivizing collaboration through appropriate funding are ways to overcome poor coordination.
Health Service Providers
The forum also discussed the need of the implementing various health programs at health service providers like Community Health Workers (CHW), to spread the reach of the program. The nutrition and child survival packages at the community health worker level have improved the interaction between care giver and child. The importance of involving communities and civil society in holding programs accountable also discussed at the forum.
Immunisation is one of the most successful and cost-effective health interventions. Since the launch of the Expanded Programme of Immunization forty years ago, vaccine coverage rates have increased from 5 % to reaching over 80% of the world’s children with life-saving vaccines.
While discussing the growth achieved so far, It was stated that since 1980 vaccines have successfully reduced once common diseases such as diphtheria, measles, whooping cough, polio and tetanus by over 90%, despite a 58% increase in the world’s population during the same period. Thanks to developments in scientific technology, the number of vaccines have grown.
It was expressed at the forum, that beyond 2015, country leadership and strong partnerships will drive new ambitious goals. The benefits of vaccines are clear: healthier children, better education outcomes, lower healthcare costs, healthier mothers, more productivity, and stronger economies.
Use of ICT
The session on ‘Bridging the Digital Divide’ opened with Kathy Calvin, United Nations Foundation, underlining the importance of mobile phones and Information and Communication Technologies (ICTs). All partners noted that partnerships are critical in creating an enabling environment for increased use of mobiles and ICTs for women’s and children’s health. Mobiles are critical because programmes such as civil registration and vital statistics, etc. cannot be scaled up through the use of conventional methods. Mobile phones can be seen everywhere. Globally, we now have 7 billion connections, with four out of five new connections coming from developing countries.
Universal Health Coverage
The panel stressed equity, rights and inclusivity as fundamental underpinnings or pillars of UHC. Political commitment and strong legislation that guarantee the right to health, including SRHR is essential for advancing UHC; and positioning this to suit a country’s reality is important. Panellists stressed the importance of measurement which is viewed as essential as well as strengthening indicators to monitor UHC with indicators of SRH as barometer of success.
Food security and optimal nutrition are at the heart of the post-2015 development agenda, and can only be achieved through the integrated and complementary participation of multiple stakeholders. Panellist felt that, there has to be a balance between food-based approaches, sustainable agriculture, food security and nutrition. This is becoming more complicated as increased urbanization and lifestyle changes pose challenges. For e.g. child obesity is emerging as a big threat even in developing countries. This will impact the prevalence of Non-Communicable Diseases and we must tackle this problem urgently.
Sexual and Reproductive Health and Rights
The session aimed to demonstrate the need to explicitly include sexual and reproductive health and rights (SRHR), including family planning, in the post-2015 agenda from the perspectives of health, equity, human rights, poverty alleviation, gender, and youth.
The Panellist stressed the importance of countries removing bureaucratic barriers to be able to work across multiple sectors – including education, water supply, sanitation, nutrition, energy, roads and women’s empowerment – for good cross-sector planning and implementation to improve health outcomes. The discussion was on how to align the roles of private, public, civil society and other sectors to accelerate progress toward health for all.
Women and Child health – Indian Scenario
In India, nearly eight million children have never stepped inside a school and the dropout rate is about 80 million, UNICEF noted.
According to a 2013 UNFPA report, globally, India has the largest number (95 million) of adolescent girls aged 10-17 years. And not surprisingly, in 2010, India had the highest number — 47 per cent (about 12 million) — of adolescent pregnancies in the world. Globally, child marriage is an important driver of early pregnancies; about 90 per cent of such pregnancies occur within marriage.
A 2009 PLoS ONE study found 44·5 per cent of women aged 20-24 years in India were married as a teenager; 22·6 per cent of them were married before age 16 years. A third of them had no formal education and more than two-thirds resided in rural areas.
There is a 50 per cent likelihood of stillbirth and death in the first week of life in babies born to mothers younger than 20 years than in those aged 20-29 years. There is also about 20 per cent risk of maternal mortality in adolescent mothers. According to the WHO, 14 per cent (2.5 million) of all unsafe abortions in low- and middle-income countries are among mothers aged 15-19 years.
From the above statistics, it is clear there is lot of ground work needed in the country. To solve the maternal and child mortality issue from root, there is a need for intervention from other sector like education, women empowerment, opinion mobilization towards the ability of women to lead family to growth and prosperity and hence contribute in building nation’s strength.
Margaret Chan, Director-General of WHO answering a question on how to reduce teenage pregnancy at a Partners’ Forum said, “Educate them [girls] and empower them and keep them in school as long as you can and those women are the best agents of change. No question about it.”
Ms. Solberg, Prime Minister of Norway said that if all women were to complete primary education in the low- and middle-income countries, there would be a 50 per cent drop in mortality of children aged under five years. And if they were to complete secondary education, a 40 per cent reduction in child mortality could be achieved. “This means preventing 2.8 million child deaths a year,” she said.
Child marriage in India had all the well-documented problems — no contraceptive use before first childbirth, high fertility (three or more births) a repeat childbirth in less than two years, multiple unwanted pregnancies, and abortion. Having a baby much earlier in life combined with multiple pregnancies within a short span of time exponentially increases the risk of child death. Adolescent pregnancy is often associated with premature delivery, stillbirth, foetal distress, birth asphyxia, low birth weight, and miscarriage.
A multi-sector approach wherein, improving school enrolment of girls and reducing the dropout rate. improving the quality of education, providing girls with the much needed sex and reproductive education, providing access to child-friendly health services and Finally, reducing the prevalence of child marriage is the need of time.