PHM-Exch> Saving mothers’ and children’s lives: What lies ahead in 2012?

[Claudio Schuftan]

Posted by Caroline Green <http://www.globalhealthcheck.org/?author=12> on
Dec 6th, 2011 in Maternal and Child
Health<http://www.globalhealthcheck.org/?cat=59>| 0
comments <http://www.globalhealthcheck.org/?p=455#respond>


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)
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