Keeping it real: Accountability for women’s, children’s, and adolescents’ health during the SDG era

“It’s important we ask women what’s actually happening on the ground. After all these strategies and initiatives, women are still giving birth on the floor. And they have to get their own water!” said Caroline Maposhere, a Zimbabwean nurse-midwife and civil society advocate, from the floor of the 5th Annual Breakfast for Accountability for Women’s and Children’s Health, September 18.

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Caroline Maposhere shares her experience working as a midwife in Zimbabwe. (Photo by J. Cook Photography)

Among an audience of distinguished ministers of health, experts, academics, and leaders of global health organizations, Caroline’s story was a stark reminder of a persistent and horrible reality and a call for real, impactful accountability.

Upon the opening of the 71st session of the United Nations General Assembly, the Partnership for Maternal, Newborn and Child Health (PMNCH), the Independent Accountability Panel for Every Woman Every Child (IAP) and Countdown to 2030–with coordination support from the FCI Program of MSH– brought together the world’s experts in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) to share ideas for better data, citizen- and youth-led accountability, and strategies for unified accountability initiatives during the Sustainable Development Goals (SDGs) era.

“This is the group of pioneers,” said David Nabarro, Special Advisor to the UN Secretary-General on the 2030 Agenda for Sustainable Development. “You’re in the laboratory where we will test out new ideas.”

Monitoring progress toward the achievement of the SDGs and the implementation of the Global Strategy for Women’s, Children’s, and Adolescents’ Health requires ambitious and innovative measures to hold governments accountable for their promises to safeguard health. “We cannot afford to slide back in the progress we’ve achieved for women and children,” warned Dr. Flavia Bustreo, World Health Organization (WHO) Assistant Director General.

Highlighting insights from the report on monitoring priorities for the Global Strategy, Dr. Bustreo stressed investment in civil and vital statistics and the disaggregation of data–e.g., by age, sex, income level, geography–so every person is counted and included in the health system. But low resource countries will need additional financial and technical support to build their expertise in collecting, analyzing, and using data to develop policies and improve health programs. The Global Strategy’s proposed Unified Accountability Framework will harmonize the myriad data sources and accountability processes so that countries are not burdened with duplicative expectations and processes for accountability.

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Richard Horton from The Lancet lauds the first report of the IAP. (Photo by J. Cook Photography)

Championing the foundation of human rights in the Global Strategy, Dr. Carmen Barroso, interim chair of the Independent Accountability Panel, urged the global health community to move beyond the aspirational and to actually measure rights. She also emphasized increased attention to inequalities, which still pose obstacles to the realization of human rights and improved health outcomes. Particularly, countries should invest in strengthening institutions that guarantee human rights and promote gender equality and youth and civil society participation. Better coordination among donors, transparency in financing, and earmarked resources for strengthening national capacity for accountability are also necessary prerequisites to ensure countries are meeting the health needs of their people. And finally, accountability requires political will; the UN and WHO need leaders who are committed to furthering the Global Strategy.

To meet the increasing demand for evidence, Countdown to 2030–an interdisciplinary collaboration of academics, government leaders, and RMNCAH experts–will build on a decade of achievement by Countdown to 2015, which tracked and assessed progress towards reducing child mortality and improving maternal health. Dr. Cesar Victora and Dr. Zulfiqar Bhutta, from Countdown to 2030 presented the Countdown Country Case Study model that systematically examines linkages between intervention coverage, its determinants, and improvements in survival. “Countdown country case studies are not about identifying ‘success’ or ‘failure’ but about learning from experience,” said Dr. Bhutta.These case studies have revealed a number of lessons on RMNCAH interventions in Bangladesh, Peru, Ethiopia, Afghanistan, and Malawi.

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Dr. Zulfiqar Bhutta (left) and Dr. Cesar Victora (right) from Countdown to 2030 chat about their presentation on country case studies with Adam Deixel (center) from the FCI Program of MSH. (Photo by J. Cook Photography)

A vibrant and vigilant civil society plays a critical part in bridging policy–and big ideas–with reality. Participants called for the inclusion of civil society, children and youth, women, and health professionals–especially midwives–in the design and implementation of accountability processes.

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George Nkhoma, a midwife from Malawi, reminds the audience that midwives are powerful advocates for reproductive, maternal, and newborn health. (Photo by J. Cook Photography)

“My mother died giving birth to me. I wanted to give back to mothers. I’m a midwife by choice, not by chance,” said George Nkhoma, a midwife from Malawi. Because midwives work in the realities the SDGs seek to address, they are powerful advocates for improved working conditions, community health programs, better training to provide high-quality care, and well-stocked and -equipped facilities. Midwives might work in the worst conditions imaginable, yet they are often underpaid, overworked, and disrespected.

Implying the importance of continued and fervent advocacy, Nkhoma posed a challenge:“The SDGs look good on paper, but how much will translate into action and resources?”

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