Women, newborns, children, and adolescents: life-saving momentum after a slow start

A new global strategy puts accountability on the map

At the UN General Assembly in 2010, the Secretary-General launched a new global strategy for women’s and children’s health, which became known as the Every Woman Every Child initiative. That high-profile event initially attracted commitments of $40 billion in funds for the five-year period leading to 2015. Full implementation of the strategy was expected to save the lives of 16 million children, prevent 33 million unwanted pregnancies, end stunting in 88 million children, and protect 120 million children from pneumonia by 2015.

Group of young girls sitting by a wall in Nigeria
WHO/A. Zouiten

The political will, so tragically missing in 1985, had arrived. The strategy was almost immediately backed by the findings of a UN Commission that identified 13 life-saving commodities for women and children that were vastly underutilized. The Commission estimated that wide and proper use of these 13 commodities alone could save the lives of at least 6 million women and children.

Health, which coordinated the work of more than 80 agencies, country programmes, civil society initiatives, academic groups, and donors. WHO was asked to lead the strategy’s implementation. In an unprecedented step, WHO was further asked to convene a Commission on Information and Accountability for Women’s and Children’s Health. The Commission’s objective was to develop a framework for ensuring that promises of resources for women’s and children’s health were kept and that results were measured. The Commission was established in December 2010 and delivered its final report in May 2011.

"Measurement and accountability formally moved into the mainstream as part of the definition of a well-conceived strategy designed to produce results."

Dr Chan, WHO Director-General

Members of the Commission agreed on 10 recommendations, with related indicators, to help ensure that the $40 billion pledged to support the global strategy were spent in the most effective way, and that both donors and recipients were held accountable. The report linked accountability for resources to the results, outcomes, and impacts they produce, and to the capacity of recipient countries to measures those results. The Commission also called for the establishment of an independent Expert Review Group to issue critical annual reports on implementation of the strategy and its impact.

The appointment of an independent Expert Review Group joined the Independent Monitoring Board of the Global Polio Eradication Initiative as “firsts” for global health. Their emphasis on measurement and accountability reshaped the design of global health strategies and action plans at WHO to consistently include accountability frameworks. Highly innovative initiatives, like the Pandemic Influenza Preparedness Framework, also appointed independent expert monitoring boards to assess impact and recommend strategic course corrections. Measurement and accountability formally moved into the mainstream as part of the definition of a well-conceived strategy designed to produce results.

However, accountability means counting. As the first reports of the independent Expert Review Group made clear, reliable measurement was greatly impeded by the absence of systems for civil registration and vital statistics in the vast majority of high-burden countries. As long as countries lacked the capacity to measure results, progress would be impaired, especially at a time of financial austerity when parliamentarians in donor countries needed to show that investments in health development brought results.