Accountability for Women’s and Children’s Health

The iERG 2015 report

Address from the Co-Chairs

This fourth and final report from the independent Expert Review Group on Information and Accountability for Women’s and Children’s Health (iERG) signals the conclusion of an unusual experiment in global health. The 2011 Commission on Information and Accountability (CoIA) was a landmark moment for women and children. Born from the UN Secretary-General’s signature Every Woman, Every Child initiative, the Commission sought to mark a new era in the way progress was measured for two critically important Millennium Development Goals. The Commission redefined the meaning of “monitoring and evaluation” and “mutual accountability,” transforming a purely technical process of tracking indicators into a political process of evaluating those indicators transparently and democratically, judging the performance of institutions responsible for making promises and commitments to women and children, and acting on the results of those evaluations and judgements.

The model of accountability adopted sought to recognise:

  • the continuum of care and service delivery, by requiring the engagement of communities; primary, secondary, and tertiary care; and rehabilitation, in the provision of services throughout the life course;
  • at every level, the need for adequate and consistent monitoring; timely and comprehensive review; and appropriate remedial and concerted action by all stakeholders;
  • the need to engage all stakeholders, and for each participant to be held accountable for their contribution;

within a social, financial, and political accountability framework that operated at both national and international levels.

Given the difficulties in transparency, as well as the non-comprehensiveness of information available, the iERG adopted a phased approach to accountability, not envisaged by the Commission. It is not surprising that this experiment has generated considerable discussion and debate. It was seen by some observers as a much-needed opportunity to strengthen accountability globally and in countries. Those who have followed the annual recommendations of the iERG have seen a marked improvement in performance and results. For those who have not, the annual iERG reports and recommendations may have appeared to be a distraction. The product of CoIA, the iERG has, with the tools available to it, sought to translate the hopes of Every Woman, Every Child into an opportunity to regularly review what has worked to advance the health of women and children, what has failed, and what needs to be prioritised in the future.

Our successors will judge whether this experiment has helped to advance the growing movement to protect and strengthen the health of women, children, and adolescents. Our tentative view is that while the imperfections of this first foray into independent accountability have been all too visible—most obviously of all, the profound difficulty of triggering sustainable accountability mechanisms in countries—independent accountability can be said to have passed the “proof of concept” stage. If independent accountability was a new medicine, it has passed its phase 1 trial.

Indeed, this final report has for the first time benefitted from the availability of data from some of the development partners that support women’s, children’s, and adolescents’ health in countries.

As we complete this final iERG report, it is becoming clearer that post-2015, the idea of an independent group to monitor, review, and stimulate action to accelerate advances in the health of women, children, and adolescents will continue. All stakeholders seem to agree that independent accountability has value for improving the oversight of results and resources globally and in countries. Again, not surprisingly, there is vigorous debate about the details. Where should this group be hosted? What should be its exact terms of reference? Who will fund it? Who should it report to? How should its recommendations be acted upon? These details matter. But, much more importantly to us, the idea of independent accountability seems secure, at least in this one sphere of global health and in the short term. The success of independent accountability depends less on the logistical details of its operation than on the commitment of stakeholders to take the notion of accountability seriously. It is up to all of us who care about delivering better health for women and children to make sure that accountability means what it says—counting and being accountable to women, children, and adolescents.

Richard Horton and Joy Phumaphi,
Co-Chairs of the independent Expert Review Group on Information and Accountability for Women’s and Children’s Health