Volume 16 Supplement 2
Accountability for women’s, children’s and adolescents’ health in the Sustainable Development Goal era
© The Author(s). 2016
Published: 12 September 2016
Commitment to the Millennium Development Goals (MDGs) in 2000 resulted in political momentum, new investments and mobilisation to implement practical steps needed to meet the framework of eight MDG goals. MDG 5 (improve maternal health) and MDG 4 (reduce child mortality) focused on improving women’s and children’s health, with newborn health not added until the mid-2000s. The MDG era saw vast improvements in maternal and child survival, with global under-five mortality rates declining by more than half, from 90 to 43 deaths per 1000 live births between 1990 and 2015, and a 45 % decline in maternal mortality ratio worldwide, with more reductions occurring since 2000 . However, as the MDGs draw to a close, the annual death toll, most of which could have been prevented, remains unacceptably high with 303,000 maternal deaths, 2.6 million stillbirths, 5.9 million deaths in children under the age of five - including 2.7 million newborn death - and 1.3 million adolescent deaths [2–7]. It also remains very unequally distributed, with poor countries and poor individuals in middle income countries shouldering the largest burden.
Evidence from this journal supplement shows that further global and national level accountability is needed for tackling persisting inequalities and uneven progress for women’s and children’s health in the post-2015 era . To achieve optimal national level accountability there is an urgent need for improvements in the quantity and quality of subnational data, as demonstrated in this supplement by Singh et al. and Armstrong et al. in their analyses of change in health systems inputs and coverage of interventions for women’s and children’s health in Tanzania [10, 11], and by Huicho et al. in their district-level analysis of reductions in neonatal mortality rates in Peru care showing remaining gaps for urban and rural populations . It is imperative to address data gaps, as well to implement high-impact interventions with an increased focus on equity and quality to ensure that women, children and adolescents are not left behind in the SDG era and that stillbirths are counted.
In order to achieve accountability for women’s, children’s and adolescents’ health, it is key to focus on political attention and leadership, promotion of individual and community voices, investment, implementation at scale, and evaluation . Also key is for nations and stakeholders to commit to intermediate milestones, key to measuring progress. To drive this accountability agenda, the Global Strategy interlinks global and country level accountability under a Unified Accountability Framework for resources, results and rights at the country, regional and global levels and between different stakeholders and sectors. The World Health Organisation with Every Woman Every Child, H6 and other partners have developed a “Global Strategy Indicator and Monitoring Framework”, aligned with SDG indicators and established global initiatives to minimise reporting burden, which will be implemented in part via the Independent Accountability Panel (IAP). The IAP is comprised of nine diverse panellists empowered to command global attention to the issues comprising the Global Strategy’s survive, transform and thrive themes, and will work to monitor, review, remedy and action progress towards women’s, children’s and adolescents’ health .
In an effort to harmonise global reporting and minimise the reporting burden on countries, the IAP will prepare a comprehensive annual synthesis report on the State of Women’s Children’s and Adolescents’ Health, using information routinely provided from United Nations agencies, independent monitoring groups and bodies such as National Human Rights Institutions (Fig. 1). This annual report will be developed independently and transparently to provide the global community with the best available evidence on progress towards achieving the Global Strategy’s objectives, together with the relevant SDGs, including SDG 16 to “develop effective, accountable and transparent institutions” . The report will provide recommendations and guidance to the Global Strategy’s stakeholders on accelerating improved health outcomes for women, children and adolescents, stressing the aspects of accountability of different duty-bearers in doing so. As part of the Global Strategy’s accountability framework, the IAP is charged with ensuring the global and national-level communities monitor, review and act to keep women’s, children’s and adolescent’s health at the heart of the SDG agenda, and to ensure they go beyond survival to thriving and transforming in the post-2015 era. Better data, better use of data and national leadership are crucial to true accountability.
We thank Neha S. Singh, Helen Owen and Joy E. Lawn for inputs to this editorial. Panellist nationalities: CB: Brazil; WL: Kenya; EM: United Kingdom; PL: South Africa; VKP: India; GP: Georgia; DW: Sri Lanka; AEY: USA.
As members of the United Nations Secretary-General’s Independent Accountability Panel for the Global Strategy for Women’s, Children’s and Adolescent’s Health, authors are in a non-salaried post and were thus not paid for writing this editorial. The costs for the publication of this editorial were provided through a sub-grant from the U.S. Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn and Child Survival grant from the Bill & Melinda Gates Foundation, and from the Government of Canada, Foreign Affairs, Trade and Development.
This article has been published as part of BMC Public Health Volume 16 Supplement 2, 2016: Countdown to 2015 country case studies: analysing progress towards maternal and child survival in the Millennium Development Goal era. The full contents of the supplement are available online at http://bmcpublichealth.biomedcentral.com/articles/supplements/volume-16-supplement-2.
EM was responsible for writing the editorial. All authors contributed to and approved the editorial.
The authors declare no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Millennium Development Goals 2015 report. [http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20(July%201).pdf] Accessed 1 July 2016.
- Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–74.View ArticlePubMedGoogle Scholar
- Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587–603.View ArticlePubMedGoogle Scholar
- UNICEF, UN Inter-agency Group for Child Mortality Estimation: Levels and Trends in Child Mortality: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. In. New York: UNICEF; 2014.Google Scholar
- Lawn J, Blencowe H, Oza S, You D, Lee A, Waiswa P, et al. Every newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189–205.View ArticlePubMedGoogle Scholar
- World Health Organisation. Health for the world’s adolescents: a second chance in the second decade. 2014, Geneva: WHO.Google Scholar
- Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423–78.View ArticlePubMedGoogle Scholar
- United Nations. Survive, thrive, transform. The global strategy for women’s, children’s and adolescent’s health. New York: United Nations; 2015.Google Scholar
- Moucheraud C, Owen H, Singh NS, Ng CK, Requejo J, Lawn JE, Berman P, Countdown to 2015 Case Study Collaboration G: Countdown to 2015 country case studies: What have we learned about processes and progress toward MDGs 4 and 5? BMC Public Health 2016, doi: https://doi.org/10.1186/s12889-016-3401-6.
- Singh NS, Huicho L, Afnan-Holmes H, John T, Moran AC, Colbourn T, Grundy C, Matthews Z, Maliqi B, Matthews M et al.: Countdown to 2015 country case studies: Systematic tools to address the “black box” of health systems and policy assessment. BMC Public Health 2016, doi: https://doi.org/10.1186/s12889-016-3402-5.
- Armstrong CE, Martinez-Alvarez M, Singh NS, John T, Afnan-Holmes H, Grundy C, Ruktanochai CW, Borghi J, Magoma M, Msemo G et al. Subnational variation for care at birth in Tanzania: Is this explained by place, people, money or drugs? BMC Public Health 2016, doi: https://doi.org/10.1186/s12889-016-3404-3.
- Huicho L, Huayanay-Espinoza CA, Herrera-Perez E, Niño de Guzman J, Rivera M, Restrepo-Méndez MC, Barros AJD: Examining national and district-level trends in neonatal health in Peru through an equity lens: a success story driven by political will and societal advocacy. BMC Public Health 2016, doi: https://doi.org/10.1186/s12889-016-3405-2.
- Mason E, McDougall L, Lawn JE, Gupta A, Claeson M, Pillay Y, Presern C, Lukong MB, Mann G, Wijnroks M et al. From evidence to action to deliver a healthy start for the next generation. Lancet. 2014;384(9941):455–67.Google Scholar
- Every Woman Every Child (WHO). Indicator and monitoring framework for the global strategy for women’s, children’s, and adolescents’ health (2016–2030). Geneva: WHO; 2016.Google Scholar