5

ACTION AREAS

Only a comprehensive human rights-based approach will overcome the varied and complex challenges facing women’s, children’s and adolescents’ health. To succeed, countries and their partners will have to take simultaneous action in nine interconnected and interdependent areas: country leadership; financing for health; health systems resilience; individual potential; community engagement; multisector action; humanitarian and fragile settings; research and innovation; and accountability.

These nine action areas were identified as key to achieving the Global Strategy objectives, based on the scientific evidence and practical experience gained from implementing the first Global Strategy and the MDGs, on new research on effective interventions and approaches, and on new thinking about the integrated nature of health and sustainable development.

The evidence shows that making progress across a core set of interlinked action areas is critical and cost-effective, as no sector or intervention can singly achieve the objectives.43-46 This will require a more integrated and holistic way of working across sectors, as envisioned by the SDGs.

The importance of context cannot be overstated: the specific details of each action in different settings will depend on political environments, power dynamics, economics, religion, social norms and factors affecting health literacy and care-seeking behaviours among women, children and adolescents.



1. COUNTRY LEADERSHIP

Effective country leadership is a common factor across those countries making the fastest progress on improving the health of women, children and adolescents.2,43 Strong leadership is provided through meaningful collaboration between different arms of government working closely with communities, civil society, young people and the private sector to achieve health targets. Leadership is visible in the role of parliament (and often among women parliamentarians) through policy- and law-making, budgeting and increased accountability for women’s, children’s and adolescents’ health.47

Political leadership at the highest level is vital to prioritizing the needs and rights of women, children and adolescents across government sectors. Government leadership (from politicians, parliamentarians and civil servants) is the only way to ensure that health systems are built on a solid foundation of strong national institutions and management capacity, comprehensive legislation, a well-equipped workforce, functioning infrastructure, sufficient funding, robust data for decisionmaking, transparency and accountability.

ACTIONS

  1. REINFORCE THE LINKS BETWEEN POLITICAL AND ADMINISTRATIVE LEADERS. Set up or improve coordination mechanisms to ensure the active participation of administrative leaders in policy formulation and decision-making. Strengthen subnational (district level) political and administrative capacity and leadership and the relationship between central and state authorities. Put in place or improve systems for performance management and to ensure continuity despite political and administrative turnover, and in the event of emergencies such as disasters or crises.
  2. STRENGTHEN LEADERSHIP AND MANAGEMENT CAPACITIES. Identify and address barriers to more effective leadership such as accessing and using data for decision-making; essential skills in negotiation, budgeting, building consensus, planning and programme management; collaborating across sectors; coordinating multi-stakeholder action; mobilizing resources; and ensuring accountability. Increase the number of women leaders and managers at all levels.43 Collaborate with academic institutions on leadership and management programmes and through south-south cooperation to promote learning and share best practices.
  3. DEVELOP MULTI-STAKEHOLDER ACCOUNTABILITY AND OVERSIGHT. Recognize the critical role of civil society organizations, academia, the business community, media, funders and other stakeholders in holding each other and governments to account for health outcomes. Foster active citizenship, advocacy and collective action. Make disaggregated data and information on women’s, children’s and adolescents’ health publically available. Engage with stakeholders to ensure participation in developing plans and programmes and monitoring and review of implementation. Strengthen the judiciary and autonomous regulatory mechanisms to provide oversight, with policies to protect “whistle blowers”.


2. FINANCING FOR HEALTH

Existing financing falls far short of the sums needed to fund all the measures envisioned in this Strategy. To scale up from current coverage to the targets for 2030 requires US$33.3 billion in 2015 alone across 63 high-burden, low-income and lower-middle-income countries, equivalent to US$10 per capita.18 Closing this gap requires an approach that combines domestic financing, external support and innovative approaches, as well as making better use of existing resources. An estimated 20-40 per cent of health spending “is consumed in ways that do little to improve people’s health due to technical or allocative inefficiencies”.48

Domestic sources are by far the largest contributors of financing for women’s, children’s and adolescents’ health services.49 However, the majority of health expenditure in many countries comes from the private sector and from individuals through out-of-pocket expenditures, which can cause economic hardship that is particularly exacerbated by crises.

Economic growth creates important opportunities to increase government spending on health.

Development assistance for health provides important complementary resources, but has historically been fragmented and inefficient and too often displaces domestic financing.49 Innovative financing mechanisms (domestic and international) are playing an increasingly important role, mobilizing nearly US$100 billion for health and development between 2001 and 2013 and growing by about 11 per cent per year.50

ACTIONS

  1. MOBILIZE SUFFICIENT AND SUSTAINABLE RESOURCES. Increase government spending on health in line with GDP growth and towards agreed targets. Facilitate policy dialogue between ministries of finance and subnational bodies to expand tax capacities, reduce subsidies that do not benefit the poor and reallocate the freed resources to programmes targeted towards the poor. Explore new ways to generate domestic health revenues, such as expanding “sin” taxes (for example on tobacco and alcohol), debt swaps and the floating of bonds marketed to diaspora communities. Incentivize private-sector investments in health, directly and through partnerships with governments or civil society.
  2. ENSURE VALUE FOR MONEY WHILE INCREASING FINANCIAL PROTECTION FOR WOMEN, CHILDREN AND ADOLESCENTS LIVING IN POVERTY. Reduce out-of-pocket expenditures for health and instead increase the share of total health expenditure that is pooled (e.g. in national health insurance schemes). Pooling resources reduces risk, facilitates the use of subsidies to ensure equity and enables strategic purchasing, which improves efficiency. Reduce barriers to the integrated planning and reallocation of these funds towards evidence-based priority services and beneficiaries, and implement strategic purchasing and performance-based financing. Foster more effective dialogue between ministries of health and finance in order to leverage more efficient and equitable domestic financing, including health insurance, to achieve universal health coverage.
  3. ADOPT INTEGRATED AND INNOVATIVE APPROACHES TO FINANCING. Break down silos between the financing flows for women’s, children’s and adolescents’ health, including for nutrition, communicable and non-communicable diseases. Enhance collaboration between international agencies around health systems strengthening and universal health coverage to reach poor, underserved and marginalized populations, and strengthen financial instruments in fragile settings. Increase funding for high-impact programmes. Explore innovative financing models at the global, regional and national levels, using, for example, health bonds as a bridge to meet upfront financing needs. Secure credit enhancement mechanisms (e.g. pooled financing, guarantees) through multilateral development banks or bilateral agencies and target endowment and sovereign wealth funds, which are increasingly looking for investments with joint economic and social returns. Use the Global Financing Facility in support of Every Woman Every Child as a dedicated financing response to the Global Strategy (see Box 4), and leverage existing innovative health financing mechanisms, such as Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to complement domestic financing as required.

The Global Financing Facility (GFF) was launched in July 2015 as an important financing platform for the Global Strategy, to provide smart, scaled and sustainable financing to support country-led investment plans for women’s, children’s and adolescents’ health. Coordinated by the World Bank and involving a broad range of partners, the GFF has adopted a model that shifts focus away from official development assistance towards an approach that combines domestic and international funding and innovative sources for resource mobilization and delivery, including the private sector. This new model acts as a pathfinder for financing for development in the post-2015 era. The GFF operates at the country level by utilizing existing structures and processes while embodying the principles of inclusivity and transparency.18 It aims to secure universal access to essential services for every woman, child and adolescent by:

Ensuring that evidence-based, high-impact interventions—whether clinical and preventive interventions, health systems strengthening or multisector interventions—are prioritized and delivered in an efficient, results-focused manner

Fully financing women’s, children’s and adolescents’ health by mobilizing more than US$57 billion through domestic resources, new external support and improved coordination of existing assistance

Promoting sustainability by assisting countries to capture the benefits of economic growth and addressing the challenges of transitioning from lowto middle-income status18

“If women can plan their families, they are more likely to space their pregnancies. If they space their pregnancies, they are more likely to have healthy babies. If their babies are healthy, they are more likely to flourish as children.”

MELINDA GATES Co-Chair and Trustee, Bill & Melinda Gates Foundation



3. HEALTH SYSTEM RESILIENCE

Health systems are weak in many countries with a high burden of maternal and child mortality. Quality of care is undermined by limited human resources and infrastructure, lack of political will, and inadequate long-term planning, emergency preparedness and sustainable financing.51

Institutional and human capacities are the bedrock of a strong health system. They are essential to create the resilience needed to withstand health system shocks and to ensure continuity in the universal delivery of effective, quality services to all people at all stages of life and in all settings.52 When health systems and health workers are well prepared for emergencies, and to anticipate the health needs of the population, they can respond more promptly and effectively in the event of a crisis. In the 2014-2015 Ebola epidemic in West Africa, many health workers died and already fragile health systems were weakened, which resulted in increased maternal, infant and child deaths.52 Health system emergency preparedness is critical to protect health workers, provide essential health services and improve health outcomes in all settings.

Governments should lead the development of a national health strategy that aims to strengthen all the building blocks of the health system to deliver universal health coverage: leadership and governance; health workforce; medical products; vaccines and technology; health information; health financing; and service delivery.53 It is also critical to define clear roles and responsibilities for all providers (public, private and not-for-profit) and to monitor performance.

Health systems strengthening brings collateral benefits. Employment opportunities in health and social care can drive broader socioeconomic development, improve gender equality and lead to youth empowerment. Community health work, an entry point into the labour market for many women, is an essential component of health system resilience.54

ACTIONS

  1. EQUIP THE HEALTH WORKFORCE EVERYWHERE TO PROVIDE GOOD-QUALITY, NON-DISCRIMINATORY CARE. Develop a plan to identify structural bottlenecks and build health system capacity at institutional, organizational and individual levels. Reform governance and stewardship, incorporating the public and private sectors and communities. Invest in improving health workforce competencies, numbers, working conditions and rewards. Invest in procurement capacity and supply-chain management for life-saving commodities across the health system. Integrate health services delivery and monitor and evaluate health services regularly for availability, accessibility, acceptability and quality in every setting.
  2. PREPARE ALL PARTS OF THE HEALTH SYSTEM TO COPE WITH EMERGENCIES. Strengthen emergency preparedness capacities at all levels in accordance with the International Health Regulations, in areas such as legal and institutional frameworks for multisector emergency management; human resources and medical supplies and equipment for emergency response; information management systems for surveillance, risk communication and emergency management; financing and social protection; and service delivery to provide continuity of essential health services and management of mass casualties in crises.55 Underpinning all of these aspects of preparedness is the ability of the health system to ensure the availability of essential health services.
  3. ENSURE UNIVERSAL COVERAGE OF ESSENTIAL HEALTH INTERVENTIONS AND LIFE-SAVING COMMODITIES. Prioritize services for women, children and adolescents in efforts to ensure universal health coverage, guided by recommendations on evidencebased health interventions, lifesaving commodities and health system requirements (see Box 5 and Annexes 2, 3, 5 and 6), adjusted for country contexts. Provide equitable financial protection for individuals and households to prevent catastrophic out-of-pocket health expenditures.56 Strengthen the availability of disaggregated data and information to acquire a detailed understanding of where and how health inequities occur, who is affected, and what barriers prevent different groups of women, children and adolescents from accessing and demanding essential health services.34

Commodities are an integral part of strong and resilient health systems. In 2012, the United Nations Commission on Life-Saving Commodities made ten recommendations to improve the availability of, and access to, 13 underutilized, low-cost, high-impact commodities5 (see Annex 6). The Commission’s recommendations have translated into support to countries in their efforts to improve distribution systems, create demand for the 13 commodities, and build know-how on when and how to use them. At the global level the recommendations are helping to improve their availability and supply.

The Commission’s recommendations remain valid. Efforts to scale up access and reduce barriers to life-saving commodities must be accelerated in order to avert preventable deaths and improve the health and well-being of women, children and adolescents. Efforts to pool commodity procurement and secure price reductions for low- and middle-income countries beyond the 13 commodities must continue. Improvements in regulatory efficiency such as joint inspections and “fast-track” applications for pre-qualified products will ensure essential medicines are introduced more quickly where they are needed most. Ensuring all countries have the laboratory capacity to test the quality and safety of medicines is essential. Supply chains are too often weak and fragmented, and further work to reduce stock-outs is required. Finally, robust and sustained technical support should be made available to countries to ensure access to the latest evidence, guidelines, tools and best-practice materials.

“Having a healthy and well-educated population is more important than ever for fostering economic growth and building communities and societies that are resilient to shocks of various kinds.”

ERNA SOLBERG Prime Minister of Norway



4. INDIVIDUAL POTENTIAL

Women, children and adolescents are potentially the most powerful agents for improving their own health and achieving prosperous and sustainable societies. They can also pass this health and social capital on to future generations. But they cannot fulfil this crucial role unless country leaders and societies uphold human rights, ensure access to essential commodities, services and information, and expand opportunities for social, economic and political participation.57

Everyone is born with a unique biological potential for health and then acquires potential from education, skills and life experience.58 Environmental factors in early development can influence later health.59 Individuals at all ages draw on their biological and acquired potential to meet individual, social and environmental demands on their health and well-being. Having the right resources and opportunities can help people make informed choices about their health.58

A child’s brain and other systems develop most rapidly through the first three years of life, so investments in early development are essential to promote the physical, mental and social development that shape each individual’s present and future health.16

Adolescence is a second critical developmental stage.10 The physical, mental and social potential acquired in childhood can blossom into skills, behaviours and opportunities that contribute to better health and well-being in adolescence and later to a more productive adulthood.

The right investments and opportunities may consolidate early gains, or offer a second chance to young people who missed out during childhood. Moreover, as possible future parents, adolescents can transfer health potentials and risks to future generations.

As adults, women contribute to society, politics and the economy in many ways that can promote health and well-being and advance sustainable development.60 Their invaluable, but often overlooked, contributions include: knowledge; resilience in the face of adversity; leadership for their own and their families’ health; contributions to the workforce; participation in cultural and political life; and the ability to mobilize themselves and their communities to prevent and mitigate crises, rebuild communities and achieve transformative social change and peace.

Many of the barriers individuals face in realizing their potential are related to violations of their human rights, including violence, abuse and discrimination. An experience of violence can disrupt development and cause immediate and longterm physical, mental, emotional and social harms.

ACTIONS

  1. INVEST IN CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT. Develop and finance integrated health and development programmes for early childhood and adolescence that combine efforts across sectors (including health, nutrition, responsive caregiving, social and mental stimulation, education, environment, water, sanitation and hygiene, employment and economic development programmes) and by a range of partners (including government, civil society, the private sector and communities). Support people caring for young children to provide nurturing care with stimulation and opportunities for learning in the first years of life. Ensure that young people achieve literacy and numeracy and have relevant technical and vocational skills for employment and entrepreneurship.
  2. SUPPORT WOMEN, CHILDREN AND ADOLESCENTS AS AGENTS FOR CHANGE. Identify context-specific needs—including barriers to realizing rights—and promote access to essential goods, services and information. Expand age-appropriate opportunities for socioeconomic and political participation. Ensure that these activities are funded in country plans and budgets.
  3. REMOVE BARRIERS TO REALIZING INDIVIDUAL POTENTIAL AND PROTECT FROM VIOLENCE AND DISCRIMINATION. Identify the root causes of exclusion, discrimination and deprivation, including inadequate civil registration and vital statistics systems. Strengthen legal frameworks to register and address human rights violations, promote human rights literacy and provide age- and gender-appropriate protection services and safe spaces for women, children and adolescents, including in humanitarian and fragile settings. Expand civil registration and vital statistics systems to increase access to services and entitlements in order for women and children to realize their rights to proper health care, education and basic social benefits, including housing and social protection.


5. COMMUNITY ENGAGEMENT

“Community” is a broad term that includes local, national or international groups of people who may or may not be spatially connected, but who share interests, concerns or identities.

Several countries offer strong evidence of the effectiveness of community engagement. Examples include women’s groups supporting those who are pregnant or new mothers,61 involvement of men and boys in health programmes,62 and involvement of patients in quality-improvement activities within urban health services.63 Ideally, the whole community, including adolescents, should be engaged in the process of deciding on health priorities and shaping health services for people of all ages.

For instance, community health workers are trusted community members in many countries, yet are under-recognized and remain peripheral in many national health systems. Civil society organizations, faith-based organizations and local, faith and traditional leaders also play important roles in addressing sociocultural barriers to the promotion of healthy behaviours.



ACTIONS

  1. PROMOTE LAWS, POLICIES AND SOCIAL NORMS THAT ADVANCE WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH. Create legal and policy frameworks to promote positive social norms, for example to prohibit violence against women and girls and promote the full inclusion in society of individuals living with disabilities. Remove legal and policy barriers to adolescents’ access to services. Improve community engagement through improved health literacy, dialogue, learning and action and community engagement strategies. Tailor mass-media campaigns to different social contexts, resources and needs to promote health literacy and positive behaviours in areas such as comprehensive sexuality education for adolescents and adults; breastfeeding and good nutrition; water, sanitation and hygiene practices; and decision-making related to health.
  2. STRENGTHEN INCLUSIVE COMMUNITY ACTION THAT RECOGNIZES THE ROLES OF DIFFERENT GROUPS. Involve community and political leaders and planners alongside other community members. Develop a more integrative and holistic approach to the continuum of health care by involving civil society organizations, including humanitarian actors, community and faith-based leaders and traditional birth attendants in dialogue and participatory learning and action. Formalize the contribution of community leaders and health workers within national health systems, with appropriate devolution of responsibility, support, supervision and remuneration. Encourage communities to participate in defining their health needs. Reorient health and development services in response.
  3. ENSURE WOMEN AND GIRLS CAN FULLY PARTICIPATE, AND ENGAGE MEN AND BOYS IN HEALTH PROGRAMMES. Involve women, children and adolescents and the organizations that support them in decision-making for health policies and programmes that affect their health and well-being. Include age and contextspecific mechanisms in health programmes to ensure their participation. Promote supportive attitudes and behaviour from health workers for engaging men and boys and provide space for male partners in health facilities.


6. MULTISECTOR ACTION

Around 50 per cent of the gains in the health of women, children and adolescents result from investments outside of the health sector.10,43,45 These include interventions and policies in education, nutrition, water, sanitation and hygiene, social protection and poverty reduction, child protection, labour, transport and energy. Cross-sector action—such as increasing women’s political and economic participation and mitigating and adapting to climate change—also contributes significantly to health outcomes while contributing co-benefits across sectors.25

Interventions beyond the health sector must therefore be considered as core to national strategies on women’s, children’s and adolescents’ health, and monitored in the same way as health sector interventions such as immunizations or provision of bednets. Annex 4 presents a prioritized list of key policies and interventions across different sectors.

These policies and interventions correspond to many of the SDG targets listed under the Thrive and Transform objectives of this Strategy, which are mostly beyond the domain of the health sector.

Many countries have successfully adopted a multisector approach to health and development. For example, India finally eradicated polio by targeting the multisector causes of diarrhoeal disease in children (lack of clean water, sanitation etc.), which was reducing the efficacy of the polio vaccinations.64 The Senegal River Basin Project, a multisector collaboration for economic development in the region, also resulted in 83 per cent of children aged under five sleeping under mosquito nets, drastically reducing malaria rates.65

ACTIONS

  1. ADOPT A MULTISECTOR APPROACH TO IMPROVING THE HEALTH AND WELLBEING OF WOMEN, CHILDREN AND ADOLESCENTS. Identify and incorporate policies and interventions (see Annex 4) led by different single sectors as core to national health strategies. Identify key structural forces that affect health and drive disparities, including gender-related structural and institutional biases. Enact broad-ranging cross-sector policies to advance shared goals and address challenges that lone sectors cannot resolve, driven by heads of government. Assess policies and interventions in different sectors to identify potential health risks.46
  2. BUILD GOVERNANCE AND CAPACITY TO FACILITATE MULTISECTOR ACTION AND CROSS-SECTOR COLLABORATION. Strengthen coordination, financing and accountability mechanisms to manage multisector action and crosssector collaboration and promote related accountability at all levels. Identify strategic areas for cross-sector collaboration and create incentives to expedite the work. Eliminate bureaucratic and financial disincentives and barriers to multisector action and cross-sector collaboration, not only in governments but also among international agencies, the private sector and non-governmental organizations.
  3. MONITOR THE IMPACT OF MULTISECTOR ACTION AND CROSS-SECTOR COLLABORATION ON HEALTH AND SUSTAINABLE DEVELOPMENT. Enact joint monitoring of policies and interventions in different sectors that impact on health and consider and report on them as core health indicators. Promote shared monitoring of cross-sector action and impact across health and other sectors, as well as shared contributions towards achieving the SDGs.


7. HUMANITARIAN AND FRAGILE SETTINGS

More than half of all maternal, newborn and child deaths occur in humanitarian settings, including conflict and post-conflict situations, transnational crises, countries that have experienced one or more serious natural disasters and situations of protracted socioeconomic and political instability.8,9,37

Health challenges are particularly acute among mobile populations, those in refugee or temporary camps and among internally displaced communities. Almost 60 per cent of the 1.4 billion living in humanitarian settings are young people under 25 years of age. Women and adolescent girls in particular are vulnerable in such settings to exclusion, marginalization and exploitation, including sexual and gender-based violence.

Humanitarian emergency responses have historically given insufficient attention to protecting women, children and adolescents, who in crises face increased risks of poor physical and mental health outcomes, harassment, assault and rape. However, lessons have been learned. A devastating earthquake in Nepal in April 2015 killed thousands and affected more than half of the country’s districts. An estimated 2 million women and girls of reproductive age and 126,000 pregnant women were among the survivors.

Local, national and international responders across sectors—including health, protection, gender-based violence, HIV/AIDS and water, sanitation and hygiene—coordinated to uphold rights and ensure provision of essential sexual and reproductive health services. Their activities included ensuring safe births, supplying reproductive health and hygiene kits, and preventing gender-based violence, which is known to increase in the aftermath of disasters.66 Applying a sustainable, human-centred approach to humanitarian efforts in crisis situations, whether short or protracted in duration, can strengthen the resilience of women, children and adolescents and their communities.

Given that a focus on humanitarian and fragile settings is an addition to this Global Strategy, the humanitarian and development sectors, while fulfilling their respective mandates, should collectively explore means of working more effectively to build resilience among women, children and adolescents and break down silos between humanitarian response and development efforts. Such efforts can be advanced through the following actions.

ACTIONS

  1. SUPPORT USE OF HEALTH RISK ASSESSMENTS, HUMAN RIGHTS AND GENDER-BASED PROGRAMMING TO BETTER PROTECT THE SPECIFIC NEEDS OF WOMEN, CHILDREN AND ADOLESCENTS IN HUMANITARIAN SETTINGS. Use a gender perspective when assessing risk and mapping community safety. In partnership with civil society and communities, build multi-hazard risk assessment and disaster risk reduction, including emergency preparedness, into country plans and budgets for women’s, children’s and adolescents’ health. Ensure that the Minimum Initial Service Package includes up-to-date evidence-based interventions (see Annex 2). Deliver comprehensive packages that meet the unique, context-specific needs of women, children and adolescents in the full range of humanitarian, disaster, outbreak and conflict situations. Empower and support civil society actors to access populations where government actors cannot do so.
  2. FULLY INTEGRATE EMERGENCY RESPONSE INTO HEALTH PLANS AND PROVIDE ESSENTIAL HEALTH INTERVENTIONS. Analyse how, when and where health and other services should be made available in ways that protect access to all essential health services for all individuals in all settings, without discrimination or unnecessary risk. Ensure effective emergency response and continuity of care through essential health service provision for women, children and adolescents (see Annex 2).
  3. ADDRESS GAPS IN THE TRANSITION FROM HUMANITARIAN SETTINGS TO SUSTAINABLE DEVELOPMENT. In this transition phase, prioritize the health and well-being of women and young people, who are key to the ability of communities to withstand crises and recover from them. Invest in strengthening governance, health systems, institutions and financing to support this transition phase. Develop new approaches and mechanisms to finance the immediate, intermediate and longer-term health needs of all people living in humanitarian settings and increase accountability for results across all activities that span the transition from humanitarian relief to sustainable development.


8. RESEARCH AND INNOVATION

The full spectrum of research is required to understand and overcome the barriers to health for women, children and adolescents. Policy, implementation and operational research can lead to stronger systems and to improved service quality, efficiency and effectiveness.67-69 Clinical research and systematic reviews of the evidence are essential to develop and update effective interventions (see Annex 2) and combat emerging challenges. These challenges include antimicrobial resistance, as well as neglected tropical diseases, particularly as they relate to women’s, children’s and adolescents’ health.70,71 More and better data are needed from monitoring and evaluation to increase the timeliness and accuracy of accountability tools and information.

Research is needed to understand the determinants and barriers that continue to restrict the access of many women, children and adolescents to health services.34 Likewise, evidence is needed on the most effective approaches to reduce these inequities, across a range of contexts.34 Social, behavioural, anthropological and community research helps to increase understanding of how to promote positive behaviour for health72—such as breastfeeding and hand washing with soap— and how to prevent harmful practices such as child marriage and female genital mutilation.

Political and social sciences are also suited to capture evidence related to important health-related human rights and social goals, such as health equity, empowerment and eliminating discrimination.40,73

Evidence shows that knowledge and technological advances can be at least as important as economic resources in improving health and well-being.74 Innovation is the starting point of a process that translates powerful new ideas and scientific evidence into effective, widely used interventions and commodities. To identify and take them to scale, the Every Woman Every Child movement has adopted the concept of integrated innovation. This states that scientific and technological, social, business and financial innovations are all needed and can often be combined to achieve transformative effects (see Box 6).75 Innovations in lowincome countries are a vital source of progress and should be supported by global partnerships and south-south cooperation. Community-based organizations have a critical role to play, particularly for innovations that go beyond health service delivery to address harmful social norms, build institutional capacity and reduce inequities.

ACTIONS

  1. INVEST IN A WIDE RANGE OF RESEARCH, PRIORITIZING LOCAL NEEDS AND CAPACITIES. Build country capacity to generate and use robust and relevant research evidence for the development of more effective policies, practices and advocacy for women’s, children’s and adolescents’ health.
  2. LINK EVIDENCE TO POLICY AND PRACTICE. INVEST IN AND NURTURE THE CYCLE OF RESEARCH, EVIDENCE, KNOWLEDGE, POLICY AND PROGRAMMING. Develop “knowledge brokering” and knowledge translation mechanisms to ensure the latest evidence is available to all stakeholders at country, regional and global levels. Invest in global and national research networks, knowledge platforms and data hubs to provide accurate, timely and transparent evidence, knowledge, data analysis and synthesis.
  3. TEST AND TAKE INNOVATIONS TO SCALE. Actively engage governments, the public and private sectors, academia, civil society, foundations, donors, sociallyminded investors and other relevant stakeholders to develop and bring successful innovations to scale. Create a positive business environment that recognizes the value of innovation to society. Prioritize innovations that have the greatest potential to reduce inequities in health, and to ensure that progress on women’s, children’s and adolescents’ health benefits disadvantaged populations at least as much as more affluent ones. Encourage the sharing of expertise and experiences.

“As we embark on the new development agenda, due consideration must be given to make sure that nobody is left behind in acquiring the adequate measurement tools. A data revolution is within our reach of today’s technological advances.”

ELLEN JOHNSON SIRLEAF President of Liberia

The pipeline of innovation is more robust than it has ever been for women’s, children’s and adolescents’ health. More than 1,000 innovations are currently in research and development.2 The bottleneck is at the “transition to scale” stage, requiring more than US$1 million in funding for each promising pilot or proof-of-concept innovation. An Every Woman Every Child Innovation Marketplace in support of the Global Strategy aims to address this bottleneck, providing a mechanism and a conducive environment—backed by a global partnership of stakeholders—to curate the pipeline of innovations, identify the most promising, and broker investment to accelerate their path to scale, sustainability and impact. The goal is to transition at least 20 investments to scale by 2020 and to see at least ten of these innovations widely available and producing significant benefits for women, children and adolescents by 2030.



9. ACCOUNTABILITY FOR RESULTS, RESOURCES AND RIGHTS

Accountability is essential to accelerating progress for women’s, children’s and adolescents’ health. It enables the tracking of resources, results and rights and provides information on what works, what needs improvement, and what requires increased attention. Accountability ensures that decision makers have the information required to meet the health needs and realize the rights of all women, children and adolescents and to place them at the heart of related efforts.

The United Nations Commission on Information and Accountability for Women’s and Children’s Health (CoIA) defined accountability as a cyclical process aimed at learning and continuous improvement and involving three principal stages: monitor, review and act (see Annex 5).3,4 The CoIA placed the focus for action “soundly where it belongs: at the country level”, but acknowledged that accountability is the responsibility of all partners and spans the local, country, regional and global levels.3

The enhanced Accountability Framework for the Global Strategy (see Figure 4) builds on the CoIA’s principles, framework and recommendations. The Accountability Framework is aligned with the High-level Political Forum on Sustainable Development, which will have the central role in overseeing follow-up and review of progress on the SDGs at the global level.76 It is also aligned with the Roadmap for Health Measurement and Accountability and its 5-Point Call to Action, which was adopted by WHO, USAID, the World Bank, countries and partners in June 2015 to advance a common agenda for health measurement.77 Its overarching aim is to establish a clear structure and system to strengthen accountability at the country, regional and global levels and between different sectors. Ultimately, the Global Strategy is accountable to all women, children and adolescents as rights holders, including the underserved and marginalized.

ACTIONS

  1. HARMONIZE MONITORING AND REPORTING. Minimize the reporting burden on countries by harnessing existing data sources disaggregated by gender, geography and income to track progress on implementing the Global Strategy, and by repurposing reports and scorecards already in use for women’s, children’s and adolescents’ health. Develop these reports by countries with support from the H4+— the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Entity for Gender Equality and Women’s Empowerment (UN Women) and the World Bank—through a collaborative and transparent process. Report on progress in implementing the CoIA recommendations, including tracking reproductive, maternal, newborn, child and adolescent health expenditures and results against the agreed targets and indicators. Use regional peer review and regional reports to link accountability at the global and country levels.
  2. STRENGTHEN CIVIL REGISTRATION AND VITAL STATISTICS. Support countries’ efforts to strengthen their accountability mechanisms and institutions, including monitoring and reporting on results. Ensure that all countries have a functioning civil registration and vital statistics system so that births, marriages and deaths and their causes can be registered and monitored. Ensure that the deaths of women, children and adolescents are monitored and audited, so that appropriate follow-up actions can be taken.
  3. PROMOTE MULTI-STAKEHOLDER ENGAGEMENT TO MONITOR, REVIEW AND ACT. Promote multi-stakeholder engagement and cross-sector collaboration for followup actions at all levels. Health sector reviews involving all stakeholders can provide a platform for monitoring, review and action. Parliamentarians and civil society can monitor and hold governments accountable, thereby ensuring citizens’ voices are heard. To ensure a transparent and independent review, an Independent Accountability Panel will prepare an annual report on the State of Women’s, Children’s and Adolescents’ Health (see Box 7). The Partnership for Maternal, Newborn & Child Health will play a coordination role in the global Accountability Framework to ensure all stakeholders can act on recommendations.

Figure 4:

The Global Strategy’s Accountability Framework

Global accountability for the implementation of the Global Strategy will be brought together in a unified framework. In an effort to harmonize global reporting, minimize the reporting burden on countries and support costeffectiveness, a comprehensive synthesis report of the State of Women’s, Children’s and Adolescents’ Health will be produced using information routinely provided from United Nations agencies and independent monitoring groups. This annual report will be developed in an independent and transparent manner and will provide the global community with the best evidence for progress on women’s, children’s and adolescents’ health towards achieving the Global Strategy objectives and the SDGs. The report will provide recommendations and guidance to all stakeholders on how to accelerate progress for improved health outcomes for women, children and adolescents.

The Independent Accountability Panel will take the lead in writing the annual report with support from a small secretariat housed at the Partnership. The annual report should not require additional data collection.

Each report will have a theme based on the findings of the previous year’s report and be submitted to the United Nations Secretary-General. Member States and other stakeholders will be encouraged to discuss the report at the High-level Political Forum on Sustainable Development, which will be reviewing progress on the SDGs, the World Health Assembly, meetings of human rights treaty bodies and other high-level political assemblies and events, and to take appropriate actions.