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
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.
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.
Existing financing falls far short of the sums needed to fund all the measures envisioned in this
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
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
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
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
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.
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.
“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.
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
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
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
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
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.
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.
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
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.