Acting on the Call: Everyone Needs to Play Their Part
Ending Preventable Child and Maternal Deaths within a Generation
By Elena Ateva and Lyubov Teplitskaya
This past August, in Addis Ababa, Ethiopia, ministers of health from 26 countries took a major leap forward when they signed a ministerial declaration committing to end Preventable Maternal, Newborn, and Child Deaths.
Moving from commitment to action
While the declaration is important, what comes next will mean the difference between meeting, or falling short of, the goals it represents. So, the question becomes, how can we, the global health community, support the commitment of these governments?
Improving quality of care
Improving the quality of reproductive, maternal, newborn, child and adolescent health (RMNCAH) services will be critical to achieving the Sustainable Development Goals, especially Sustainable Development Goal 3, which focuses on preventing maternal and child mortality and adolescent pregnancies. Governments are beginning to recognize that the provision of high-quality care also includes a patient’s experience of care, as highlighted in the World Health Organization Quality of Care Framework. Respectful maternity care focuses on the interpersonal experience in the health services provided to women, babies, and families throughout the whole pregnancy, during labor and birth, and after birth. The Charter of the Universal Rights of Childbearing Women is a guiding document in the movement for respectful maternity care and has been adopted by governments and non-governmental and professional organizations around the world. In this health-systems approach — which seeks improvements at all levels to ensure the safety and well-being of mothers and newborns — every actor in the system has a role to play for the provision of respectful maternity care.
Sustaining financing to build strong health systems
Ending preventable maternal, newborn, and child deaths will also require sufficient, sustainable financing to support high-impact RMNCAH interventions. In countries with high maternal and child mortality rates, high levels of poverty, and low coverage of pre-payment mechanisms for health, overall health sector strengthening is essential to realizing improvements in RMNCAH. Universal health coverage (UHC) based reforms will support better access to high-quality healthcare and ensure financial protection, particularly for the poorest and most vulnerable populations. As part of UHC efforts, Health Policy Plus is working with the ministries of health in Madagascar and Mozambique to develop RMNCAH investment cases as a method to prioritize high-impact, equitable RMNCAH interventions. These investment cases provide countries with an understanding of the resource requirements needed to implement prioritized activities, including an estimate of the funds needed to strengthen referral systems, to staff optimal human resources for health, and to invest in appropriate infrastructure, supplies, and commodities needed specifically for reproductive, maternal, newborn, child and adolescent health. RMNCAH investment cases also provide a basis for continuous dialogue with the Ministry of Finance and donors regarding sustained financing for maternal and newborn health service delivery, ultimately contributing to increased access to high-quality healthcare. Through these investment cases, countries can better understand their timelines for meeting Sustainable Development Goal targets and the improvements possible in lowering maternal, neonatal, and child mortality for a given investment.
As part of UHC goals, health systems also need to ensure that healthcare benefits are distributed based on need, as opposed to ability to pay, for services and that no individuals face financial hardship when accessing healthcare. Many countries have implemented health insurance schemes and other programs to address inequities in access and quality of healthcare, such as RMNCAH services among the poor. For example, Indonesia launched its national health insurance Jaminan Kesehatan Nasional, or JKN, in January 2014 with the goal of achieving UHC by 2019 and improving access to quality healthcare for all Indonesians without financial hardship. Historically, Indonesia has focused on improving the quality of its RMNCAH services, including strengthening its referral system for obstetric and neonatal emergencies; however, inequities still persist.
Using household survey data, countries can better understand, through a quantitative lens, whether access to RMNCAH services is equitable. Techniques, such as benefit incidence analyses, can be useful to objectively assess whether different socioeconomic groups benefit equally from government spending on healthcare. Quantitative data from national and subnational household surveys can also be used to understand trends in healthcare use and out-of-pocket health spending over time. Out-of-pocket healthcare spending can be a major source of financial distress and may cause impoverishment. Understanding the levels of out-of-pocket spending among different socioeconomic groups, particularly the poorest, can be a useful way to monitor a country’s progress in reducing inequities in access to RMNCAH care.
Acting on the call
Overcoming critical barriers to maternal and child survival requires political will, like the political will demonstrated at this latest Acting on the Call Summit. But, it also requires support and innovation from the global health community to help countries move from commitment to meaningful action — and everyone needs to play their part.
 The following Ministers of Health and their counterparts from 26 countries signed on to the declaration: Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, Ghana, Haiti, India, Indonesia, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Myanmar, Nepal, Nigeria, Pakistan, Rwanda, Senegal, South Sudan, Tanzania, Uganda, Zambia, Cote d’Ivoire, and Benin.