When leaders of country governments sign political commitments such as the Millennium Development Goals (MDGs), they are not only making commitments to the global community but more importantly to the people whose lives depend on the country’s ability to meet these targets to improve health.With stunting rates for children under five at 58 percent in Burundi, maternal mortality rate at 488 per 100,000 live births in Kenya, child mortality rate at 76 per 1,000 live births in Rwanda, 27 percent unmet need for contraceptives in Tanzania, and skilled attendants at only 59 percent of births in Uganda, the countries that comprise the East African Community (EAC) have an opportunity and are committed to improve RMNCH through leveraging the collective market size, knowledge, and continual successes in the region in order to meet and continue to improve beyond the targets identified in recent political commitments. I applaud the leadership of the UN Secretary General as well as the commitment of East Africa’s leaders to focus on Reproductive, maternal and Child Health. They deserve all our support.
Recognizing the great breadth and depth of knowledge within the EAC, the Open Health Initiative to Improve Reproductive, Maternal, Child, and Newborn Health in the East African Community Partner States (OHI) aims to support the partner states reach their goals for women’s and children’s health by focusing on three thematic areas: ‘Accountability for Results and Resources’, ‘Results-based Financing’, and ‘Innovation’.
Only through quality data, including vital registration, can the EAC as a region measure, target, and scale-up successful interventions. Within the current financial context, improving women’s and children’s health in the EAC Partner States will primarily rely on using existing funds — domestic and external — more efficiently and effectively. The OHI is therefore prioritizing increased accountability and transparency for results and resources by all stakeholders as essential to improving women’s and children’s health and reaching country’s targets for MDGs 4 and 5.
Furthermore, the initiative, as a long-term and catalytic intervention, will initially focus on three cross-cutting strategies to make an immediate impact within the partner states across the three thematic areas and against MDGs 4 and 5: ‘Strengthen and Maintain Political Momentum’, ‘Best Practices and Knowledge Sharing for Action’, and the ‘Acceleration Fund for RMNCH’.
In a clear and decisive step in prioritizing the health of women and children, the OHI was approved by all five heads of state in the EAC in November 2012 with implementation set to begin in January 2013.
How will greater accountability save lives?
Accountability encompasses political accountability to previous commitments, performance accountability to meet targets, economic accountability for reporting financial information. Most importantly accountability is necessary to provide quality care for patients. It is not just standards and commitments that will improve accountability, and therefore health for women and children, but actions taken within countries to ensure that data are properly recorded and reported and that financial information is tracked and shared. Given current global financial constraints, we must do more with what resources and knowledge we have by increasing accountability and efficiency of resources and decreasing duplication of efforts.
In signing the OHI into regional policy, for example, the partner states agreed to track all health budget and expenditure data and publish a routine report of actual allocation for women’s and children’s health. This action will require not only greater effort from national governments, but full cooperation and openness from global donors and stakeholders. Furthermore, the Open Health Initiative will support the facilitation of an agreement on a set of key maternal and child health indicators already collected through the national health systems that will be reported annually to heads of state within the EAC. Monitoring and reporting the progress of targets for improving outcomes of women’s and children’s health to high levels of governments will help keep policy makers and government officials accountable against stated commitments and to their constituencies.
Tracking resources and comparing allocations with health outcomes will inform decision-makers on whether more resources are needed in procuring commodities such as family planning, training skilled birth attendants, or conducting immunization campaigns. Moreover, tracking resources and results will let us know which regions of a country are struggling most and can help improve equity of care and access and identify best practices that can be leveraged regionally.
And, the capacity to learn from each other exists in East Africa. In Rwanda for example, the national health resource tracking system provides a detailed overview by health area of money being budgeted and spent and is linked with key objectives of the health sector strategic plan, ensuring that money is allocated based on previously made commitments and goals. Since all development partners and donors are engaged along with government, the system is more transparent and coordinated, resulting in more informed decision-making and a more efficient use of limited resources and hence potentially better health outcomes for patients. It is possible to track all budgets and expenditures against an agreed health strategic plan. Through the Open Health Initiative, I look forward to partner states have implementing systems that increase accountability for both results and resources.
At the global level, given the economic and financial challenges we face, and the struggle by all countries to meet the MDGs, there is an acute need to ensure a maximum impact and effective use of funds towards clear outcomes. Resources available to countries must be predictable and long term. They must also be protected from the vagaries of global politics. The lives of women and children are too important to be allowed to fall through political cracks.
Despite the adoption of policies and commitments to improve womenfs and childrenfs health, there are resource shortages and funding gaps to supporting successful interventions. As a key strategy in the implementation of the OHI, the Acceleration Fund for RMNCH will help address some of the funding shortages while being complementary of other funding mechanisms. The Acceleration Fund for RMNCH will make flexible resources accessible in real time to Partner States that can be used for scaling]up high impact interventions towards the improvement of womenfs and childrenfs health and as an incentive to the Partner States to improve on accountability commitments made through initiatives like the UN Commission on Accountability and Every Women, Every Child by linking subsequent disbursements of funds to improvement of selected indicators. This catalytic, innovative, and results oriented fund will provide fast and flexible resources to countries to improve womenfs and childrenfs health while strengthening accountability measures.
Time to change business as usual
Right now, across all five of our partner states, there is an unacceptably high rate of maternal and child mortality which hinders the development and advancement of individuals, families, and nations. No woman should die or suffer debilitating results from childbirth and every newborn should have a healthy childhood. We owe this to our people, and by uniting as one EAC and as a larger global community, we have the knowledge and capability to improve the welfare of women, children, and families and take significant steps towards decreasing maternal and child mortality. There is a long road ahead to build these systems and put quality information in front of decision makers, however improvement is not only possible, it is essential for the posterity of our nations.
By empowering our assiduous leaders in countries, along with partners in development both domestic and foreign, with information on where resources are most needed and which interventions are yielding the greatest impact, progress can be made towards meeting previously made political commitments and improving the lives and health of women and children. Additionally, the Acceleration Fund will be the first regional incentive funding mechanism based on ‘results’ no ‘inputs’ changing the way financing is disbursed.
The East African Community (EAC) is the regional intergovernmental organization of the Republics of Burundi, Kenya, Rwanda, the United Republic of Tanzania, and the Republic of Uganda, with its headquarters in Arusha, Tanzania. The Vision of EAC is a prosperous, competitive, secure, stable and politically united East Africa; and the Mission is to widen and deepen Economic, Political, Social and Culture integration in order to improve the quality of life of the people of East Africa through increased competitiveness, value added production, trade and investments.