September 22, 2014
Written by Dr. Koki Agarwal, MD, MPH, DrPH, Director Maternal and Child Survival Program
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The Maternal and Child Survival Program enters its inaugural year with 2015 on the horizon and the world engaged in a discussion of the post–Millennium Development Goal (MDG) agenda. This new flagship, USAID-funded program carries forward the momentum and lessons learned from the Agency’s Maternal and Child Health Integrated Program (MCHIP), which made significant progress in improving the health of women and children in over 50 developing countries throughout Africa, Asia, Latin America and the Caribbean.
And yet, with the 500-day deadline for the MDGs now behind us, we realize how much more there is to do to end preventable maternal, newborn and child deaths. Under no circumstances can we afford to lose the momentum in the days leading to the culmination of the MDGs. At the core of this stalled progress is equity: the ability to reach those most in need, especially in low-resource settings, with high-quality services.
The Maternal and Child Survival Program is motivated by a vision of self-reliant countries equipped with the analytical tools, effective systems, and technical and management capacity to improve the health of mothers and families. But to truly improve health care and reach the MDGs—and achieve the post-MDG goals in the process—we must recommit our efforts in ways that address equity and general health systems strengthening.
To keep the promise we made to the world’s mothers and children in 2000, we must ask ourselves five questions:
Accountability is a process of data analysis, review, shared responsibility, and action taking. We cannot talk about accountability without a process of shared responsibility between partners. It is not the sole role of ministries of health to ensure services are delivered; all partners — including nongovernmental organizations, civil societies, the community, and private sector — have to take responsibility and act in a coordinated manner under national plans.
Communities are crucial in promoting equity, and they must be educated and empowered. Through heath volunteers, peer groups, and advisory boards, communities help to ensure that the right people are getting the right services at the right time. For instance, we know that it’s feasible to achieve high coverage of uterotonic use — even in low-resource and post-conflict settings — by distributing misoprostol in advance of birth during home visits. And that community plans for emergency transportation and obstetric care are critical to saving lives. Many countries have also taken up the challenge of scaling up integrated Community Case Management programs for the main killers (pneumonia, diarrhea and malaria) of children under five, with the idea of extending services to those without current access. We must continue to improve the performance of village health workers to meet these needs.
Above all, we cannot assume that our efforts will increase equity. We must monitor not only the quality of services, but also their equity, tracking performance and taking corrective actions where necessary. Ensuring gender equity here — outside of the formal health system, in the most remote areas — is critical to improving care for the most vulnerable women and children.