Each year in developing countries, more than 350,000 women die due to pregnancy and childbirth complications; 8 million children under 5 die from preventable causes.
As G8 leaders meet in Canada, momentum builds for greater investment in global maternal, newborn, and child health, and nutrition, to meet the Millennium Development Goals.
Health systems approaches in Rwanda, Nepal and elsewhere show reductions in infant and child mortality rates.
June 24, 2010─ Across the developing world, 8 million children under 5 die each year due to complications of preventable diseases such as malaria and diarrhea. Their deaths have everything to do with broken health systems in desperate need of repair.
Although malaria, for example, is a common, preventable and treatable infection, families often don’t have access to the free bed nets and anti-malarial drugs available in their countries due to inadequate distribution systems. In addition, at some local clinics, there are no health workers; they don’t attend work because they aren’t getting paid. This means children go without diagnoses or treatment, their symptoms worsening over time due to poor nutrition and sanitation.
By the time many of these malaria-stricken children arrive at the hospital, complications are so advanced that they can’t recover.
Their plight underscores the importance of a ‘systems approach’ to better health, which coordinates among all institutions and resources devoted to health care, from financing to policy to service delivery. This week, ensuring healthier, better nourished and more productive lives for poor mothers and their children—the promise of Millennium Development Goals (MDGs) 4 and 5— will take center stage at the G8 Summit in Canada.
With the clock ticking down to the 2015 MDG deadline, G8 leaders are expected to lend their support to the so-called Muskoka Initiative—an international effort to expand cost-effective investments in maternal, newborn, and child health, and nutrition, to drive overall better health and drastically reduce poverty.
The meeting builds on global momentum, nine months after a High-Level Taskforce, co-led by World Bank Group President Robert B. Zoellick that highlighted the need for stronger, better financed health systems, and improved access to health services for women and children. In addition, at a September 2010 United Nations Summit on the MDGs, leaders are expected to adopt a Joint Action Plan for Women’s and Children’s Health to accelerate progress toward achieving the goals.
“Every moment should be a pivotal moment for maternal, newborn, and child health,” said World Bank Managing Director Ngozi Okonjo-Iweala during the international Women Deliver conference in Washington, D.C., earlier this month. “But now there’s a sense of urgency—more work needs to be done to reach the MDGs by 2015.”
A Case for Greater Investment
Recent work by the World Bank makes a strong case for greater investments in maternal, newborn, and child health, and in good nutrition. In May, the Bank released its five-year plan to help developing countries reduce their fertility rates and prevent the widespread deaths of mothers and children. In developing countries, more than 350,000 women succumb to pregnancy and childbirth complications each year.
In endorsing its Reproductive Health Action Plan 2010-2015, the Bank warned that family planning and other reproductive health programs that are vital to poor women had fallen off the development radars of many low-income countries, donor governments, and aid agencies.
“Vastly better health for women and families lies at the heart of the transformational promise of the MDGs,” said Tamar Manuelyan Atinc, Vice President for Human Development at the Bank. “The new Reproductive Health Action Plan is a reaffirmation of the Bank’s commitment to helping countries mobilize the financing and technical expertise they will need to achieve the MDGs.”
With malnutrition causing the deaths of as many as 3 million mothers and young children every year, the Bank and more than 80 multilateral, bilateral, academic, and civil society agencies and institutions have endorsed the global Framework for Action for Scaling Up Nutrition (the SUN Framework), which was released at the Bank’s 2010 Spring Meetings. The Framework calls for increased investments in specific, cost-effective nutrition interventions in the critical window between pregnancy and age 2, and for making nutrition central to the strategies of other sectors—particularly food security and agriculture, health, education, and social protection.
Sustaining improvements in maternal and child health also requires strengthening entire health systems in countries. Without a passable road to reach a clinic, trained health care workers, affordable or free care, and available drugs or vaccines, any progress made toward MDGs 4 and 5 will stagnate, and mothers and children will continue to suffer and die. Thus, the cornerstone of the Bank’s strategy for health, nutrition and population is to help countries strengthen their health systems and address underlying constraints to better health.
Country Success with Systems Approach
A recent impact evaluation of a Bank-supported health systems strengthening effort in Rwanda shows significant, verifiable improvements in attended birth deliveries and preventive child health visits. The evaluation, "Paying Primary Health Care Centers for Performance in Rwanda," was the first-ever rigorous study of pay-for-performance programs in low-income countries, and will spur follow-up studies in other countries during the coming months.
“What’s so gratifying about this study is that it helps governments answer the eternal question of how to use their money to best advantage when they only have $5 to spend on better health for every woman and child in the country,” says Christel Vermeersch of the World Bank’s Human Development Network and one of the lead study evaluators.
In Tanzania, Bangladesh, and Nepal, efforts to strengthen country health systems through sector-wide approach programs have shown substantial improvements and reductions in infant and child mortality rates. A systems approach also provides a strategic framework for donor coordination and monitoring and evaluation, and lowers transaction costs for governments.
The Bank is increasingly rolling out rigorous impact evaluations to understand what works and what does not. The Bank emphasizes results-based financing, a primary component in, for example, a recent health system performance project in Benin. The Bank is working with 24 governments in Africa on results-based financing, including 10 countries in which the Bank is currently providing financing.
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