Memorandum submitted by Maternity Worldwide
Maternity Worldwide is a UK based INGO which
works in partnership with communities and local organisations
(public and NGOs) to support the awareness of, access to and provision
of emergency obstetrics care.
Maternity Worldwide welcomes the opportunity
provide input into the International Development Select Committee
Inquiry on Maternal Health. In order to provide our feedback we
have sought the opinion of our staff and our partners and discussed
this to ensure that the views we are putting forward are representative
and in line with actual experience.
In summary we believe that DFID has played a
significant role in helping to address the critical issues associated
with improving maternal health in developing countries. We believe
that there is scope for further intervention and support to continue
to make a real difference in this area. We have outlined some
specific responses below and take this opportunity to highlight
the need for an emphasis on continued strengthening of health
systems and human resource development in all areas of MCH.
1. How can donors (specifically DFID) catalyze
progress towards MDG 5?
The new DFID new health strategy, the support
for the Global Campaign for the Health MDGs and the new International
Health Partnership are examples of DFID's potential to help catalyse
progress. The evidence based approach to developing capacity and
to strengthening health systems is to be encouraged, as is more
consultation in the development of initiatives such as the IHP.
The move away from utilising NGOs as part of the solution causes
some concern and a number of our partners request that DFID and
others have a role to play in increasing the funding available
to NGOs.
DFID has shown an obvious commitment to funding
maternal health however there remain concerns over the actual
and perceived decline in funding for this area (as reported in
a number of studies and evaluations, including The Lancet 2006
series of papers). DFID and other funders can play a real role
in helping to address shortfalls.
Additionally there is a role to be played in
helping to ensure that policy is appropriate (and adaptable to
reflect the actual needs of women in situ) and that policy is
translated into action (funding required).
Donors are well placed to fund effective and
innovative approaches, including smaller scale approaches, but
are on occasion not well enough linked to beneficiaries and local
expertise and understanding. There is scope to increase the expertise
within DFID and to work in closer collaboration with local health
professionals, NGOs and other civil society organisations. In
addition there is scope to provide leadership in creating intersectoral
and comprehensive approaches which include and reflect a range
of different demands and providers.
Continuing to support initiatives to address
issues around equity in the access to and uptake of information
and services (within the context of broader civil society initiatives
and rights based approaches) is a vital role.
2. How effectively is DFID working to ensure
EMOC is available and accessible with adequate numbers of skilled
birth attendants?
The answer to this question varies between stakeholder
groups and with the parameter within which it is placed. At a
macro level there is recognition that DFID has played a significant
role in this area through the development of policies and the
provision of funding.
Whether or not this has been effective is less
easy to answer. There is a suggestion that more collaboration
with local health professionals and local organisations would
make the approach more effective. Comments from our local partners
reflect that the effectiveness of any donor will be limited by
extent to which the agreed health plans are being implemented.
In many areas the critical shortages of manpower and skills, particularly
the lack of an alternative for TBAs, along with other barriers
to access, prevents effective implementation and consequently
limits the overall effectiveness. There can be significant variation
within and between regions in many countries (particularly with
fragile states). In many areas there is limited progress in this
area and services are provided by NGOs and/or missionary providers
in absence of any (or any effective) public health initiatives.
There is a need for better monitoring of outcomes
(both in terms of the provision of services and the other determinants
of accessibility) in order to help assess where progress is not
being made and to increase accountability at all levels.
3. How effective is DFID in mainstreaming
maternal health across related policies?
Again the responses to this question vary with
the focus of the respondent and the definition of "related
policies". There is recognition that DFID has played a significant
role in pushing for and supporting the strengthening of health
systems and also a recognition that more needs to be done in linking
the outcomes of operational research to policy and to supporting
the implementation of policies.
4. How is MDG 5 being supported and prioritised?
As outlined above there are concerns that whilst
prioritisation is clearly demonstrated at policy and planning
level, this does not cascade to operational level. Where roadmaps
and other plans exist there is inadequate funding, inadequate
manpower and other issues that limit the ways in which MDG 5 is
supported and prioritised. Additionally it is not always immediately
obvious where support (particularly funding) and activities are
specific to maternal health or part of more general health initiatives;
there needs to be a greater focus on MCH and on monitoring inputs
and outputs related to MDG 5.
5. Is DFID's approach to supporting the 2006
MDG target of universal access to reproductive health effective?
The UK's involvement in the creation of this
new target is welcomed and DFID's role in this is recognised.
However there are concerns that the lack of agreed indicators
is far from ideal; it potentially negates the credibility of the
target and prevents an assessment of progress against the aims
and goals of the target. There is a clear role for DFID to play
in supporting the development of indicators and of continuing
to work towards ensuring that funding is available and that appropriate
policies are developed to support universal access.
6. Are you aware of what progress is being
made to reduce the number of women dying from unsafe abortions?
Progress is being made and specific organisations
(NGOs in particular) are recognised as being particularly active
in this area: MSI, IPAS and IPPF. However progress remains slow
and funding is insufficient to provide the required awareness
and access to safe services, including prevention. The role of
donors such as DFID in providing funding and in supporting an
integrated approach to addressing the demand and supply issues
is less clear.
7. How effective do you think DFID is in working
with bilateral and multilateral donors, NGOs and other stakeholders,
to improve maternal health (in your country)?
Internationally it is recognised that strong
and productive relationships exist between DFID and other key
stakeholders as evidenced by the support to the WHO RH Research
Department and the Partnership for Maternal Newborn and Child
Health. There is scope for DFID to continue to use its relationship
with other governments and stakeholders (notably the US government,
the EU, the Global fund and the World Bank) to support and promote
positive changes in funding and support policies towards achieving
the MDGs.
The relationship with NGOs is variable and appears
to be in decline which causes concerns. The range and variety
of NGOs is seen by many as a strength which should be incorporated
into comprehensive approaches to addressing the MDGs. DFID's approach
to reducing the number of "partners" and NGOs in particular
is a real concern to many of our partners and stakeholders who
welcome a more holistic approach to strengthening health systems
and to supporting a CSO-initiated drive for advocating for better
health care.
Some concern was expressed over the IHP approach
representing a culmination of a policy to remove NGOs (and in
absence of evidence for other initiatives to address this, the
presumed loss of effective civil society representation) from
the equation and as seen by some as a indication of DFID's loss
of autonomy and a failure to seek intersectoral initiatives to
addressing poverty.
8. What leadership is the UN providing in
addressing maternal health and how well co-ordinated is its agencies?
UNFPA is widely recognised as providing significant
support to addressing maternal health, particularly in Africa
where the secondment of expertise and effective individuals is
seen as real progress. It is less clear what role UNFPA or other
UN agencies have in providing effective leadership on a macro
and national level; this has implications on the co-ordination
aspect of this question. There is no standard approach and the
focus of the different agencies differs across continents and
countries. The feedback suggests that the remit of each (and their
effectiveness) is linked to individuals in post. There is evidence
that the three WHO departments focused on maternal health are
duplicating work, which is indicative of a lack of co-ordination
and also of the potential for contradiction, interpretation or
even lack of action in some areas.
9. How effective is DFID in addressing the
socio-economic barriers to women's empowerment and the low status
of women in relation to maternal health?
We do not have a comment on this question.
10. How can the international community improve
maternal health in crisis and conflict settings?
There is a need to ensure that RH and maternal
health is prioritised within these contexts.
There are a number of suggestions, the majority
of which centre on the need for better collaboration and co-ordination
of activities (with the need to improve systems for communications,
knowledge management etc).
Access to funding is critical as is the need
to ensure that longer term financing solutions will be available
to support those communities however the situation is resolved
(or not).
NGOs are often able to operate in climates that
challenge public sector providers and should be included within
the solution.
There is now significant operational (and academic)
research into ensuring the efficacy and appropriateness of responses
and there is a need to help ensure that this evidence informs
responses.
Increased collaboration and information provide
a platform for appropriate responses where the flexibility to
remain responsive and to work in the absence of policy is key.
Along side this is the need for improved accountability. A recognition
that in many fragile states the architects of the systems into
which investment is generally being made may be a substantial
part of the problem.
Community involvement is critical to inform
responses and as the basis against which to help evaluate the
effectiveness and appropriateness of services.
September 2007
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