The 2010 Millennium Development Goals Review Summit

Written evidence submitted by World Vision UK

October 2010

World Vision is a Christian relief, development and advocacy organisation dedicated to working with children, their families and communities to overcome poverty and injustice. Motivated by our Christian faith and the belief that no child should live in poverty, we work with communities of all faiths and none to improve the lives of children. World Vision’s 40,000 locally based staff work in nearly 100 countries worldwide, 97 % of our staff are nationals of the country in which they work, and work with 100 million people worldwide.

World Vision knows that the best way to change the life of a child is to change the world in which they live. Children and their communities must be active participants in shaping a better future, empowered to find sustainable solutions to poverty.

World Vision welcomes this opportunity to provide written evidence to the International Development Select Committee on the outcomes of the UN MDG Review Summit.

1. Key outcomes from the Summit

1.1. World Vision welcomes the UN Secretary General’s Global Strategy for Women’s and Children’s Health and its aim to save the lives of 16 million women and children by 2015. This strategy is the result of many months of collaboration between the UN, governments and NGOs to design a launching pad for a global push to accelerate progress towards MDGs 4 and 5, on child and maternal health.

1.2. We welcomed the opportunity to engage with the drafting of the UN Secretary General’s Global Strategy for Women’s and Children’s health and our hosting of joint consultations at key international events and participated in national level dialogue in a number of developing countries.

1.3. Building on existing commitments and the momentum created by the G8 Muskoka Initiative, the aim of the Global Strategy is to galvanise new commitments behind a coordinated effort on child and maternal health, as well as to ensure accountability for delivering results. The US$40 billion in funding commitments that accompanied the launch of the Global Strategy was a significant step towards filling the gap between the estimated investment needed and what is currently being provided for women’s and children’s health. World Vision would welcome clarity on how much of the US$40 billion is new funding and how much has been rebadged or restated.

1.4. World Vision welcomes the strong emphasis within the Global Strategy on putting women and children at the centre of strong national health plans developed by country governments and for donors to align their resources with these plans, in line with the principles of aid effectiveness.

1.5. The Global Strategy does not provide a mechanism for turning the commitments into action plans for progress on child and maternal health. The Global Strategy calls for an accompanying accountability framework to be developed, and for the World Health Organisation to lead this process. The development of an accountability mechanism for the Global Strategy must now be prioritised, with a view to being completed within the next three months, and must include consultation with civil society organisations from developing and developed countries.

1.6. The Global Strategy did not sufficiently address the barriers that prevent the poorest children and families accessing health care. U ser fees prevent poor families accessing health care and most stakeholders agree that health care should be free at the point of use for the poor, starting with pregnant women and children under five. [1] The absence of clear language in the Global Strategy around health care ‘free at the point of use’ risks undermining progress made recently, including the removal of user fees for children under five and pregnant women in Sierra Leone in April this year, supported by DFID.

1.7. Our experience has shown both the need for more coordinated mechanisms to harmonise global health efforts and also that accountability for health systems must start at the community level. Community ownership and engagement is a crucial part of the accountability chain because it enables better data collection, tracking of results and coordination. Civil society organisations like World Vision have a particular role to play in empowering children, families and communities to take control of their own health and engage with local health systems to hold service providers to account. DFID should increase support to those civil society organisations who are empowering citizens to participate in local level accountability processes and hold their own governments to account.

2. Delivering the Global Strategy for Women’s and Children’s Health – The role of the Department for International Development (DFID)

2.1. DFID played a key role in the development of the Global Strategy. This leadership must continue and extend to the delivery of the Global Strategy over the next five years and the achievement of the promised impact on child and maternal health.

2.2. As a result of the Global Strategy, the UK government has committed to increase efforts up to 2015 to double the number of maternal, newborn and children’s lives saved. In order to achieve this, the UK has pledged to double its annual support for maternal, newborn and child health by 2012, sustaining this level to 2015. This means providing an average of £740 million for maternal, newborn and child health from 2010 to 2015. These figures mean that the UK will spend an additional £2.1 billion on maternal, newborn and child health. Part of this growth in the budget will come from the UK continuing to increase their spending on official development assistance (ODA) to reach the target of 0.7% of GNI by 2013.

2.3. The UK’s contribution to child and maternal health gives it credibility and authority to play a central role in the delivery of the Global Strategy. Beyond just the financial pledges, DFID should play a key role to ensure the speedy development of the accountability framework to accompany the Global Strategy, in order to ensure that progress can be tracked.

2.4. The UK government has been a champion for the removal of user fees, recognising the disproportionate impact of user fees on the poorest and most marginalised, and should continue to keep this issue at the centre of its efforts for women and children. In making their own commitments to the Global Strategy, a large number of developing country governments articulated a desire to provide (or extend) free healthcare for women and children, including Zimbabwe, Liberia, Malawi, Nepal, Niger and Haiti. The UK government must provide financial and technical support to these countries, and others, to ensure that quality healthcare extends to all mothers and children.

2.5. DFID made a large financial commitment on malaria, recognising the interconnectedness of all the health MDGs, and especially the fact that an estimated 85 per cent of malaria deaths occur in children under five. World Vision would welcome clarity on this commitment in relation to that made to the Global Strategy on Women’s and Children’s Health.

2.6. The strong declaration of support that DFID made at the launch of the ‘Scaling up Nutrition’ framework needs to be translated into action and World Vision is keen to see how this relates to the commitments to double annual support for maternal, newborn and child health. Undernutrition is the underlying cause in more than one-third of all under-five child deaths and contributes substantially to maternal health, and it is the focus of a new DFID strategy in March 2010. It is important to have clarification from DFID on how these various priorities intersect and where greatest impact can be made from DFID’s investment in health.

3. Delivering the Global Strategy for Women’s and Children’s Health - the role of developing countries

3.1. World Vision welcomes the principle of country ownership embodied by the emphasis within the Global Strategy on developing country governments taking responsibility to improve child and maternal health within their own populations. Developing country governments must be given the financial and technical support required from donor countries and all other stakeholders. Donors must take note of the commitments and priorities stated by developing countries in relation to the Global Strategy, and in particular provide financial and technical support to the many developing countries articulating a desire to introduce or expand free healthcare to women and children.

4. Delivering the Global Strategy for Women’s and Children’s Health - the role of the UN, the World Bank, the European Commission and NGOs

4.1. A wide range of stakeholders beyond governments, including key health funders like the Gates Foundation and also a large number of NGOs made commitments towards the Global Strategy. It is essential that all stakeholders are held to account on these commitments through the development of an accountability framework as previously stated.

4.2. World Vision recommends a review of global health governance to be championed by the UK Government with other donors and multilaterals to ensure that aid for health is most effective in improving child and maternal health. The current system of global health governance is inadequate and has failed to respond to the changing nature of global health in recent years, both in terms of accurately reflecting the aid effectiveness principles of harmonisation, ownership and alignment and in adapting to the rapidly increasing numbers of global health stakeholders. The strain being placed on developing country health systems by the plethora of actors in global health will not be completely addressed by the implementation of the Global Strategy, better coordination and priority setting is urgently required and there must be discussion about what form this should best take.

4.3. There was rather limited opportunity for civil society engagement in the MDG Review Summit itself. This was disappointing, given the role of civil society, in both developing and developed countries, in holding their governments to account. One exception was the participation of the Chief Executive Officer of World Vision Canada as a member of the official delegation of the Canadian Government. We recommend that this model of positive engagement, including Civil Society representation and collaboration be used by the UK Government for future similar meetings.

5. Looking ahead to after the MDG deadline of 2015

5.1. The MDG targets have proved to be powerful tools in galvanising greater efforts in finance, policy and delivery to make significant progress on child and maternal health, as well as the range of other poverty-related indicators. As discussions on looking ahead past the MDG deadline occur, it is important not to lose sight of the need to scale up efforts to meet the current MDG targets, particularly with the momentum that has gathered behind child and maternal health as a result of the Global Strategy.

5.2. The Global Strategy for Women’s and Children’s Health aims to improve child and maternal health in line with MDGs 4 and 5. The targets of these two MDGs, to reduce child and maternal mortality by two-thirds and three-quarters respectively, are ambitious, but even if met would not deliver the desired outcomes of ending the preventable deaths of children and mothers completely.

5.3. As future priorities and targets are discussed they must be build on the many successes of the MDGs, in line with more than ten years of implementation experience and learning since their inception. Future goals should not be based solely on global, or national, averages but include measurements of equity which require deliberate efforts to reach the most vulnerable and marginalised. Progress amongst the hardest-to-reach populations is likely to be the biggest challenge that remains after 2015, even if MDGs 4 and 5 are achieved, and will require different approaches.

6. Summary of Recommendations

1. HM Government should clarify how much of the US$40 billion announced is new funding and how much has been rebadged or restated.

2. The development of an accountability mechanism for the Global Strategy must be prioritised, with a view to being completed within the next three months, and must include consultation with civil society organisations from developing and developed countries.

3. HM Government should increase support to those civil society organisations who are empowering citizens to participate in local level accountability processes and hold their own governments to account.

4. HM Government leadership on child, newborn and maternal health must continue and extend to the delivery of the Global Strategy over the next five years and the achievement of the promised impact on child and maternal health.

5. DFID should play a key role to ensure the speedy development of the accountability framework to accompany the Global Strategy, in order to ensure that progress can be tracked.

6. HM Government should continue to champion the removal of user fees, recognising the disproportionate impact of user fees on the poorest and most marginalised, and should continue to keep this issue at the centre of its efforts for women and children.

7. HM Government should clarify its commitment on malaria in relation to that made to the Global Strategy on Women’s and Children’s Health.

8. HM Government should lead champion a review of global health governance with other donors and multilaterals to ensure that aid for health is most effective in improving child and maternal health.

9. A model of positive engagement, including Civil Society representation and collaboration should be used by the UK Government for future meetings similar to the UNGA.

10. Future goals should not be based solely on global, or national, averages but include measurements of equity which require deliberate efforts to reach the most vulnerable and marginalised. Progress amongst the hardest-to-reach populations is likely to be the biggest challenge that remains after 2015, even if MDGs 4 and 5 are achieved, and will require different approaches.