WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH: status update and strategic priorities
1.4

Creating an enabling
environment for progress

The EWEC Global Strategy advocates simultaneous action on women’s, children’s and adolescents’ health across nine interconnected and interdependent areas. It also recommends that action should be guided by a set of 10 core principles, including human rights, equity, partnership, universality and accountability.86These action areas and principles amount to an agenda for co-ordinated multisectoral action at country level.
The H6 partnership has developed a toolkit to support country implementation of the EWEC Global Strategy that includes a wide range of tools and technical resources for multisectoral action.87 Key resources include the health in all policies framework and training manual, gender tools, and specific guides to multisectoral implementation, both general and for specific policy areas. Analytic tools such as LiST, EQUIST and Innov8 provide some scope for multisectoral analysis, but this could be expanded. Overall, however, there is a need for greater support for countries to implement multisectoral action. This having been said, global partners themselves need to address their own limitations in working across sectors, tackling silos within and between organizations, and most importantly, genuinely engaging people from non-health sectors in efforts to achieve the objectives of the EWEC Global Strategy. Priority areas such as adolescent health and early child development, which by definition require multisectoral action, could provide a focus for this.
The 2030 Agenda for Sustainable Development’s call to “leave no one behind” echoes the EWEC Global Strategy’s emphasis on rights, equity and universality. It links strongly to the need for better health information: more and better-quality data are urgently needed to identify women, children and adolescents who are underserved or marginalized. As further discussed in Chapter 2, international law obliges governments to help their citizens realize their human rights, including the right to health.88 This requires the creation of an enabling environment for health and wellbeing by ensuring that the necessary services, polices, legislation and administrative structures are in place.
Priorities for delivering this agenda are discussed thematically in the next three sections.

 

 

THE HEALTH SECTOR: SUPPORTING SYSTEMS, STANDARDS AND TOOLS

The people-centred focus of the EWEC Global Strategy has implications for the whole health system, and for all actors, structures and processes that support health, such as a country’s health policies, financing, workforce and health infrastructure.
A primary implication is that national governments need a detailed understanding of the health needs of women, children and adolescents and of the population overall. This is necessary to identify those being left behind and to generate data to inform evidence-based policy-making and programmes in priority areas.
Civil registration and vital statistics (CRVS) and health information systems are central to these aims, although in most low- and middle-income countries these need to be strengthened, or in some cases created.89

NATIONAL GOVERNMENTS NEED A DETAILED UNDERSTANDING OF THE HEALTH NEEDS OF WOMEN, CHILDREN AND ADOLESCENTS AND OF THE POPULATION OVERALL

Efforts have also been made to strengthen the frontline capacity of health systems to capture data for accountability across the monitor, review and act functions. A leading example is Maternal Death Surveillance and Response, a monitoring and review system enabling countries to capture detailed information about maternal mortality, and take remedial action.90, 91

Another priority is the design and financing of resilient health services and facilities that are fit for purpose to sustain and accelerate progress and “achieve universal health coverage, including financial risk protection and access to quality essential services, medicines and vaccines” (SDG 3.8).

Government spending on health is essential to build resilience throughout the health sector and is one of the EWEC Global Strategy’s 16 key indicators. In the 2001 Abuja Declaration, African Union heads of state pledged to allocate at least 15% of their annual public expenditures to health; since then most African governments have increased the proportion of that allocation. However, spending the recommended amount is not sufficient to guarantee good health outcomes, especially if decisions about health spending are not evidence-based.92

Although better outcomes are associated with greater health expenditure per capita, for any given level of spending there can be a wide range of outcomes, depending on efficiencies within the health sector. For example, the green oval in Figure 11 highlights the wide range of maternal mortality outcomes between countries that have the same level of health expenditure.93

Investments also need to be targeted to areas and populations in greatest need. An example of how targeted policies and investments can result in more equitable access to health services, especially for women, children and adolescents living in poverty, comes from Colombia. Coverage of skilled birth attendance there has increased, particularly for the poorest 20% of the population. Even more remarkable has been the increase in the proportion of reproductive-age women whose family planning needs were met by modern contraceptives. By 2015, coverage was over 90% across the whole population, and inequalities were markedly reduced (Figure 12).94

Central to the achievement of universal health coverage and health systems resilience is a skilled, motivated and well-supported health workforce, including in fragile settings. There has been substantial progress: 27 out of 53 countries with data have shown growth in health worker availability.95 However, a huge global shortage remains (Figure 13).