The Importance of Accountability in Saving Girls’ and Womens’ Lives

By: Jill Sheffield, President of Women Deliver

I was honored to attend the first meeting of the Commission on Information and Accountability for Women's and Children's Health that was held in Geneva at WHO Headquarters on Wednesday, 26 January 2011. President Kikwete of Tanzania and Prime Minister Harper of Canada co-chair the Commission, with the Secretary General of the International Telecommunication Union, Hamadoun Toure, and the Director General of the World Health Organization, Margaret Chan, as vice chairs. The 30 members of the Commission (“Commissioners”) were chosen from a wide range of stakeholder groups including governments, international organizations, civil society, the private sector, foundations and academia, and Women Deliver is proud to be one of the civil society representatives. The time-line of the Commission is expected to be both brief and intense, and the action plan has ambitious goals to focus on results and resources.

The United Nations Secretary-General asked for the Commission to be convened to propose ways to make countries and their partners more accountable for women's and children's health and to keep MDGs 4 and 5 high on the agenda. Two working groups were appointed: one on results and one on resources. Both groups presented preliminary reports to Commissioners and heard the discussion. The resulting accountability framework is expected to bring greater transparency and improvements in the monitoring of progress of MDGs 4 and 5 while minimizing reporting burden on countries. A small, core set of indicators are envisioned to aid efficient investment in data generation and data sharing, addressing data gaps and monitoring vital events. Opportunities for the utilization of innovative information technology to ease and improve accountability for results and resources are being identified to bring maximum benefit to countries. Once the framework is established, it will bring greater transparency to the flow of resources and expenditures, and it will be linked to the results of programmes. Knowing which programmes work will help countries target their resources more efficiently to save lives.

In summarizing the discussion from the Working Group on Results, Working Group Chair, Richard Horton, said that accountability includes: Monitoring, Review and Remedy.  He pointed to country-level gaps in data and committed the working group to simplify and tightly focus their work, including a shorter list of indicators. He said that the work would be accomplished in close coordination with the Working Group on Resources and would use a human rights-based accountability mechanism as an organizing principle. Comments were made to ensure that reproductive health and family planning needs, as well as the needs of young people, would be taken into account. The Commission was frequently reminded that the HIV/AIDS community has a history of +10 years reporting against key indicators with important lessons to the work of the group. There was recognition that there are a number of important cross-cutting influences (i.e., gender, equity, sustainability) which must be recognized and taken into account. Horton was pressed a number of times to restrict the focus on the Working Group to MDG 4 (under 5 mortality), MDG 5, maternal mortality and universal access to reproductive health services, and MDG 1c (nutrition) in an effort to reduce reporting burden on countries and, in addition, to keep the number of indicators small. The Working Group will focus on countries, donors and 'non-state actors' globally and at country level. There was frequent repetition of the need for 'value for money'. The need to increase the role of various actors, including Parliamentarians, and to increase the use of mobile technology were mentioned frequently.

In the absence of Anne Mills, Chair of the Working Group on Resources, Mariam Ally summarized the work to date, including proposed indicators to monitor and report on funding from external and domestic resources. There was considerable conversation about weak information systems and the major time lag in reporting. Commissioners hope that technologies may be used to speed this process. There was general agreement that the $40 billion committed at the launch of Every Woman Every Child in September 2010 would be tracked, as well as country budgetary commitments. Commissioners encouraged the Working Group to focus on the 68 priority countries where 97% of all maternal deaths occur (identified by Countdown to 2015). It was agreed that both Working Groups would maintain close linkages, and that both include a small number of indicators, a tight focus, and simple methods to disaggregate expenditures and results. The synergies and inter-active/inter-related nature of the work of both groups was obvious. Many expressed the opinion that the report should include not only the public sector expenditures but also non-government (donor and NGO) expenditures as well as family/household-level out-of-pocket expenditures.

As we move forward, I hope that the Commission can focus on the following priorities:

• MDG5b: In working to achieve MDG5 , we cannot forget MDG5b – ensuring universal access to reproductive health care. We need to make sure childbirth and delivery is safer – ensuring access to skilled care and lifesaving technologies like misoprostol – but we also need to make sure women and girls are empowered with access to reproductive health counseling and services, including education, contraceptives, and safe abortion.
• Protecting the health of girls: Young people make up a major portion of the population, particularly in the developing world, and the truth is that too many ‘mothers’ are actually girls. We need to focus explicitly on the unique needs of this especially vulnerable population. Let’s prioritize, include, and count on young people to help us deliver for women.
• Maintaining a human rights framework: Maternal deaths are a human rights issue for girls and women. We must devise a rights-based accountability mechanism that protects and augments women's freedoms.
• Delivering real results: I am impressed by the commitment and enthusiasm of my fellow commissioners. We are a busy bunch, and defining manageable goals – so we really can deliver for girls and women – is crucial.

  Next steps:

• An open site will be maintained for transparency, with frequent updating for those interested in the work of the Commission.
• The Commission will have their next conversation before the end of February. The Working Groups are working non-stop to meet the February deadline to determine the next iteration of indicators and cross cutting themes. 
• Work of the Commission is targeted to be complete by end of May 2011.
• We would also like to take this opportunity to inform you that discussion papers by each Working Group are available for public comment under the tab Discussion Forums: www.everywomaneverychild.com/accountability_commission