Outing Global Development “Committers”: The Case of the UN Global Strategy on Women’s & Children’s Health

This is a joint post with Rachel Silverman New York City’s annual high level UN bash is an occasion for grand, development-related announcements and commitments. This year’s meeting, which took place last week, focused on the Prevention and Control of Non-communicable diseases (NCDs), but I was particularly pleased to see follow up from one of last year’s big announcements--the  Global Strategy for Women’s and Children’s Health. Following its launch at last year’s UN Leaders’ Summit for the Millennium Development Goals (MDGs) 2010, the strategy inspired over $40 billion in financial commitments, aiming “to save the lives of 16 million women and children by 2015.” This year, on September 20th, the Partnership for Maternal, Newborn and Child Health (PMNCH) released its one-year assessment of progress under this strategy. Too often, a grand global vision such as this can quickly recede into a distant memory, leaving no legacy but unfulfilled commitments and unrealized goals. So, many kudos to PMNCH for releasing this report to keep the strategy in the spotlight; to remind donor and developing countries alike of their commitments to this cause, and to track progress toward better child and maternal health around the world. But clear analysis and sharing of data and results trumps good intentions, and I’m worried that the report inexplicably omits the most important information. Clocking in at 60 pages long, the report is heavy on analysis and complicated charts, but strangely short on meaningful data and clear messages about progress. Specifically:

1. Where is the $40 billion coming from and what’s the breakdown? Seems important, right? PMNCH clearly has that information available; at one point, for example, they cite that low-income countries alone made commitments valued at $10 billion. And yet, the report fails to include a simple pie chart illustrating the distribution of financial contributions.
2. The report focuses on global collective action and doesn’t give much concrete information about individual commitments and implementation to date. The data is presented anecdotally rather than systematically; sometimes we’ll get a general narrative descriptions of the findings, sometimes a chart, and sometimes nothing at all. For example, the text of the report tells us that 24 governments in low-income countries committed to expand access to family planning. Good to know, I suppose. But that doesn’t specify which countries, or tell me the depth of their commitments, or let me know if they’ve made any policy changes to-date toward that goal. As is, the report provides only synthesized information, compiling data from around the world to analyze patterns of global commitments and assess overall progress towards the strategy goals. Notably missing is what we really need – a disaggregated list of individual stakeholder commitments and progress to date.

While Annex 4 provides a nice snapshot of relevant MDG indicators for each country, it says nothing about the actual commitments and progress. Similarly, the UN sponsored “Every woman, Every child” campaign website has a section on commitments by category of “committer” i.e. donors, country governments, NGOs, etc. But here again, the presentation does not facilitate efforts to track implementation progress from year to year. Media reports suggest that the poorest countries are now investing more for maternal and child health – great news! – but you’d never know that simply by reading the report. Moving forward, we have one suggestion to improve the strength and value of such a large and important monitoring effort: Create a transparent and simple reporting tool for all “committers” Maybe the authors were overwhelmed by the sheer quantity of available data. The report relied heavily on the results of a survey questionnaire/interview, distributed to each of the 111 stakeholders who had made commitments in September 2010. The survey asked a lot of good questions, but it also asked a lot of questions – 28 in total – and suffered from a 30 percent non-response rate. While a long questionnaire is no excuse for lax reporting from recipient governments, I wonder if some ministries, particularly in low income and perhaps high mortality countries (we just don’t know!), struggled to complete the laundry list of requested information. With some digging, I found that the PMNCH has publically posted survey responses from 46 stakeholders, but information for the other countries, NGOs and companies remains inaccessible to the public because these organizations did not agree to post their responses publicly. Nonetheless, instead of a long survey, wouldn’t it be better to construct a simple reporting tool that would facilitate universal data collection and clearly display individual “committer’s” progress? A one-page template could allow each “committer” to enumerate its commitments (financial, policy, program etc.) and corresponding implementation progress from year to year in an easily digestible format. This template would enable an efficient and transparent tracking system to monitor every “committer’s” progress, but also feed in to a master data set for meaningful analysis of global collective action. Non-responders -- donors, NGOs, and country governments alike -- would automatically be exposed to added scrutiny from all stakeholders concerned, giving them a strong incentive to fulfill their reporting responsibilities. Why does this matter? This UN effort has created an accountability commission to ensure that all stakeholders live up to their commitments. Creating a meaningful and transparent reporting tool would promote accountability among donor and recipient countries alike, as they would be required to clearly tie commitments to action, and, eventually, to impact via MDG indicators. Indeed, the report speaks repeatedly of “accountability” as a key objective but how can we hold a country accountable if we know almost nothing about what it’s doing, or what it’s promised to do?  In addition, “country ownership” remains a popular buzzword in development circles and this type of a transparent reporting tool could give some teeth to this elusive concept.  If ordinary citizens can refer to a list of commitments to reduce maternal and child mortality and track their countries’ progress against these, wouldn’t this create accountability beyond just the donor-recipient relationship? Bottom Line: The PMNCH should be applauded for its dedication to rigorous monitoring, and for pushing donors, countries, NGOs, etc. to act on their commitments under the global strategy.  A recent Lancet paper shows that even though there has been progress on reducing maternal and child mortality in developing countries, it will be several years, and well after 2015, before many countries reach their MDG 4 & 5 targets. We don’t know if these commitments will accelerate reduction in maternal and child mortality, but assuming they – the $40 billion and other pledges—do have the desired impact, we need an efficient and transparent system to monitor progress and learn from this effort. Otherwise, what is the point?