UN H4. Joint Country Support for Accelerated Implementation of Reproductive, Maternal and Newborn Care

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1 UN H4 Joint Country Support for Accelerated Implementation of Reproductive, Maternal and Newborn Care

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3 Coverage Along the Continuum of Care Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

4 UN H4 Scope of Work builds on Comparative advantage, core expertise /experience and collective strength in RMNH of each agency Existing collaboration at the regional and country levels across agencies Ongoing harmonization processes such as the IHP+ New opportunities derived from aid effectiveness frameworks such as the IHP+, HHA in Africa, Asia-Pacific Investment Case etc.

5 H4 Scope of Work: Guiding Principles Country led processes and national ownership Family Planning, Adolescent Sexual and Reproductive Health, Delivery Care, Newborn Care Coordination of funding mechanisms such as the Catalytic Initiative, Maternal Health Thematic Fund, Result Based Financing, among others

6 Initiatives must be consistent whatever the scope and scale

7 Scope of work: 7 agreed programme components 1. Support needs assessments to identify constraints to improving RMNH in countries and ensure that health plans are MDG-driven and performance-based 2. Develop and cost national plans and rapidly mobilize required resources 3. Scale up quality health services to ensure universal access to reproductive health 4. Address the urgent need for skilled health workers, particularly midwives and other related cadre of personnel and for HR management including supervision. 5. Address financial barriers to access, especially for the poorest 6. Tackle the root causes of maternal mortality and morbidity including gender inequality, low access to education -especially for girls-, child marriage and adolescent pregnancy 7. Strengthen monitoring and evaluation systems

8 Planned Outputs 1. Support needs assessments Mapping and conducting rapid analysis to identify gaps and needs EmONC Alliance, UN H4 +AMDD: 11 NAs to be conducted in ; e.g. Ethiopia conducted jointly, RHCS assessments, WB-UNICEF agreement Information used to identify bottlenecks and strengthen national health plans Development of sub-national and district implementation plans (Russian Dolls)

9 2. Develop and cost national plans and support the rapid mobilization of required resources RMNH of national plans costed using harmonized tools (MBB - UNICEF: 49 countries; Costing Tools harmonization-in process) MTEF and RBF fully reflect requirements of costing exercise (Aid effectiveness workshops for Africa and Asia-Arab World, WHO,UNICEF, UNFPA) Eligible countries submitted proposals and acquire funds from HSS windows of GAVI and GFHMT (round X, CB workshop) and other funds

10 3. Scale up quality health services: Defined country specific package of interventions which includes universal access to RH (ongoing assessment of Africa Road Maps) Capacity building for implementing packages at scale (IMPAC, integrated management of pregnancy and child birth) SPP -Strategic programmatic partnership: WHO-UNFPA (from FP to RMNH, help countries to develop national tools and guidelines for implementation) RHCS: standardization and improvement of procurement of commodities EmONC capacity building and institutional strengthening (AMDD, UNICEF, UNFPA, WHO)

11 3. Scale up quality health services: Challenges Need consensus on the minimum package of interventions to scale up Lack of capacity and funding In low income countries 24 $ per capita in 2006, of which: 11 $ out of pocket, 6 $ from external funding, of which more than 50% goes to MDG6 So only 2 US$ per capita external funding for all other health issues (source HLTFIIFHS)

12 4. Address the urgent need for skilled health workers RMNH in national human resources development and management plans, including motivation and incentives strategies, deployment Strengthen country capacity to train skilled HR pre and in service (e.g. Midwifery programme: ICM-UNFPA, Sweden- Dutch funding, professional associations of midwives) Task shifting, defined resources in national plans : planned national post-graduate committees meeting in Ethiopia

13 5. Address financial barriers to access, especially for the poorest Documenting and developing best practices on various experiences that address financial barriers: Conditional Cash Transfers, Mutuelles de Santé, Micro-financing, Risk pooling, Vouchers, etc. Result-based financing (WB-NORAD) Innovative mechanisms, including removing user fees Assist countries in equity-based distribution of SDP at all levels

14 6.Tackle the root causes of maternal mortality and morbidity Multi-sectoral approaches: tap on existing initiatives of the agencies in other sectors Inter-agency Task Force on Adolescent Girls SG initiative on Violence Against Women UNFPA-UNICEF thematic fund on FGM Girls education, fast track initiatives 17 priority countries to prevent adolescent pregnancy Community empowerment to increase demand and access to quality services

15 7. Strengthen monitoring and evaluation systems Strengthening HIS, civil registration, vital statistics, specific surveys (MICS, DHS, MDG 5 monitoring, IMMPAC), censuses Improving country use of maternal death audits, programme reviews, to improve access, quality and coverage (BTN: package for audits) Strengthening countries capacity for data collection, analysis and use

16 7. Strengthen monitoring and evaluation systems continued Supporting countries to report regularly through WHA, UN MDG monitoring mechanisms: Key indicators of RMNH included on IHP+ and other global health initiatives Countdown to 2015, target b of MDG 5 on universal access to RH

17 Ways forward: Country Level Ensure RMNH is appropriately addressed in policies, plans, budgets and system design Identify our partners, country by country. Map where they are working and pursue realignment to close gaps Use IHP+ country health sector team approach to establish co-ordination and complementary roles and responsibilities

18 Ways forward: Country Level 2 Initially concentrating on 6 of the 25 UN highest priority countries (inc. Afghanistan, Bangladesh and India) Sensitise our country teams to the agenda and ways they must work together Ensure RMNH is prioritized in UNDAF and Delivering as One Work through IHP+ in the 14 corresponding countries

19 Ways forward: Country Level 3 Follow IHP+ principles and use IHP+ tools in the other 11 countries, for example Joint Assessment of Plans and Budgets Analysis of costing and constraints (already done in 23 of the countries) Service Delivery Working Group etc. Establish health system monitoring and evaluation

20 Ways forward: Global Level Coordinating mechanism of the core global group for rolling out (looking at existing models e.g. IATT) Strengthen the capacity of each organization to deliver on the Scope of Work at country level Develop accountability mechanism for the H4

21 SUMMARY LEADERSHIP INTEGRATION/COORDINATION CAPACITY BUILDING COUNTRY OWNERSHIP