Opinion Piece by Helga Fogstad, Executive Director, Partnership for Maternal, Newborn and Child Health (PMNCH), and Martin Chungong, Board Member, PMNCH, and Secretary General of the IPU.
On this World Health Day, occurring in the midst of the greatest pandemic the world has seen since the 1918 influenza, we are reminded of the centrality of healthy people to the functioning of our societies. The current COVID-19 outbreak will have significant health and socio-economic consequences. Despite a dearth of gendered analyses on the current outbreak, global health actors are highlighting the vulnerabilities of women and girls linked to disruptions in the global supply of contraception, increased risk linked to their roles as caregivers, increased risks of violence, and mental health issues. Crises exacerbate inequalities and place women, girls and other vulnerable populations at risk. Today, we need to work together to continue to prioritize the health of women, children and adolescents.
Members of parliaments around the world have a responsibility and play an important role in improving health outcomes. Without them we cannot succeed. Therefore we, the IPU and the Partnership for Maternal, Newborn and Child Health (PMNCH), call for all actors to scale up their efforts, and work in partnership with parliamentarians, to achieve universal health coverage – prioritizing women, children and adolescents.
Where we are
Despite laudable gains made since 2000 – a 29 per cent reduction in maternal mortality and a 43 per cent reduction in child mortality – women, children and adolescents still face substantial health challenges made more complex in recent years due to the growing burden of non-communicable diseases. Today, 295,000 women and 5.9 million children under the age of 5 continue to die annually from largely preventable causes, and while more children are surviving early years and progressing into their adolescence, they are confronted with major health challenges linked to maternal conditions, mental health, substance abuse and injuries. Also, this progress has not been equal across and within countries; the fate of populations is increasingly defined by where they live, how wealthy they are, their gender, and what schools they attend – if any.
Improving health outcomes for women, children and adolescents will depend in large part on functional health systems underpinned by an empowered, motivated and supported health workforce that can ensure access to appropriate services of the highest quality when and where they are needed. Nurses and midwives play a vital role in providing health services. They account for over 30 per cent of the workforce, are responsible for providing the bulk of primary health care and are often the first and only health entry point for communities. The World Health Organization has estimated that 9 million more nurses and midwives are needed to achieve universal health coverage by 2030.
What parliamentarians have committed to do
Parliamentarians can help improve the well-being of women, children and adolescents. They enact legislation, approve budgets and mobilize resources, provide oversight to ensure government accountability and transparency, encourage multisectoral action, ensure national implementation of global commitments, and foster the participation of constituencies in policy discourse.
There is clear commitment from parliamentarians to improve population health. In 2012 the IPU adopted the first-ever resolution on Access to health as a basic right: The role of parliaments in addressing key challenges to securing the health of women and children (updated in its 2017 addendum), and in 2019 the IPU adopted a resolution on Achieving universal health coverage by 2030: The role of parliaments in ensuring the right to health.
In these resolutions, parliamentarians call for quality health services for women, children, adolescents to be available, accessible, affordable and acceptable. They urge States to allocate more resources for the recruitment of health-care workers and for the resourcing of health facilities. Parliamentarians themselves commit to using their functions to create an enabling legal and funding environment to support an effective workforce that delivers for women, children and adolescents and to hold the executive arm to account for better health outcomes.
There is extensive evidence documenting that parliamentarians are making a huge difference in improving health, including by supporting the strengthening of health system pillars such as the health workforce. For instance, in Tanzania, parliamentarians played an important role in ensuring that low-performing health centres in rural areas were supported to improve performance through small grants instead of being closed. In Uganda, in 2012, the Parliament blocked the national budget and forced the Government to increase the health budget in order to ensure health workers were available in lower-level health facilities.
Placing parliamentarians at the heart of the women’s, children’s and adolescents’ health agenda
Recognizing the importance of parliamentarian leadership in improving health outcomes, the IPU and the PMNCH have jointly published a new Road map for action on women’s, children’s and adolescents’ health, which provides an action-oriented framework to support parliamentarians in their decision-making process. This road map is an important capacity-building tool for parliamentarians on health issues.
The IPU and PMNCH have supplemented knowledge resources such as the road map with advocacy efforts and capacity-building workshops, but long-term meaningful engagement through multi-stakeholder partnerships needs to be increased.
Evidence suggests that national and subnational multi-stakeholder partnerships that facilitate parliamentarians’ access to data and information and model legislation can strengthen the frequency and effectiveness of their efforts to improve health outcomes. For instance, a recent case study documents how a multidisciplinary partnership in Italy which included women parliamentarians was able to decrease caesarean section rates.
The collaboration between the IPU and PMNCH, which can count on more than 1,000 partner organizations worldwide, is increasingly focusing on forging these partnerships to make a real difference in the lives of women, children and adolescents. In these uncertain times, we urge the global health community to do the same. We also call on parliamentarians to act on their commitments to achieve universal health coverage and improve the health of women, children and adolescents. Their voice is needed now more than ever.
 Talhiya Yahya and Mohamed Mohamed (2018), “Raising a mirror to quality of care in Tanzania: the five-star assessment”, comment, The Lancet, vol. 6, issue 11, p. 1155.