On New Year’s Eve, the UK government released its new “Framework for results for improving reproductive, maternal and newborn health in the developing world.” With the title, Choices for Women, this strategy was the result of a major consulatation last year. You can read the submisison that Save the Children’s made here.
On first reading, the Strategy is a very positive document and addresses many of the concerns that we had expressed. One of our biggest worries is that the new UK government, with its emphasis on “measureable results”, would be losing many of the principles which has made DFID one of the most respected donor agencies. The government is to be congratulated for ensuring that its approach is still rooted in building nationally-led health systems. While there are many other organisations that have a role in health (Save the Children being one ourselves), the only long-term sustainable solution is to build accessible health sytems that serve the whole population. Many of the actions under this document are in line with this approach and the fact that almost every indicator is ambitious and national-level should ensure that small-scale projects should take a back seat to building national systems.
We very much welcome the recognition that women’s rights must be central to improving women’s health, and that empowerment and rights are essential if women are able to control their fertility. No amount of services or “contraception education” will make a difference unless women’s legal and social status is changed. The UK is also to be congratulated for its strong stand on safe abortion, a controversial topic which needs powerful champions. We are pleased that girls’ education status is seen as vital to improving rights.
The strategy gives strong emphasis to the need to remove barriers to access and rightly emphasises health user fees as a priority. The UK has an proud record in this area and recently the UK has confirmed that it will support more countries that want to move from regressive to equitable ways of financing their health services.
The Strategy also has very welcome sections on the importance of health workers to deliver services, the need for pro-equity approaches that looks at the poorest communities, improved health information systems and birth and death registration, a focus on fragile and conflict-affected states and the role of civil society.
We have a few ongoing concerns, of course. We believe, as DFID says it does, that it makes sense to plan action as part of continuum of care from reproductive health through to child health. Since many women with young children are likely to be pregnant or avoiding pregnancy, since family planning needs do not stop after birth, since young children accompany their mothers to health services, failing to planning integrated action and services is a mistake.
The document acknowledges that there is a lack of evidence for use of vouchers for healthcare or for equitable outcomes from using private providers but it continues to explore these options when it would be better to be unequivocal that free-at-the-point of use government-led services are the best system.
Finally, the push for measureable results and accountability is important but, as many others are starting to point out, can mean the opposite of the transformative action that is needed to make permanent changes in poor societies. Donors should not be holding developing country governments to account, their citizens should. There is a real danger that trying to attribute specific changes to UK money will undermine this democratic accountability and national leadership, although the strategy, as written, skilfully avoids this.
Save the Children warmly welcomes this Framework for Results and, as one of the recipients of DFID’s Programme Partnership Agreements, we are ready to play our part in ensuring communities are able to demand their right to reproductive, maternal, newborn and child health.