22 January 2017
I have focused on the health of women and children throughout my professional life.
An interest in mother and child health led me to start working in a health team recruited by the NGO Save the Children as soon as I qualified as a medical doctor in 1974. In the subsequent two decades I worked in numerous settings – with governments, NGOs and universities - in more than 20 countries.
During this period, I was involved in direct clinical care both in hospitals and health centres. I worked with communities to understand how women and children sought to keep healthy and to cope with different forms of illness. I analysed the links between household assets, women’s time, community know-how and access to health services on the one hand, and the health of women and children on the other. I learned about ways in which seasons, climatic events and conflicts impacted on the health of children and mothers. This was a unique and privileged experience which prepared me well for my later positions within national governments and the multilateral organizations.
I relate all I do now to the many people with whom I interacted as a clinician and as a community worker, listening to people in their homes and communities, and – where possible – speaking their language. I relate all I do now to the thousands of people who participated - with me in training programmes on maternal and child health and nutrition (and I am still passionate about teaching). I relate all I do now to those with whom I undertook community-based surveys, travelling month after month to the same households, asking about how things are going and understanding about sickness and its past history. In this way I started to appreciate ways in which health and development programmes could best benefit the people who needed them most. Even then, the importance of connecting the different determinants of ill health, and working horizontally, through initiatives that communities owned for themselves, was always evident. Vertical delivery programmes might have been easier to organize and monitor, but were less useful viewed from the perspective of those who they were designed to help.
The links between the health and nutrition of children and their ability to perform well at school, to earn a good income and to become leaders in their own society became increasingly apparent to me and to those who worked with me over the years. We watched, season after season, and saw those who had the best start tended to do well. We did all we could to help the others catch up. We were particularly concerned about girls and women who often seemed to have fewer opportunities. And poorer people always had less room for manoeuvre being less able to afford days away from work than those who are better off. We saw that when poor people were sick they require the best possible treatment: getting them well as quickly as possible so they can get back to earning rapidly. Rarely do they benefit from health insurance.
As I progressed I sought at all times to focus on the extent to which all people could access effective health services. I saw how well-trained and supervised community health workers could make a big difference to children’s health especially if they were immunized and enabled to recover quickly from respiratory or diarrhoeal diseases. I saw the interplay between sickness and poor nutrition especially when children are young. And I appreciated that if the interval between births is short, it is difficult for mothers to devote to each child the time needed for them to be healthy and well-nourished. Everywhere I worked I heard from women that they sought help to be able to choose when they had children, and to be able to access effective family planning services. I also heard men and women giving high priority to accessible and functioning maternity services to reduce the likelihood of women suffering or dying during pregnancy and delivery.
Every Woman and Every Child
Since I have been working in the office of the UN Secretary-General I have been impressed with the commitment to children’s and women’s health through the Every Woman and Every Child (EWEC) initiative. There has been strong support for this initiative from governments, UN entities (especially WHO, UNFPA, UNAIDS, UNICEF, UN Women and World Bank) development agencies and civil society, scientists and businesses. They are all intensifying efforts to respond to the challenges facing women, children and adolescents.
The EWEC ecosystem includes the well-established Partnership for Maternal Newborn and Child Health which is hosted by WHO and engages hundreds of different entities in an aligned effort. It includes the high-impact Global Financing Facility, with the engagement of a growing number of countries. It includes the everywhere workstream, with its focus on women’s and children’s health in crisis and emergency situations. It has a strong challenge mechanism that engages the private sector in innovation. It brings together 6 international organizations at country level as well as globally.
EWEC takes account of the importance of inclusion, the principle of leaving no-one behind and the emphasis on partnerships. It has changed to align with the Sustainable Development Goals and to take account of the specific health needs of adolescents, especially adolescent girls.
It is guided by the Global Strategy for Women’s, Children’s and Adolescents’ Health which was developed through several years of consultations and agreed in September 2015. It serves as a roadmap for concerted efforts to end all preventable maternal, newborn and child deaths, including stillbirths by 2030, and improving the overall health and well-being of women and children. The strategy seeks to keep women, children and adolescents at the heart of the sustainable development agenda: it is designed to unlock their vast potential for transformative change.
At the macro-level this Global Strategy recognizes the value of healthy, educated and empowered women, children and adolescents as contributors to a more sustainable and peaceful future. At the local level the strategy recognizes the need to respond to the needs of all in ways that reflect their domestic realities. At the national level the strategy focuses on national needs and on strengthening capabilities.
The Global Strategy aims to ensure that by 2030 every pregnancy in our world should be healthy and wanted, every birth is safe, children survive beyond their 5th birthday, and women, children and adolescents are enabled to thrive and realize their full potential.
Whilst this vision can be achieved, millions of women, children and adolescents still don't have access to the life-saving information, services and supplies they need.
The role of WHO
WHO has a catalytic role to play in advancing the Global Strategy both at local and national, as well as regional and global levels. Here are some of its contributions and required actions:
- Aligning efforts around a common purpose. All actors with a stake in Women’s and Children’s health have already saved the lives of millions of women and children and supported them to achieve their full potential.Building on results achieved and lessons learned, they are laying the foundations for healthier, equal and more prosperous lives for generations to come. This effort encourages ambitious commitments from governments, businesses, academia, civil society and all sectors of society.
- Supporting in-country implementation. There is a need for a focus on country implementation and strong accountability, alignment with national priorities and transparency. There must be an absolute recognition of the role of the national authorities and a willingness of all concerned to align in support of these priorities.
- Encouraging the scale-up of interventions to ensure the survival of women, children and adolescents is key. We have all learned that in public health the focus goes beyond survival to ensuring that all enjoy the best possible health and wellbeing. This means that health people partner with those from the other sectors that have an impact on health, from nutrition, education, water and sanitation. .
- Engaging a range of actors, including the humanitarian community to prioritise women’s, children’s and adolescents’ health and ensure stronger integration in relief efforts. Humanitarian and fragile settings are globalized, and are now found in almost every community and country. We must bridge the gap between humanitarian and development efforts, with the same view to integrating sectors and interventions.
- Monitoring progress against agreed targets and identifying aspects of work that need to be refined to improve impact.
WHO’s work on Women’s, Children’s and Adolescents Health will continue to be critical in advancing the Global Health Strategy and I am personally committed to this issue. It reflects the priorities that I found to be particularly important in my early work because it puts the interests of women and children at the centre of a multi-disciplinary response. It will empower women to get the services and support they need both to survive and to thrive. The 2030 Agenda supports this approach to implementation with no one left behind. To make it come to life women children and adolescents need to become agents of change and be supported by capable professionals from a full range of different sectors, disciplines, systems and cultures. They will then be in a position to transform our collective development experience.