Kristen Cox Mehling, Senior Consultant
In the wake of the second world war, UNICEF was created to feed, clothe, and care for the health of children in war-devastated Europe. During this post-war era, no one had yet stumbled through the acronym RMNCAH, nor alluded to the importance of child health in the RMNCAH continuum of care. But this was arguably the start of an era during which the world would become less tolerant of children dying from preventable causes. Their mothers would (eventually) get the same attention, even though, by 1985, Allan Rosenfield and colleagues were still asking “Where is the M in MCH?” Over the next 30 years, momentum built, and advocates asked similar questions about family planning, newborns, mothers (again), and adolescents. At last, the full RMNCAH continuum of care had arrived, swimming in the alphabet soup of at least half a dozen global action plans and splashy global moments.
Advocates had succeeded in elevating the critical components of the RMNCAH continuum of care, but each in relative isolation. Findings from the recent Global Health Visions report, Engendering Accountability, commissioned by the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation, starkly illustrate the need for more robust alignment of global accountability processes in-country. Issue-specific plans that did not situate themselves within an overarching health framework have been ineffective because they have failed to provide insight into systemic problems. The report highlights the need for common data sets, reporting processes, and fiscal incentives for collaboration at the country level. As one respondent insisted, “It’s not about [specific global initiatives] …we need countries to rally behind this cause of ending preventable deaths.”
It’s our job as advocates to determine what this means for in-country advocacy. The Global Financing Facility (GFF) presents an important opportunity to bring advocacy and implementation across the full continuum together at the country level, but strong civil society engagement will be critical. A recent GHV report written jointly with Catalysts for Change and developed with support and guidance from RESULTS Educational Fund found that there is room for improvement in civil society engagement in front runner countries. The report calls for minimum standards for RMNCAH country platforms, timely and transparent communications about the GFF and its processes, coordinated platforms for civil society engagement, and resources and support for civil society organizations.
We have reached an era in which game-changing improvements in political commitment and resources to women and children’s health will no longer come one issue area at a time. They will come as a fundamental shift in values, priorities, and understanding. We will need to consider not only the continuum of care, but the enabling environment as well – water, sanitation and hygiene, education, and economic opportunity. We will need all hands on deck to reach an era when avoidable deaths among women and children are once and for all recognized as completely unacceptable in all countries. As the often-cited African proverb reminds us, "If you want to go fast, go alone; if you want to go far, go together."