Universal Access to Reproductive Health: Strengthening Institutional - - PowerPoint PPT Presentation
Universal Access to Reproductive Health: Strengthening Institutional Capacity Why? What? And How? Presented at International Workshop on Capacity-Building in Programme Management on Population and Development, Beijing, China, November 7-9,
Presented at International Workshop on Capacity-Building in Programme Management on Population and Development, Beijing, China, November 7-9, 2006 By Jay Satia International Council on Management of Population Programmes (ICOMP)
achieving universal access to reproductive health by 2015, as set out at the ICPD,
integrating this goal in strategies to attain the internationally agreed development goals, including those contained in the Millennium Declaration, aimed at reducing maternal mortality, improving maternal health, reducing child mortality, promoting gender equality, combating HIV/AIDS and eradicating poverty.
Why? Gap in access How?
What?
Framework for Institutional Capacity Development
Framework for Institutional Capacity Development
How well are we doing on universal access to RH?
How well are we doing on universal access to RH?
Percent of Deliveries Attended by Skilled Attendants
10 20 30 40 50 60 70 80 90 100
Asia Latin America Middle East/North Africa Sub-Saharan Africa Central Asia Republics Caucasus % d eliveries atten d ed b y skilled atten d an ts 58.7% Source: Ross et al., 2005
How well are we doing on universal access to RH?
Percent of Unmet Need for Contraception for All Women
5 10 15 20 25
Asia (ex. China) Sub-Saharan Africa Latin America Middle East/North Africa Central Asia % of unmet need
13.0% Source: Ross et al., 2005
How well are we doing on universal access to RH?
Percent of Women Ages 15-24 with Comprehensive Knowledge of HIV/AIDS
40 38 34 18 15 7 1 37 25 5 10 15 20 25 30 35 40 45
B
t w a n a G h a n a K e n y a N i g e r i a H a i t i A r m e n i a I n d
e s i a C a m b
i a V i e t N a m
percent
Source: Ashford et al., 2006
How well are we doing on universal access to RH?
Prevalence of Physical Violence by an Itimate Partner according to Severity of Violence, among Ever-partnered Women
49 36 26 25 19 24 19 18 20 17 20 16 13 8 4 12 13 23 22 22 17 21 16 14 16 11 12 10 15 9
10 20 30 40 50 60 70
Peru province Ethiopia province Peru city Tanzania province Bangladesh province Samoa Bangladesh city Thailand province Brazil province Tanzania city Namibia city Brazil city Thailand city Serbia & Montenegro city Japan city
percent
moderate physical violence severe physical violence
Source: WHO, 2006
If the countries of the Asia-Pacific region are to achieve the Millennium Development Goals (MDGs) they will need to invest sufficient resources. Just as important, … well functioning INSTITUTIONS can help to accelerate this progress towards the MDGs – especially those that are crucial for delivering health, education and other vital services to the poor.
UN ESCAP, September 2005
… The Commission for Africa, the Millennium Review and the G8 Gleneagles meeting reached a clear conclusion:
capacity development
is one of the most critical issues for both donors and partner countries.
Richard Manning Chair, OECD Development Assistance committee (2005)
Malaysia has achieved the health MDGs and attributes some of this success to its strong health system and institutional capacities.
Malaysia MDG Report 2005
Thailand, having achieved the health MDGs, would like to go beyond them. It seeks to address some of the institutional issues for this purpose:
for HIV infections.
Thailand MDG Report 2004
The MDG Reports of many countries focus
but do not adequately address institutional issues
implemented
What?
Framework for Institutional Capacity Development
provide universal access to needed health interventions
arrangements to address special needs for population and RH issues
Strengthen service delivery: Reaching the poor
Percent of Demand Satisfied by Wealth Quintile
23.7 38.1 50 49.7 37.9 48 68 70.7 70.5 62.1 10 20 30 40 50 60 70 80
Africa Latin America Asia North Africa/West Asia Global Average
%
and satisfied
Q1: poorest Q5: richest
Source: Ross et al., 2005
Strengthen service delivery: Reaching the poor
Percent of deliveries attended by doctor, nurse or trained midwife
20 40 60 80 100 R i c h e s t F
r t h M i d d l e S e c
d P
e s t Quintiles % Brazil Indonesia India
Source: Bulletin of WHO 2003:81:616-623
Strengthen service delivery: Reaching the poor
individual (Progressively narrower targeting)
Strengthen service delivery: Reaching the poor
The framework of accountability relationships
Policymakers Providers Poor people
WDR 2004, World Bank
Strengthen service delivery: Reaching the poor Governments themselves, and in partnership with civil society and private sector, must take the lead if the reproductive health status of the poor is to significantly improve.
Strengthen service delivery: Improving quality of care
Strengthen service delivery: Improving quality of care
Key measures taken
Increased staff and training 77 Introduction of quality standards 45 Improvement of management and logistics 36 Affordable reproductive health services 21 Provision of youth-friendly services 9 Total number of countries reporting 143
UNFPA State of World Population Report 2005
Strengthen service delivery: Improving quality of care
Availability of Multiple Contraceptive Methods
10 20 30 40 50 60 70 80 90 100
At least one long-term method At least one short-term method At least one long-term and at least one short-term method
% of countries reaching 50% of population
Strengthen service delivery: Strengthening health systems
planning, implementation skills)
sector-wide financing (SWaPs), formulating essential service packages)
Strengthen service delivery: Strengthening health systems
Health sector reforms are failing reproductive health. A rethink is needed Local level commitment to reproductive health Emphasize quality of care Gender awareness Greater community participation Reorientation of service delivery to local needs
Towards
Appropriate institutional arrangements for special population and reproductive health issues
reproductive health,
are lacking.
Relation of Percent of Deliveries Attended by Skilled Attendants to GDI score
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 20 40 60 80 100 120 % of deliveries attended by skilled attendants
GDI score
Relation of Percent of Deliveries Attended by Skilled Attendants to Female Literacy Rate
20 40 60 80 100 120 20 40 60 80 100 120 % of deliveries attended by skilled attendants fem ale literacy rate
Role of public, private and civil society sectors
Incentives for good performance and capacity to hold providers accountable
Middle way between state and private sector
How?
Framework for Institutional Capacity Development
Amartya Sen Nobel Prize Winning Economist
Institutional capacity development is neglected
Institutional capacity development is neglected
Institutional capacity development
Institutional capacity development requires
practices
capacities
Institutional capacity development : Change is resisted
Set an ambitious tone Encourage a culture of results- based management Create a consensus for change Garner support from broad coalition of interest groups
Why? Gap in access How?
What?
Framework for Institutional Capacity Development