H4+ − Brief of activities and plans Providing joint support to the 49 countries with the highest rates of maternal, newborn and child mortality

H4+ main achievements in 2011

• Streamlinedsupporttodevelopnationalhealthplansinseveralcountries,includingAfghanistan,Bangladesh,DemocraticRepublicofCongoandEthiopia.

• Fifty-sixlow-andmiddle-incomecountriesregisteredcommitmentstotheGlobalStrategyforWomen’sandChildren’sHealth.

• Anewsystemtosupportcountriesinprovidingongoingmonitoringofprogressinmeetingtheircommit-mentstotheGlobalStrategy,sotheycanbetteridentifygapsandtechnicalsupportneeds.

• Acceleratedactivitiestosupportcountriesinimplementingtheircommitmentstoimprovingwomen’sandchildren’shealthinthecontextofthreemajorgrantsprovidedbytheCanadianInternationalDevelopmentAgency,theFrenchMinistryofForeignandEuropeanAffairs,andJohnson&Johnson.

• AreportontheStateoftheWorld’sMidwiferyhelpedtriggerfollow-upactivities,suchasin-depthnationalassessmentsofmidwiferyineighthigh-burdencountries.

• LaunchofaGlobalPlantowardstheeliminationofnewHIVinfectionsamongchildrenandkeepingtheirmothersalive.

• Developmentofaglobalactionplantofollow-upontherecommendationsoftheCommissiononInforma-tionandAccountabilityforWomen’sandChildren’sHealth.

TheH4+aimstoprovidejointsupporttocountrieswiththehighestratesofmaternal,newbornandchildmortality,inordertoaccelerateprogressinsavingthelivesandimprovingthehealthofwomenandnewborns.TheH4+comprisestheUNPopulationFund(UNFPA),theUnitedNationsChildren’sFund(UNICEF),theWorldHealthOrganization(WHO)andTheWorldBank,memberssince2008,andtheJointUnitedNationsProgrammeonHIV/AIDS(UNAIDS)andUNWomen,morerecentmembers.

Buildingonthecollectivestrengthsandeachagency’srespectivecountry-specificadvantagesandcapacities,thiscoordinatedandharmonizedsupportaimstoaccelerateprogresstowardsachievingMillenniumDevelopmentGoals(MDGs)4and5by2015,inlinewiththeUnitedNationsSecretary-General’sGlobalStrategyforWomen’sandChildren’sHealth(theGlobalStrategy).

TheH4+workstoensurethefullinvolvementofcountriestargetedintheStrategyandinsupportingthemtofulfiltheircommitments.

H4+ Commitment to the Global Strategy:

• mobilizingpoliticalsupportfortheGlobalStrategyinthe49countriesoffocusoftheStrategy;

• buildingregionalandcountrytechnicalcapacitytoaddressmaternal,newbornandchildissues;

• focusingonthemostvulnerable;

• ensuringuniversalaccesstoanintegrated,essentialpackageofhealthservices;

• addressingrootcauses(e.g.genderinequity)ofmorbidityandmortality;

• engagingothersectors(e.g.education,gender,nutrition,water&sanitation,culture&humanrights);

• strengtheninginteragencycollaboration;

• sustainingmomentumbeyond2015.

Todate,theH4+membershavejointlyprogrammedtheirreproductive,maternal,newbornandchildhealth(RMNCH)work,buildingonexistingpartnershipsandsector-wideapproaches,incountriessuchasAfghanistan,Bangladesh,DemocraticRepublicofCongo,Guinea,Ethiopia,Mali,Nigeria,andTogo,andhaveprovidedcoordinatedsupportto 1

THE WORLD BANK

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strengtheningprogrammesinothercases.ThejointtechnicalsupportofH4+hasinitiallybeeninformedandguidedbyadetailedmappingofin-countryactivitiesthatidentifiedgapsandneedsinrelationtoreproductive/maternal,newbornandchildhealth,ineachofthehigh-priority25countriesthatweretheinitialfocusofH4+.1

Current H4+ activitiesThecurrentworkofH4+isorganizedaroundthreemainworkstreams:

• continuedworktostrengthentheprovisionofharmo-nizedtechnicalsupporttocountriesforRMNCH;

• galvanizingacceleratedactionsinselectedcountries;

• strengtheningactivitiesoncross-cuttingissues.

Continued work to strengthen the provision of harmonized technical support to countries

Thisworkisbasedontherequestfromcountries.Technicalsupporthasbeenprovidedtoreviewandrevisecountrynationalplans,strategiesandguidelines.Streamlinedsupporttodevelopnationalplanshasbeenprovidedinseveralcountries,includingAfghanistan,Bangladesh,DemocraticRepublicofCongo,andEthiopia.

Country commitments to the Global Strategy and the role of H4+

AspartofstrengtheningandprovidingjointsupporttoRMNCHincountries,H4+hasplayedaparticularroleinfacilitatingcountries’commitmentstotheGlobalStrategythroughconsultativeprocessesatcountrylevel.Atotalof56low-andmiddle-incomecountrieshavemadecommitments.

TheH4+continuestosupportcountriesinthecontextoftheGlobalStrategy,throughprovidingongoingmonitoringofcountryprogressinmeetingtheircommitmentstotheGlobalStrategy.TheH4+isworkingwithcountriestoidentifythegapsandtechnicalsupportneedsrequiredtomeetthecommitments,andprovidestechnicalsupportaccordingly.

H4+partnershavealsocollaboratedontheimplementationoftheglobalactionplanforaccountabilityforwomen’sandchildren’shealth.Todate,fourintercountryworkshopshavebeenheldinwhichmulti-stakeholdercountryteamshavedevelopednationalroadmapstoaugmentaccountability.Theseroadmapsarethebasisforcountry-levelworkshopsinwhichactionplansandbudgetallocationswillbeagreed.

Galvanizing accelerated actions in selected countries

Thisworkincludesjointsupporttocountriesinplanningandimplementationofacceleratedactionswiththehelpofdedicatedfundsfromdevelopmentpartnersandother

agencies.Currentlythreegrants–fromtheCanadianInternationalDevelopmentAgency(CIDA),theFrenchMinistryofForeignandEuropeanAffairs,andwiththeprivatesectorthroughJohnson&Johnson–arebeingimplemented.

Accelerating progress in maternal and newborn health – collaboration with the Canadian International Development Agency

TheH4+CanadianInternationalDevelopmentAgencyinitiativerepresentsthefirstcountry-levelcollaborationamongtheH4+insupportoftheimplementationoftheGlobalStrategy.Throughtheprovisionofjointsupporttofivecountries(BurkinaFaso,DemocraticRepublicofCongo,SierraLeone,ZambiaandZimbabwe),theH4+intendstodevelopprogrammingthatiscatalyticinnature,acceleratingexistingcountryleveleffortsbytargetingidentifiedimplementationbottlenecksandgaps,andprioritizingspecificinterventionsandinnovationsaccordingly.

Specifically,theprogrammeobjectivesareto:

• providejointsupportfornationalscale-upofintegrated,RMNCHinterventionswithafocusonequity,throughmaximizingthecoordinationandsynergiesbetweentheagencies;

• supportthestrengtheningofnationalhealthsystems,rangingfromstewardshipthroughtotheimplementationandmonitoringofmaternal,newborn,adolescentandchildhealthinterventions,inpartnershipwithothersandguidedbynationalhealthplans;

• collectandanalysedatatoidentify,documentandsupportinnovativeapproachesandevidenceofwhatworksforadaptationandroll-outinotherhigh-burdencountries.

Thedurationoftheprojectisfiveyears(March2011–March2016).FundingisprovidedtoUNFPAasanadministrativeagentofthejointprogramme.Basedontheapprovalofcountry-specificandglobalworkplans,fundsaredisbursedbyUNFPAtoeachagencyfortheircomponentsofthecountry-specificannualworkplansandfortheircontributiontotheglobal-levelwork.

Progress

Achievements to date include:

• developmentofcountry-levelworkplanswithspecificactionstoacceleratemeetingtheircommitments;

• developmentofjointH4+plansforgloballevelactivities;

• initiationofbaselineassessmentsofthecurrentRMNCHstatusinallfivecountries;

• acommonmonitoringandevaluationframeworkanditsapplicationtofivecountryworkplans:inBurkinaFaso,DemocraticRepublicofCongo,SierraLeone,Zambiaand

Zimbabwe.1WHO,UNFPA,UNICEFandTheWorldBank.Mappingofin-countryactivitiesbyUNpartners(WHO,UNFPA,UNICEFandWorldBank)towardsimprovingreproductive,maternalandnewbornhealthinthecontextofMDG5.Geneva,WorldHealthOrganization,2009.

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AttheSteeringCommitteemeeting,28–29February2012,betweenH4+andCIDA,allcountriesreportedthatCIDA-fundedactivitiesarewellalignedwithnationalplansand

strategies,andarenotstand-aloneprojects.

Accelerating reduction in maternal, newborn and child mortality, and strengthening family planning programmes and gender sensitivity – collaboration with the French Ministry of Foreign and European Affairs

TheprojectprovidesassistanceinacceleratingtheimplementationofactivitiestowardsachievingMDGs4and5.Theinitiativeaimstobecatalyticandtoacceleratecountry-leveleffortsthroughidentificationofbottlenecksandgapsinimplementation,andprioritizationofinnovations.

ParticipatingagenciesincludeUNFPA,UNICEF,WHOandUNWomen.Theprojectdurationwillbefiveyears(November2011–October2016).

FundsarecontributeddirectlybytheMinistrytoeachagencyaccordingtoanannualfinancialagreement.Althoughtheproposalsandfinancialagreementsareagency-specific,allproposalsareorganizedaccordingtothesixbuildingblocksofhealthsystems–servicedelivery;healthworkforce;healthinformationsystems;accesstoessentialmedicines;financing;andleadership/governance–plusthepromotionofkeyfamilypracticesinthecommunity.

ImplementationoftheFrenchgrantisbasedoncomplementarityandstrengthsofagencies,withUNFPAfocusingonsexualandreproductivehealthandfamilyplanning;UNICEFoncommunityapproachesformaternalandchildhealth;WHOonmaternalhealth,communitymanagementofchildhoodillness,essentialmedicines,familyplanning,andhumanresources;andUNWomenongenderissues.UNICEFalsosupportsactivitiesrelatedtoHarmonizingHealthinAfrica(HHA),andregional-levelactivitiesincludingoperationsresearchandoverallmonitoringandevaluation.

ElevencountriesaresupportedbythegrantfromFrancefor2011–2012(Benin,BurkinaFaso,CentralAfricanRepublic,Chad,Côted’Ivoire,DemocraticRepublicofCongo,Guinea,Haiti,Mali,Niger,Senegal,andTogo).Threeofthecountriesareconsidered‘flagships’whereallfouragenciesareactiveusingthissourceoffunding:Guinea,MaliandTogo.

Progress

Acommonplanningandimplementationframeworkforcountrylevel,basedonnationalplans,wasagreedamongagenciesandapplied.Inthefirstinstance,focushasbeenplacedonthethreeflagshipcountries(Guinea–leadagencyWHO;Mali–leadagencyWHO;Togo,–leadagencyUNICEF).AllcountrieswiththeexceptionofHaitiandNigerhavenowdevelopedplansofactionforthefirstyearoftheinitiative.

Follow-upvisitstofacilitateimplementationareplannedoverthecomingsixmonths.Allplanningactivitiesinvolvethetechnicalandfinancialpartnersgroupinagivencountry,includingtheAgenceFrançaisedeDéveloppement.

AtthefirstmeetingoftheTechnicalCommitteeinMarch2012,anoverallmonitoringandevaluationframeworkwasagreed,harmonizedwiththeframeworkdevelopedfortheH4+CIDAgrant.Operationsresearchquestionsofregionalrelevancehavebeenproposed,aswellasmeansofstrengtheningandbenefitingfromlinkageswithHHA.UNICEFwillensurethecoordinationofcountryvisitsandtechnical

support,andcoordinationwithHHA.

Accelerating progress in MDGs 4 and 5 through human resource strengthening – collaboration with Johnson & Johnson

Johnson&JohnsonbecamethefirstprivatesectororganizationtosupporttheH4+.ItisnowworkingtosupportUNFPAandWHOcountryteamsforpilottrainingprogrammesforhealthcareworkersinEthiopiaandUnitedRepublicofTanzania,whowillprovidecriticalprenatalandobstetriccareformothersandnewborns.

Other H4+ activities – in cross-cutting thematic areas Strengthening human resources for health

The State of the World’s Midwifery Report: Delivering Health, Saving Lives,supportedby30partnersandlaunchedin2011wasthefirstreporttoexplorethestateofmidwiferypracticesacrosstheglobe.Itprovidesacomprehensiveanalysisofmidwiferyservicesandissuesincountrieswheretheneedsaregreatest.

Thereportprovidesnewinformationanddatagatheredfromthe58humanresourcesforhealth“crisis”countriesinallregionsoftheworld.Itsanalysisconfirmsthattheworldlackssome350000skilledmidwives–112000intheneediest38countriessurveyed–tomeetfullytheneedsofwomenaroundtheworld.Thereportexploresarangeofissuesrelatedtobuildingupthiskeyhealthworkforce.

Ahigh-levelmeetinghostedbytheGreentreeFoundation(NewYork,18–19September2011),co-sponsoredbytheH4+andtheInternationalWomen’sHealthCoalition,withtheMDGAdvocatesgroupconvenedkeyactorswhocanaccelerateprogressonreproductiveandneonatalhealth,twoaspectsoftheMDGsthatarethefurthestbehind.Themeetingagreedontheneedtoconductin-depthassessmentsofhumanresourcesformaternalandnewbornhealthatthecommunityleveltoo.

AspartofTheHighBurdenCountryInitiative,in-depthnationalassessmentsofmidwiferyineighthigh-burdencountries(Afghanistan,Bangladesh,DemocraticRepublicofCongo,

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Ethiopia,India,Mozambique,Nigeria,andUnitedRepublicofTanzania)arebeingconducted.Thenationalassessments,tailoredtothecontextandindividualneedsofthecountries,havestartedinAfghanistan,Bangladesh,Ethiopia,andUnitedRepublicofTanzania.Theassessmentreportswillprovidegovernmentsandpartnerswithcostedscenariosandpolicyoptions.

LinkageswiththeGlobalHealthWorkplaceAlliance(GHWA).InthecontextoftheFrenchGrant,theGHWAisafullpartner.TheGHWAsupportscountriestoensurethatcoherenthumanresourceplansforRMNCHwillbeinplace,withanemphasisonmidwifery.

Elimination of mother-to-child transmission of HIV (MTCT)

TheGlobalPlantowardstheEliminationofNewHIVInfectionsamongChildrenby2015andKeepingtheirMothersAlivewaslaunchedin2011throughaconsultativeprocessbyahigh-levelglobaltaskteamconvenedbyUNAIDSandco-chairedbyUNAIDSExecutiveDirectorandPEPFAR.AparticularfocuswillbeplacedonstrengtheningintegrationofRMNCHandHIVservices.

Looking aheadSupport to implementation of country commitments:• continuetoimplementCIDAandFrenchGrantwork-

plans,withregularreviewandguidancewithrespectiveSteeringCommittees;

• continuesupporttoalladditionalcountriesintheimple-mentationofcommitmentstotheGlobalStrategyandthenationalplanofactiontostrengthenaccountability.

• mobilizeadditionalcommitmentsandcontinuetosup-portall75countries(49countriesoffocustotheGlobalStrategyandadditional26countrieswiththelowestincomeand/orhighestburdenofmaternalandchildmortality).

Areas for support include:

• developmentofRMNCHplansandstrategieswithinthenationalhealthsectorplans;

• technicalsupportforscalingupeffectiveinterventions,addressinghumanresourcescapacity;

• capacitydevelopmentforstrengtheningaccountabilityforresultsandresourcesincountries.

Monitoring the implementation of commitmentsAsafollow-upandexpansionofitsinitialmappingexercisein2009,theH4+isfollowingupprogressincountriesincludingtheadvancementofcommitmentstheyhavemadetotheGlobalStrategy.AnupdatedprogressreportisplannedforSeptember2012.

H4+ main objectives for 2012–2013

• SupportimplementationofcountryplansinthecontextofthegrantsprovidedbytheCanadianInternationalDevelopmentAgency,theFrenchMinistryofForeignandEuropeanAffairs,andJohnson&Johnson.

• AnalysethebaselineandimplementthesystemforongoingmonitoringofprogressinmeetingcountrycommitmentstotheGlobalStrategy,withafocusonidentifyinggapsandtechnicalsupportneeds.

• Supportdevelopmentandimplementationofcountrypriorityactionstoaccelerateprogressinmeetingcom-mitments.

• FacilitateaglobalresearchnetworkplatformthatbringstogetherexistingrelevantnetworkstosupporttheroleoftheresearchcommunityarticulatedintheGlobalStrategy.

• Conductaglobalreviewofinnovationsforwomen’sandchildren’shealthwiththeaimofprovidingguidancetocountriesontheidentificationandscalingupofeffectiveinterventions.

• Supportscalingupofsuccessfulinnovationsandensuretheirsustainability.

Support to research to facilitate the implementation of the Global StrategyTofacilitatetheroleofresearchinsupportingtheimplementationoftheGlobalStrategy,acommitmentwasmadebyHRP(theUNDP/UNFPA/WHO/WorldBankSpecialProgrammeofResearch,DevelopmentandResearchTraininginHumanReproduction),toestablishaglobalresearchnetworkplatformincollaborationwithH4+partnersandotherstakeholders.Theresearchnetworkaimstobringtogetherexistingrelevantnetworkstosupportresearchcapacitystrengthening,enhancingresearch/policydialogue,anddeliveringapriorityresearchagendainlinewiththeroleoftheresearchcommunityarticulatedintheGlobalStrategy.TheresearchnetworkplatformwillbeestablishedbyOctober2012withelementsofitsworkplanspecified.

Support to innovation InthecontextoftheCIDAgrant,H4+willundertakeaglobalreviewofRMNCHinnovationsaswellasreviewingconceptualframeworksforscalingupwiththeaimofprovidingguidancetocountriesontheidentificationandscalingupofeffectiveinterventions.

Additionally,H4+partnersareprovidinginputtotheUnitedNation’sInnovationWorkingGroup(IWG),apartoftheGlobalStrategy.TheIWGhasprioritizedmHealth(mobilehealth)asakeystrategicinnovationapproachtoachievingMDGs4and5.Workisunderway,incollaborationwiththemHealthAlliancetosupportsuccessfulmHealthpilotprojectstomovetowardsscaledandsustainablesolutions. April 2012