Всемирная организация здравоохранения (ВОЗ / WHO) · Publications

A policy guide for implementing essential interventions for reproductive, maternal, newborn and child health (RMNCH): a multisectoral policy compendium for RMNCH

31 марта 2014 г. Всемирная организация здравоохранения

Полный текст размещён на сайте публикующей организации. lawenc.com индексирует метаданные и ведёт на официальный источник.

Полный текст

A POLICY GUIDE for Implementing Essential Interventions for Reproductive, Maternal, Newborn and Child Health (RMNCH)

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

A POLICY GUIDE for Implementing Essential Interventions for Reproductive, Maternal, Newborn and Child Health (RMNCH)

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

A POLICY GUIDE for Implementing Essential Interventions for Reproductive, Maternal, Newborn and Child Health (RMNCH)

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

A Policy Guide for Implementing Essential Interventions for Reproductive, Maternal, Newborn and Child Health (RMNCH): A Multisectoral Policy Compendium for RMNCH emerged from a series of multi-stakeholder consultations by networks of partners working on policies which affect reproductive, maternal, newborn, child and adolescent health. The document is designed for an audience of policy-makers, programme managers and advocates who seek to classify and assess information on specific policies to promote the implementation of essential reproductive, maternal, newborn and child health interventions to address the main causes of maternal, newborn and child ill-health and deaths. For a full list of partner organizations and contributors please see the back and inside covers.

WHO Library Cataloguing-in-Publication Data A policy guide for implementing essential interventions for reproductive, maternal, newborn and child health (RMNCH): a multisectoral policy compendium for RMNCH. 1.Women’s Health. 2.Child Welfare. 3.Maternal Health Services. 4.Reproductive Health Services. 5.Health policy. 6.Delivery of Health Care. I.World Health Organization. ISBN 978 92 4 150685 4 © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

(NLM classification: WA 310)

Printed in Spain. Recommended citation: Partnership for Maternal, Newborn & Child Health and WHO. A Policy Guide for Implementing Essential Interventions for Reproductive, Maternal, Newborn and Child Health (RMNCH): A Multisectoral Policy Compendium for RMNCH. World Health Organisation. Geneva, 2014.

A POLICY GUIDE for Implementing Essential Interventions for Reproductive, Maternal, Newborn and Child Health (RMNCH)

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

a POlICy guIde FOr ImPlementIng essentIal InterventIOns FOr rePrOduCtIve, maternal, newBOrn and ChIld health (rmnCh)

INDEX OVERVIEW

Pg. 2 Pg. 4 Pg. 4 Pg. 5 Pg. 6 Pg. 7 Pg. 8 Pg. 9 Pg. 9

Overview Approach and Methods Background: Policies for Reproductive, Maternal, Newborn and Child Health (RMNCH) What is the purpose of this compendium? Who is it for? How were policies selected? How is it organized? How can it inform policy dialogue, planning and implementation? How can it be used?

APPROACH AND METHODS

Pg. 10 Health Sector Policies Health sector policies to support RMNCH programming and the delivery of RMNCH essential interventions

HEALTH SECTOR POLICIES

Pg. 28 Multisectoral Policies Multisectoral policies that influence RMNCH service delivery and outcomes

Pg. 40 Annexes and References MULTISECTOR POLICIES

Pg. 40 Pg. 42 Pg. 43 Pg. 48 Pg. 49 Pg. 50

Annex 1: One-Page Summary of Essential Interventions Annex 2: Opportunities for Using the RMNCH Policy Compendium as a Technical Reference Annex 3: Tools and Methods for Reviewing, Developing and Implementing Policies for RMNCH Endnotes Acronyms used in this document Acknowledgements

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

OVERVIEW A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS This overview presents an ‘at a glance reference’ of key policies areas included in the guide. Electronic users: click on the icon to go to the corresponding content and resources.

HEALTH SECTOR POLICIES FOR SUPPORTING DELIVERY OF RMNCH INTERVENTIONS POLICY TOPIC AREAS 1. Constitutional and legal entitlements that facilitate universal access to health care in support of RMNCH programming 2. Strategies, plans and mechanisms to guide RMNCH programme implementation 3. Human rights-based approach to maternal, newborn and child health, including related sexual and reproductive health issues 4. Mobilization and allocation of financial resources

POLICY ON: - Right to the highest attainable standard of health - Universal access to health care and services

- Integration of RMNCH into National Health Strategy and Plan - National RMNCH strategy(ies) and implementation plan(s) - RMNCH institutional arrangements - RMNCH programming includes a human rights based approach - Access to sexual and reproductive health services - Legal basis for safe abortion Sustainable financing of RMNCH RMNCH resource allocation and expenditure Elimination of financial barriers RMNCH resource reporting and tracking Deployment and retention Accreditation and certification Authorization of service provision and task shifting RMNCH training curricula

5. Human resources

6. Essential health infrastructure

- Essential health infrastructure and health facilities

7. Essential medicines and commodities

- Essential medicine, supply and equipment list - Medicine and commodity security Adapting RMNCH essential interventions for local use Standards on quality of RMNCH care Standards for RMNCH referral care Supportive supervision for all RMNCH health workers in the delivery of quality RMNCH care - Community participation - Community mobilization and health education Birth registration Death notification Death reviews Well-functioning health information systems, including logistics, and surveillance system for RMNCH - Defining key RMNCH indicators - National and subnational RMNCH targets - Data review process

8. RMNCH service accessibility and quality

9. Collection and use of data for planning and evaluating progress

2 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH) Detailed policy content and links to related resources are presented in the section that follows. In the content page, click on the icon again to come back to the overview.

OVERVIEW OVERVIEW

MULTISECTORAL POLICIES WHICH INFLUENCE SERVICE DELIVERY AND RMNCH OUTCOMES POLICY TOPIC AREAS 1. Inclusive economic development

POLICY ON: - Eradicating income poverty and hunger - Reducing inequalities - Ensuring decent working conditions and opportunities and productive employment Adequate nutrition Quality education Social protection Gender equality Protecting biodiversity Stable climate Safe and affordable drinking water Adequate sanitation APPROACH AND METHODS

2. Inclusive social development

3. Environmental sustainability

HEALTH SECTOR POLICIES

4. Peace and security

- Freedom from violence and abuse - Resilience to natural hazards - Conflict-free access to natural resources - Information and Communication Technologies and eHealth - Essential infrastructure - The respect, protection and fulfilment of human rights - International standards of behaviour and practice - Efforts to improve development assistance and impact on development Voice and accountability Political stability and absence of violence Government effectiveness Regulatory quality Rule of law Control of corruption

5. Infrastructure for development

6. Obligations and duties

MULTISECTOR POLICIES

7. Good governance

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

APPROACH AND METHODS

BACKGROUND: POLICIES FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH) Policies are essential for ensuring that all women and children have the opportunity to achieve the highest standard of health, by supporting the development of and sustaining effective health systems and by creating environments that promote health more broadly. The majority of mortality and morbidity in women and children can be prevented with effective and affordable interventions that prevent or treat the most common causes of illness.1 There is widespread consensus that improving the coverage and quality of these interventions should be the focus of policies and associated programmes (Box 1). Social determinants, including education, income, clean energy, availability of housing and access to improved water sources and sanitation facilities, also influence women’s and children’s health and their ability to receive essential interventions. However, in many settings, interventions are still not reaching women and children, and key social determinants of health remain unaddressed. In 2010, an estimated 287 000 women died during pregnancy and childbirth2 and in 2012, 6.6 million children under the age of five died.3 Many countries are not yet on track to achieve MDGs 4, 5 and 6, - to reduce child mortality, improve maternal health and combat HIV/AIDS, malaria and other diseases, respectively.4

BOX 1: ESSENTIAL EVIDENCE-BASED INTERVENTIONS FOR RMNCH1 Demonstrated to be effective in improving maternal, newborn and child health and survival by addressing the main causes of mortality; Delivered along the continuum of care for women and children – from the reproductive years, through pregnancy, birth, the newborn period, infancy and childhood; Suitable for implementation in low- and middle-income countries; Delivered at all levels of the health system: community/home, first level and outreach, and referral-level services; Selected based on systematic data reviews and meta-analyses; WHO recommendations and guidelines; and input from experts in the field.

4 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

The need for accelerated action is emphasized in the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health5 and by the Every Women Every Child initiative,6 which build on the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) and other initiatives, and aim to mobilize resources and intensify global efforts for RMNCH. It is essential to strengthen RMNCH programmes to ensure that the most vulnerable women and children have improved access to high-quality services. Health-specific policies and multisectoral policies are central to this effort because they establish: an environment conducive to health promotion; the legal and technical basis for which RMNCH interventions are delivered; how they are delivered; and who is eligible to receive them (Figure 1).

OVERVIEW

FIGURE 1: SUMMARY IMPACT MODEL: SUPPORTIVE POLICIES FOR RMNCH POLITICAL, ECONOMIC, SOCIAL, TECHNOLOGICAL AND ENVIRONMENTAL FACTORS

APPROACH AND METHODS

HEALTH SECTOR POLICIES For example: planning and management; financing; human resources; medicines; service availability and quality; health information.

MULTISECTORAL POLICIES For example: policies affecting social determinants (e.g. education and social protection).

HEALTH SECTOR POLICIES

INCREASED AND EQUITABLE INTERVENTION COVERAGE – EVIDENCE-BASED INTERVENTIONS PRE-PREGNANCY Eg. Family planning; Women’s nutrition; Counseling on sexual and RH. PREGNANCY Eg. ANC; Treatment of malaria; Prevention of mother to child transmission of HIV; Tetanus vaccine. CHILDBIRTH Eg. Skilled birth attendance; Essential newborn care; EmONC. POSTNATAL Eg. Postnatal care for mother and baby; Infant and young child feeding. CHILDHOOD Eg. Standard case management of newborn and childhood illness; Vaccines; Prevention of malaria.

MULTISECTOR POLICIES

REDUCED PREVENTABLE MORTALITY AND IMPROVED HEALTH AND NUTRITION FOR WOMEN AND CHILDREN Source: Countdown to 2015. Building a better future for women’s and children’s health. The 2012 Report. WHO and UNICEF, Geneva, 2012.

WHAT IS THE PURPOSE OF THIS COMPENDIUM? This compendium is a companion document to the Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.1 It presents key health-systems-related policies that support the delivery of proven interventions to women and children. It also includes policies on the economic, social, technological and environmental factors that influence health outcomes and service delivery. By synthesizing policy areas, the compendium aims to provide the basis for an integrated approach to advocacy, policy dialogue and planning for RMNCH – both within the health sector and across sectors that influence RMNCH. Policy recommendations change over time, as new evidence on effective interventions and delivery channels are added. For this reason, the compendium is a living document and will be regularly updated. The more detailed process of policy review, development and implementation is beyond the scope of this document. Links are provided to tools and resources for this purpose. A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

ANNEXES AND REFERENCES

WHO IS IT FOR? The compendium is designed for policy-makers and managers who are responsible for developing, implementing and evaluating RMNCH strategies, plans and programmes, as well as those from sectors that influence health-service delivery and RMNCH outcomes. In addition, a number of actors outside the government may play an important role in delivering RMNCH services, including civil society organizations, professional associations and the private sector. Within Ministries of Health, RMNCH programmes may be housed in a single department (such as reproductive and family health) or across several departments such as reproductive and maternal health, newborn and child health, immunization, nutrition, malaria, and HIV/AIDS. RMNCH programmes work in close collaboration with health systems departments such as human resources, essential medicines and commodities, health promotion/communication, monitoring and evaluation. Policy-makers and programme managers in all of these areas may have responsibility for aspects of RMNCH policy – and need to be involved with reviewing and developing policy content. Sectors that influence RMNCH include financing, agriculture, education, transportation, energy, social and community development and national human rights institutions. Advocates, policy-makers and managers working in these sectors may also use the compendium to inform policy dialogue and planning.

6 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

HOW WERE POLICIES SELECTED? Policies are defined as decisions, plans or actions that are necessary to improve RMNCH health outcomes and reduce mortality.7 Using this definition, policies may be written plans, strategies, laws, regulations, codes of practice or guidelines that are needed to deliver all or parts of the minimum package of interventions; or to improve social determinants of RMNCH. Policies are usually established by national policy-makers and managers for widespread use in a country. Often in decentralized systems, national policies can be further endorsed/adopted at subnational levels. Also, in these decentralized systems, subnational policymakers can develop specific policies in response to local needs. The compendium brings together evidence and consensus-based policy recommendations and guidance that can be used to support four types of policies that are required to support the implementation of essential RMNCH interventions. These types of policies include: Health systems policies that are approved by ministries of health, such as strategies, plans and guidelines for human resource training and deployment, and procurement and distribution of medicines and supplies; RMNCH policies that are specific to the technical components of RMNCH along the continuum of care, such as clinical guidelines, roles and responsibilities for health workers and in-service training plans; International agreements/conventions that governments approve and that apply across sectors and countries, including laws, regulations and codes; Multisectoral policies that influence RMNCH service delivery and outcomes, such as water and sanitation, food security, education and infrastructure. Health-sector-related policy recommendations and guidance were identified from policy, strategy, and programme documents from the United Nations, Countdown to 2015, WHO and associated initiatives including the International Health Partnership (IHP+), Commission on Information and Accountability for Women’s and Children’s Health, in the areas of reproductive, maternal, newborn, child and adolescent health and health systems. These policies were reviewed using three principal criteria: technical relevance to RMNCH, availability of evidence and consensus on its importance. In order to be included in the compendium, the policy needed to meet these three criteria as defined in Box 2. OVERVIEW

APPROACH AND METHODS HEALTH SECTOR POLICIES MULTISECTOR POLICIES

BOX 2: CRITERIA FOR SELECTING KEY HEALTH-SECTOR-RELATED POLICIES CRITERIA Technical relevance to RMNCH Evidence available Consensus DEFINITION Required to deliver essential evidence-based RMNCH interventions along the continuum of care (as defined in the Global Review of the key interventions related to RMNCH).1 Available evidence supports the importance of the policy area for global RMNCH programme implementation (WHO technical and clinical guidelines tools or reports and/or reviews from peer-reviewed journals). Included in UN/International/treaties, codes, conventions, declarations; World Health Assembly resolutions; and/or in global monitoring and evaluation frameworks such as WHO, UN and related partners’ statistics and databases.

ANNEXES AND REFERENCES

The multisectoral policy recommendations included in the compendium were identified from key United Nations reports related to sustainable development and the MDGs, including the UN System Task Team’s proposed framework of the core dimensions of sustainable development in the post-2015 development agenda.8 The policies are those that the health sector engages with across government and with other development sectors of major impact for women’s and children’s health, to improve RMNCH and influence its determinants. A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

HOW IS IT ORGANIZED? In this compendium, policies are organized into two broad categories: Health sector policies for supporting delivery of RMNCH interventions along the continuum of care divided into nine topic areas based on an adapted version of the health systems building blocks framework9 and; Multisectoral policies that influence service delivery and RMNCH outcomes divided into seven topic areas based on the proposed framework of the core dimensions of sustainable development in the post-2015 development agenda. The Policy Compendium contains key policy content and supporting documents and guidelines for relevant policies within each topic area (See Box 3).

BOX 3: ORGANIZATION OF POLICY COMPENDIUM EXPANDED TABLES HEALTH SECTOR POLICIES FOR SUPPORTING DELIVERY OF RMNCH INTERVENTIONS Policy Topic Areas 1. Constitutional and legal entitlements that facilitate universal access to health care in support of RMNCH programming 2. Strategies, plans and mechanisms to guide RMNCH programme implementation 3. Human rights-based approach to maternal, newborn and child health, including related sexual and reproductive health issues 4. Mobilization and allocation of financial resources 5. Human resources 6. Essential health infrastructure 7. Essential medicines and commodities 8. RMNCH service accessibility and quality 9. Collection and use of data for planning and evaluating progress MULTISECTORAL POLICIES WHICH INFLUENCE SERVICE DELIVERY AND RMNCH OUTCOMES Policy Topic Areas 1. Inclusive economic development 2. Inclusive social development 3. Environmental sustainability 4. Peace and security 5. Infrastructure for development 6. Obligations and duties 7. Good governance Content Key content for policies within each topic area Supporting documents and guidelines Documents for each topic area which support a wide consensus on its adoption and use Content Key content for policies within each topic area Supporting documents and guidelines Documents for each topic area that support a wide consensus on its adoption and use

8 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

HOW CAN IT INFORM POLICY DIALOGUE, PLANNING AND IMPLEMENTATION? The Policy Compendium is intended to support policy dialogue and integrated planning of RMNCH programmes (see Annex 2). Reviewing and developing many of the core policies requires expertise from different RMNCH technical areas, health systems and sectors outside of health and therefore requires better integration and coordination among stakeholders. Integrated planning for RMNCH has a number of benefits, including: Ensuring that RMNCH policies are incorporated into national health strategies and plans. Encouraging integration of RMNCH interventions and health programmes. Since RMNCH interventions are often closely related and delivered by the same staff and systems, they can be delivered more efficiently and effectively by integrated programmes. Encouraging integration of essential RMNCH interventions into other health programmes (such as HIV/AIDS, TB, malaria, noncommunicable diseases and nutrition). Linking with other programmes can improve quality and coverage of women’s and children’s health interventions and improve programme efficiency. Having core policies in place is an essential step to improve the coverage and quality of RMNCH interventions. For this reason the core policy content contained in the compendium should inform strategic planning, priority setting and implementation planning for RMNCH. Key policy measures should be included in reviews of RMNCH programme performance. When gaps are identified, the core policy content can inform advocacy, consensus building between stakeholders and best approaches to develop needed policies. Further examples of how the compendium may be used for planning, priority setting and advocacy are summarized in Annex 2. A more in-depth process is required to review the status and effectiveness of existing policies and to further develop and implement policies. Tools and methods for this purpose are presented in Annex 3, along with example benchmarks for tracking the process of policy implementation more broadly. APPROACH AND METHODS HEALTH SECTOR POLICIES OVERVIEW

HOW CAN IT BE USED? MULTISECTOR POLICIES

This compendium could be used in different ways. If the user is interested in all areas of the RMNCH continuum of care, this compendium could be used as a checklist, in which case the user is recommended to look at both health and the multi-sector policy categories. Within each of the two broad policy categories, the reader can choose to examine a single policy topic area at a time (see the Overview for a list of policy topic areas and policies). For example, within the Health Sector policy category the user may choose to focus on the health workforce policy topic area for RMNCH. If the user is interested in addressing one area of the continuum of care, for example childbirth, the recommendation is to first look at all policy topic areas and then the policies specific to childbirth e.g. emergency obstetric care.

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

HEALTH SECTOR POLICIES HEALTH SECTOR POLICIES TO SUPPORT RMNCH PROGRAMMING AND THE DELIVERY OF RMNCH ESSENTIAL INTERVENTIONS The Health Sector Policies focuses on RMNCH programming within the health sector and key health sector policies for delivering RMNCH essential interventions. It is divided into nine topic areas, based on the RMNCH legal and policy environment and the health systems building blocks framework.9,10

10 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

1. IS HEALTH PROTECTED IN THE NATIONAL CONSTITUTION AND ARE THERE LEGAL ENTITLEMENTS THAT FACILITATE UNIVERSAL ACCESS TO HEALTH CARE IN SUPPORT OF RMNCH PROGRAMMING? POLICY ON: Right to the highest attainable standard of health CONTENT

SUPPORTING DOCUMENTS / GUIDELINES UN. Universal Declaration of Human Rights. Article 25, para. 1. 1948.

OVERVIEW

Specifies that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of gender, race, religion, political belief, economic or social condition.

http://www.un.org/en/documents/udhr/

WHO. Constitution of the World Health Organization. 1946.

http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf

EU. The Right to Health and The European Social Charter. 2009.

http://www.coe.int/t/dGHl/monitoring/Socialcharter/Theme%20 factsheets/FactsheetHealth_en.pdf 1981. http://www1.umn.edu/humanrts/instree/z1afchar.htm

AU. African Charter on Human and Peoples’ Rights. African Union,

APPROACH AND METHODS

UN. General Comment on The Right to the Highest Attainable

Standard of Health. 2000. http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/40d009901358b0e2c12 56915005090be?Opendocument Rights. 1976. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx Commodities and Guidelines for RMNCH. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, PMNCH, 2011. http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html http://www.un.org/ga/search/view_doc.asp?symbol=A/67/L.36 and child health interventions & Sustainable health financing, universal coverage and social health insurance. WHA58.31, WHA58.33. 2005. http://apps.who.int/gb/ebwha/pdf_files/WHA58-REC1/english/ A58_2005_REC1-en.pdf – Guiding principles for inclusion in national medicines lists. Geneva, 2006. http://www.who.int/reproductivehealth/publications/general/ a91388/en/ to Universal Coverage. Geneva, 2010. http://www.who.int/whr/2010/en/index.html

UN. International Covenant on Economic, Social and Cultural

Universal access Specifies guaranteed legislated access to a to health care comprehensive package of essential interventions, as and services well as more costly, specialized interventions associated with specific diseases and health conditions.

WHO, Aga Khan University and PMNCH. Essential Interventions,

HEALTH SECTOR POLICIES

Specifies a comprehensive approach to ensure universal access to quality health care and services.

UN. Resolution ‘Global Health and Foreign Policy’. A/67/L.36. 2012. WHA. Working towards universal coverage of maternal, newborn

WHO, PATH, UNFPA. Essential medicines for reproductive health

WHO. World Health Report – Health Systems Financing: The Path

MULTISECTOR POLICIES

WHO. Resolution WHA58.31: working towards universal coverage

of maternal, newborn and child health interventions. Geneva, 2005. https://apps.who.int/gb/ebwha/pdf_files/WHA58/WHA58_31-en.pdf http://www.worldbank.org/universalhealthcoverage Care, Alma-Ata, USSR, 6-12 September 1978. http://www.who.int/publications/almaata_declaration_en.pdf

The World Bank. Universal Health Coverage. 2013.

Alma-Ata Declaration. International Conference on Primary Health

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

2. ARE THERE POLICIES TO SPECIFY STRATEGIES, PLANS AND MECHANISMS TO GUIDE RMNCH PROGRAMME IMPLEMENTATION? POLICY ON: Integration of RMNCH into national health strategy and plan CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

UN. Global Strategy for Women’s and Children’s Health. 2010. RMNCH interventions, indicators, and targets are http://www.everywomaneverychild.org/images/content/files/ specified in the national health strategy and plan and are reflected in the overall national development plan global_strategy/full/20100914_gswch_en.pdf Countdown to 2015. Reports and Articles. and budget.

http://www.countdown2015mnch.org/reports-and-articles

European Observatory on Health Systems and Policies. Health

Targets in Europe: Learning from Experience. Geneva, WHO, 2008. http://www.euro.who.int/__data/assets/pdf_file/0008/98396/ E91867.pdf http://www.carmma.org/resource/african-health-strategy

CARMMA. African Health Strategy. Johannesburg, AU, 2007. AU. Maputo Plan of Action: Universal Access to Comprehensive

Sexual and Reproductive Health Services in Africa. 2006. http://www.unfpa.org/africa/newdocs/maputo_eng.pdf tuberculosis, and other infectious diseases. 2001. http://www.un.org/ga/aids/pdf/abuja_declaration.pdf

Organisation of African Unity. Abuja declaration on HIV/AIDS,

National Specifies RMNCH interventions to be delivered, how WHO. World Health Assembly Resolution. EB128.R12: strengthening national policy dialogue to build more robust health policies, RMNCH they will be delivered (delivery channels), who will strategies and plans. Geneva, 2011. strategy(ies) and receive them (specify target populations and how http://www.who.int/nationalpolicies/B128_R12-en.pdf implementation marginalized and excluded populations will be OHCHR. Technical guidance on the application of a human rights plan(s) reached) and how resources will be allocated. -

Implementation plan includes costed estimates ○

The strategy and implementation plan may be developed for a two-to-five year timeframe

A single (integrated) RMNCH plan may be available or separate plans for one or more components (reproductive, maternal, newborn and child health).

based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality. Paragraphs 14, 15, 17. HRC: 2012. http://www2.ohchr.org/english/issues/women/docs/A.HRC.21.22_ en.pdf Version 2. 2011. http://www.internationalhealthpartnership.net/fileadmin/uploads/ ihp/Documents/Key_Issues/NHP___JANS/JANS. Tool&Guidelines.2011_EN.pdf the attainment of international development goals and targets. Global strategy adopted by the 57th World Health Assembly. Geneva, 2004. http://www.who.int/reproductivehealth/publications/general/ RHR_04_8/en/

IHP+. Joint Assessment of National Health Strategies and Plans.

A national health workforce strategic plan is included. Includes a behaviour change and communication plan. Specifies involvement and approval process by key stakeholders. Sets out strategies and guidelines for public-private partnerships. Specifies dissemination strategy to key national and subnational stakeholders.

WHO. Reproductive health strategy to accelerate progress towards

ECOSOC. United Nations Public-Private Alliance for Rural

Development: Resolution 2007/36. UN, 2007. http://www.un.org/en/ecosoc/docs/2007/resolution%202007-36.pdf Every Child, 2012. http://www.who.int/pmnch/knowledge/ publications/20120628_private_enterprise_guide/en/index.html Development Goals. London, 2012. http://www.internationalhealthpartnership.net/en/tools/globalcompact/ http://www.unglobalcompact.org/AboutTheGC/index.html http://www.chpp.org/

PMNCH, IWG. Private Enterprise for Public Health. Every Women

RMNCH institutional arrangements

Sets out institutional arrangements and coordinating mechanisms for: -

IHP+. IHP+ Global Compact for Achieving the Health Millennium

multi-stakeholder coordination group to support and monitor the implementation of RMNCH essential interventions technical working group to review and update implementations plans of RMNCH essential interventions.

UN. Global Compact.

WHO. Country Health Policy Process Tool. WHO. Country Planning Cycle Database.

Sets out institutional arrangements for RMNCH focal person (s) in MoH and role in planning, coordinating and managing RMNCH activities.

http://www.nationalplanningcycles.org/

12 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

3. ARE THERE POLICIES TO ENSURE A HUMAN RIGHTS-BASED APPROACH TO MATERNAL, NEWBORN AND CHILD HEALTH, INCLUDING RELATED SEXUAL AND REPRODUCTIVE HEALTH ISSUES? POLICY ON: CONTENT SUPPORTING DOCUMENTS / GUIDELINES OVERVIEW

OHCHR. Technical guidance on the application of a human rights Emphasizes that RMNCH-related services and RMNCH based approach to the implementation of policies and programmes facilities have to be available, accessible, acceptable programming to reduce preventable maternal morbidity and mortality. and of good quality. includes a Paragraphs 14, 15, 17. HRC, 2012. human rights Specifies that the realization of the right to health is http://www2.ohchr.org/english/issues/women/docs/A.HRC.21.22_ based approach indispensable for the enjoyment of all other rights en.pdf (civil, political, economic, social and cultural) and is OHCHR. Human Rights, Health and Poverty Reduction Strategies. also dependent on the realization of many other rights. Geneva, WHO, 2008.

Specifies that human rights standards and principles, such as participation, equality, nondiscrimination and accountability, should guide RMNCH programming in all health-related sectors and at all stages of the process.

http://www.ohchr.org/Documents/Publications/HHR_ PovertyReductionsStrategies_WHO_EN.pdf

APPROACH AND METHODS

Every Woman Every Child. Recommendations on Human Rights.

2010. http://www.who.int/pmnch/activities/jointactionplan/100922_3_ humanrights.pdf

UN. Convention on the Rights of the Child. Committee on the

Rights of the Child: General Comment 15. The Right of the Child to the Enjoyment of the Highest Attainable Standard of Health. 2013. www2.ohchr.org/english/bodies/crc/docs/GC/CRC-C-GC-15_en.doc

Access to sexual and reproductive health services

UN. Convention on the Rights of the Child. Committee on the Specifies that all females and males of reproductive Rights of a Child. General Comment 4. Adolescent Health and age have access to sexual and reproductive health services and rights to confidentiality regardless of age. development in the context of the Convention on the Rights of the

Child. CRC/GC/2003/4 Para 28. 2003. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G03/427/24/PDF/ G0342724.pdf?OpenElement http://www.unfpa.org/public/home/publications/pid/1973 http://www.un.org/esa/gopher-data/conf/fwcw/off/a--20.en

HEALTH SECTOR POLICIES

UNFPA. ICPD Programme of Action. 1995.

UN. Beijing Declaration and Platform for Action (Para 223). 1995. UNFPA. ICPD and Human Rights: 20 Years of Advancing

Reproductive Rights through UN Treaty Bodies and Legal Reform. Center for Reproductive Rights. 2013. http://www.unfpa.org/webdav/site/global/shared/documents/ publications/2013/icpd_and_human_rights_20_years.pdf

WRC, STC, UNHCR, UNFPA. Adolescent Sexual and Reproductive

Health Programs in Humanitarian Settings. UNFPA, 2012. http://www.unfpa.org/public/home/publications/pid/14407 http://www.unhchr.ch/huridocda/huridoca.nsf/(symbol)/a. conf.157.23.en http://www.un.org/womenwatch/daw/csw/shalev.htm

UN. Vienna Declaration and Programme of Action. Para 41.

MULTISECTOR POLICIES

UN. Rights to Sexual and Reproductive Health. 1998.

Legal basis for safe abortion

International Commitments: UN international conference on Establishes legal framework for safe abortion and population and development (1994) and Cairo 5+ meeting (1999). defines parameters for ensuring universal access to health workers qualified to perform safe abortion and http://www.un.org/popin/icpd/conference/offeng/poa.html http://www.iisd.ca/Cairo/program/p00000.html post-abortion services.

Establishes regulatory framework to clear procedures for women to have affordable access to alternative service providers in cases where individual service providers exercise conscientious objection.

UNFPA. ICPD Programme of Action.

http://www.unfpa.org/public/home/publications/pid/1973 Reproductive Rights through UN Treaty Bodies and Legal Reform. Center for Reproductive Rights, 2013. http://www.unfpa.org/ webdav/site/global/shared/documents/publications/2013/icpd_and_ human_rights_20_years.pdf Systems. Geneva, 2012. http://www.who.int/reproductivehealth/ publications/unsafe_abortion/9789241548434/en/

UNFPA. ICPD and Human Rights: 20 Years of Advancing

ANNEXES AND REFERENCES

WHO. Safe Abortion: Technical and Policy Guidance for Health

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

4. ARE THERE POLICIES ON THE MOBILIZATION AND ALLOCATION OF FINANCIAL RESOURCES TO SUPPORT THE IMPLEMENTATION OF RMNCH ESSENTIAL INTERVENTIONS? POLICY ON: Sustainable financing of RMNCH CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

Identifies funding sources and provides guidelines on WHO. World Health Report: health systems financing: the path to universal coverage. Geneva, 2010. mobilizing public and private resources for RMNCH. Within the context of universal access, specifies a focus on value for money of existing resources and accountability for resources and results. http://www.who.int/whr/2010/en/index.html World Health Assembly. Sustainable Health Financing Structures

and Universal Coverage. WHO, 2011. http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R9-en.pdf

PMNCH. Strengthen National Financing KS21. Geneva, 2012.

http://www.who.int/pmnch/knowledge/publications/summaries/en/ Health Coverage SB17. Geneva. http://www.who.int/pmnch/knowledge/publications/strategybriefs/en/ Geneva, 2013. http://www.who.int/pmnch/knowledge/publications/summaries/en/ for Women’s and Children’s Health. Geneva, 2012. http://www.hha-online.org/hso/system/files/domestic_financing_ mechanisms__final2_27062012.pdf

PMNCH. Financing Access to RMNCH Interventions for Universal

PMNCH. Economic Case for Investment in RMNCH KS24.

PMNCH. Promising Mechanisms to Strengthen Domestic Financing

14 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON: RMNCH resource allocation and expenditure

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES WHO. Macroeconomics and health: investing in health for

Specifies per-head total expenditure on health to implement RMNCH programmes. Specifies general government expenditure on health (expressed as a percentage of the overall budget) to implement RMNCH programmes.

economic development. Geneva, 2001. http://whqlibdoc.who.int/publications/2001/924154550x.pdf universal coverage. Geneva, 2010. http://www.who.int/whr/2010/en/index.html

OVERVIEW

WHO. World Health Report: health systems financing: the path to

Organization of African Unity. Abuja declaration on HIV/AIDS,

tuberculosis, and other infectious diseases. 2001. http://www.un.org/ga/aids/pdf/abuja_declaration.pdf

Every Women Every Child. Financial Estimates in the Global

Strategies. 2010. http://www.who.int/pmnch/activities/jointactionplan/100922_1_ financial_estimates.pdf http://www.who.int/healthsystems/publications/abuja_declaration/en/ (www. who.int/nha/database), World Health Statistics, Countdown 2015.

APPROACH AND METHODS

WHO. The Abuja Declaration: Ten Years On. 2011.

Data sources: WHO Global Health Expenditure Database

Elimination of financial barriers

Specifies that out-of-pocket public expenditure for those accessing care is to be minimized for all essential RMNCH services, based on an assessment of current out-of-pocket expenditure. Specifies that financing arrangements are to rely on prepayment and risk-pooling to promote equitable access to RMNCH essential interventions for women and children.

Xu K, et al. Designing health financing systems to reduce

catastrophic health expenditures. Technical Brief for Policy Makers number 2. Geneva, WHO, 2005. http://apps.who.int/iris/bitstream/10665/70005/1/WHO_EIP_HSF_ PB_05.02_eng.pdf

HEALTH SECTOR POLICIES

RMNCH resource reporting and tracking

World Bank, WHO, USAID. Guide to producing National Health Specifies the reporting of RMNCH resource Accounts – with special applications for low-income and middleallocation and expenditure in a separate budget line income countries. Geneva, WHO, 2003. (including national health accounts with sub-account http://www.who.int/nha/ for RMNCH established to allow tracking of financial WHO. Guide to Producing Reproductive Health Subaccounts resources allocated to this area).

Sets out requirements to establish a compact or formal http://www.who.int/nha/docs/guide_to_rh/en/index.html agreement between government and partners for WHO. Guide to Producing Child Health Subaccounts within the reporting on partner commitments and disbursements National Health Accounts. Geneva, 2012. (including on flows for RMNCH) to allow tracking of http://www.who.int/entity/nha/chsubrcolumn.pdf external resource commitments and allocations.

within the National Health Accounts. Geneva, 2010.

UN. Commission on Information and Accountability for Women’s

and Children’s Health. Keeping Promises, Measuring Results. New York, 2011. http://www.everywomaneverychild.org/images/content/files/ accountability_commission/final_report/Final_EN_Web.pdf are the gains. 2012. http://www.internationalhealthpartnership.net/fileadmin/uploads/ ihp/Documents/Upcoming_events/Developing%20a%20compact. Dec2012.pdf Health Resources. 2007. http://www.cgdev.org/files/13711_file_Resource_Tracking.pdf

MULTISECTOR POLICIES

IHP+. Developing a country compact: what does it take and what

CGDev. Following the Money: Towards Better Tracking of Global

WHO, Countdown to 2015, HMN, UNICEF. Monitoring Maternal

Newborn and Child Health: Understanding Key Progress Indicators. Geneva, WHO, 2011. http://www.who.int/healthmetrics/news/monitoring_maternal_ newborn_child_health.pdf Expenditure (and budget) Tracking tool. Geneva, 2011. http://www.who.int/entity/choice/gettool.pdf

ANNEXES AND REFERENCES

WHO. Guidelines for RMNCH-GET: A RMNCH Government

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

5. ARE THERE POLICIES TO ENSURE HUMAN RESOURCES ARE AVAILABLE WHERE NEEDED FOR RMNCH PROGRAMMING? POLICY ON: Deployment and retention CONTENT

SUPPORTING DOCUMENTS / GUIDELINES WHO. World health report 2006: working together for health.

Specifies the distribution of RMNCH workforce at all levels of the health-care system (referral, first level, community) in all geographic areas. Sets out standards for retaining and motivating the RMNCH health workforce, including of public and private health workers

Geneva, 2006. http://www.who.int/whr/2006/whr06_en.pdf

WHO. Optimizing Health Worker Roles for Maternal and Newborn

Health. Geneva, 2012. http://www.who.int/reproductivehealth/publications/maternal_ perinatal_health/978924504843/en/ Geneva, WHO/GHWA, 2008. http://www.who.int/workforcealliance/knowledge/resources/ kampala_declaration/en/index.html Recruitment of Health Personnel. Geneva, 2010. http://www.who.int/hrh/migration/code/practice/en/

GHWA. The Kampala Declaration and Agenda for Global Action.

WHO. The WHO Global Code of Practice on the International

WHO. WHA Resolution EB128.R9: Health Workforce Strengthening.

Geneva, 2011. http://apps.who.int/gb/ebwha/pdf_files/EB128/B128_R9-en.pdf

GHWA. Workforce Country Coordination and Facilitation. WHO.

http://www.who.int/workforcealliance/knowledge/resources/CCF_ Principles_Processes_web.pdf

16 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON:

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

Specifies quality assurance systems for education and WHO, GHWA. Scaling up, Saving Lives. Task Force for Scaling Up Accreditation Education and Training for Health Workers. Geneva, 2008. and certification training (in technical procedures, ethics and human http://www.who.int/workforcealliance/documents/Global_ rights), including accreditation and certification, for Health%20FINAL%20REPORT.pdf both public and private health workers, and GHWA. Building Stronger Human Resources for Health Through indicators of progress to ensure that training Licensure, Certification and Accreditation. Geneva, 2006. programmes meet nationally agreed standards.

OVERVIEW

http://www.who.int/workforcealliance/knowledge/toolkit/37_1.pdf

Edinburgh Declaration, 1988 WHA Resolution 42.38, 1989. WHO. Quality and Accreditation in Health Care Services: A Global

Review. Geneva, 2003. http://www.who.int/hrh/documents/en/quality_accreditation.pdf Midwifery Regulation, 2011. http://www.internationalmidwives.org/what-we-do/educationregulation-association/ Midwifery Education, 2010, amended 2013. http://www.internationalmidwives.org/what-we-do/educationregulation-association/

International Confederation of Midwives. Global Standards for

APPROACH AND METHODS

International Confederation of Midwives. Global Standards for

Authorization of service provision and task shifting

Specifies what each cadre of the health workforce is authorized to provide. Provides guidance on the process of modifying roles and responsibilities of RMNCH workforce to allow improved access to RMNCH essential interventions. -

WHO. Optimizing Health Worker Roles for Maternal and Newborn

Health. Geneva, 2012. http://www.who.int/reproductivehealth/publications/maternal_ perinatal_health/978924504843/en/

UNAIDS. Task Shifting: Rational Redistribution of Tasks Among

Specifies that in settings with insufficient numbers of trained health workers, task shifting should be implemented as an interim measure alongside other strategies designed to increase the total number of health workers in all cadres. Task shifting should not be seen as a substitute for other investments in human resources for health.

Health Workforce Teams. Geneva, WHO, 2007. https://www.unaids.org/en/media/unaids/contentassets/dataimport/ pub/manual/2007/ttr_taskshifting_en.pdf

HEALTH SECTOR POLICIES MULTISECTOR POLICIES

RMNCH training curricula

World Health Assembly. Rapid Scaling Up of Health Workforce Provides guidelines for RMNCH training curricula Production. 2006. and materials for doctors, nurses, midwives, nurse http://www.who.int/hrh/resources/WHA_59-23_EN.pdf midwives, other categories of facility-based health workers and community health workers who manage WHO, Aga Khan University and PMNCH. Essential Interventions, Commodities and Guidelines for RMNCH. A Global Review of the women’s and children’s health care.

Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, PMNCH, 2011. http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html Competencies & Tools. 2012. http://www.internationalmidwives.org/what-we-do/globalstandards-competencies-and-tools.html

International Confederation of Midwives. Global Standards,

ANNEXES AND REFERENCES

PAHO/WHO Resolution CD50.R7 Strategy for Health Personnel

Competency Development in Primary Health Care-Based Health Systems. 2010. http://www2.paho.org/hq/dmdocuments/2010/CD50.R7-e.pdf

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

6. ARE THERE POLICIES TO ENSURE THE AVAILABILITY OF ESSENTIAL HEALTH INFRASTRUCTURE AND HEALTH FACILITIES FOR RMNCH PROGRAMMING? POLICY ON: Essential health infrastructure and health facilities CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

Specifies number of health-care facilities at all levels OECD. Strengthening Health Information Infrastructure. 2013. http://www.oecd.org/els/health-systems/ (primary, tertiary, referral) needed to ensure access to strengtheninghealthinformationinfrastructure.htm essential RMNCH services. Specifies supply chain infrastructure Specifies space and design of health facilities. Specifies health-care waste management. Specifies emergency transportation and referral system. Specifies other essential infrastructure for health and development – see Multisectoral Policies.

Harvard University, International Business Leaders Forum, The

Conference Board. Business as a Partner in Strengthening Public Health Systems in Developing Countries. UN, 2006. http://www.un.org/partnerships/Docs/report_13_HEALTH%20 FINAL.pdf Activities (second version). Geneva, WHO, 2013. http://www.healthcarewaste.org/resources/documents/

Chartier Y, et al. Safe Management of Wastes from Health-Care

UNHRC. Technical Guidance on the Application of Human Rights

Based Approach to the Implementation of Policies and Programmes to Reduce Preventable Maternal Morbidity and Mortality. UN, 2012. http://www2.ohchr.org/english/issues/women/docs/A.HRC.21.22_ en.pdf

18 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

7. ARE THERE POLICIES TO ENSURE THE AVAILABILITY OF ESSENTIAL MEDICINES AND COMMODITIES FOR RMNCH PROGRAMMING? POLICY ON: Essential medicine, supply and equipment list CONTENT

SUPPORTING DOCUMENTS / GUIDELINES WHO, Aga Khan University and PMNCH. Essential Interventions,

OVERVIEW

Specifies the inclusion of minimum essential medicine, supplies and equipment to implement RMNCH essential interventions by service provision level (referral, first level, community).

Commodities and Guidelines for RMNCH. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, PMNCH, 2011. http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html Children. 2012. http://www.unfpa.org/public/home/publications/pid/12042

UN. Commission on Life-Saving Commodities for Women and

WHA. Implementation of the recommendations of the United

APPROACH AND METHODS

Nations Commission on Life-Saving Commodities for Women and Children. Resolution WHA66.7. 2013. http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R7-en.pdf Global Strategy for Reproductive Health Commodity Security. 2002. http://www.unfpa.org/public/home/publications/pid/3204 Guiding principles for their inclusion on national medicine lists. 2006. http://www.path.org/publications/detail.php?i=1283 A Global Agenda to Improve Quality and Access. 2012 pp. 1-20. http://www.path.org/publications/files/ER_mhs_policy_rpt.pdf

UNFPA. Reproductive Health Essentials – Securing the Supply.

PATH, WHO, UNFPA. Essential Medicines for Reproductive Health.

PATH. Safeguarding Pregnant Women With Essential Medicines –

WHO. World health report 2006: working together for health.

HEALTH SECTOR POLICIES

Geneva, 2006. http://whqlibdoc.who.int/publications/2006/9241563176_eng.pdf

Adolescents and adults of reproductive age

WHO, Aga Khan University and PMNCH. Essential Interventions, Specifies essential medicines and commodities for Commodities and Guidelines for RMNCH. A Global Review of the adolescents and adults of reproductive age including: Key Interventions Related to Reproductive, Maternal, Newborn and Contraceptives: Barrier methods, oral contraceptives, Child Health (RMNCH). Geneva, PMNCH, 2011. emergency contraceptives and hormonal injections; http://www.who.int/pmnch/knowledge/publications/201112_ long-acting reversible and surgical contraception. essential_interventions/en/index.html STI/HIV: test kits, treatment antibiotics, antiretroviral medicines Folic acid: tablets, fortified staple foods.

Pregnancy

Specifies essential medicines and commodities during WHO, Aga Khan University and PMNCH. Essential Interventions, Commodities and Guidelines for RMNCH. A Global Review of the pregnancy, including: Key Interventions Related to Reproductive, Maternal, Newborn and ANC – fetal stethoscope, scale, sphygmomanometer, Child Health (RMNCH). Geneva, PMNCH, 2011. hemoglobinometer, iron and folic acid, TT vaccine. http://www.who.int/pmnch/knowledge/publications/201112_ Malaria: antimalarial medicines (local guidelines), ITNs. essential_interventions/en/index.html STIs/HIV: HIV and syphilis test kits, penicillin, FIGO Safe Motherhood and Newborn Health (SMNH) Committee. cotrimoxazole, ARVs. Management of the second stage of labor. International Journal of Gynecology & Obstetrics. 119(3): 111-116. 2012. Hypertensive disorders in pregnancy including prehttp://www.ijgo.org/article/S0020-7292(12)00415-8/fulltext eclampsia and eclampsia: calcium, low dose asprin, magnesium sulphate and antihypertensives. Preterm labour/rupture of membranes: oxytocin/ misoprostol, partograph, antibiotic (erythromycin), corticosteroids. Unintended pregnancy/safe abortion: mifepristone/ misoprostol, vacuum aspiration equipment, uterotonics (misoprostol, oxytocin), antibiotics (local guidelines), equipment for surgical procedures. Specifies essential medicines and commodities during WHO, Aga Khan University and PMNCH. Essential Interventions, Commodities and Guidelines for RMNCH. A Global Review of the childbirth, including: Key Interventions Related to Reproductive, Maternal, Newborn and Caesarean section: Antibiotics (ampicillin, cefazolin); Child Health (RMNCH). Geneva, PMNCH, 2011. surgical environment, sphygmomanometer. http://www.who.int/pmnch/knowledge/publications/201112_ Postpartum haemorrhage – prevention: uterotonics essential_interventions/en/index.html (oxytocin, misoprostol, ergometrine). FIGO Safe Motherhood and Newborn Health (SMNH) Committee. Postpartum haemorrhage –management: oxytocin, Management of the second stage of labor. International Journal of ergometrine, misoprostol; IV fluids; blood transfusion; Gynecology & Obstetrics. 119(3): 111-116. 2012. http://www.ijgo.org/article/S0020-7292(12)00415-8/fulltext surgical facilities, HIV testing kit and ARV drugs.

MULTISECTOR POLICIES ANNEXES AND REFERENCES

Childbirth

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

POLICY ON: Postnatal – mother

CONTENT Specifies essential medicines and commodities for postnatal-mother, including:

SUPPORTING DOCUMENTS / GUIDELINES WHO, Aga Khan University and PMNCH. Essential Interventions,

Family planning supplies (see above). Anaemia prevention and treatment: ferrous salt, folic acid, hydroxyl-cobalamine, laboratory tests, blood products. Detection and management of postpartum sepsis: gentamicin, metronidazole. HIV: HIV test kits; ARV medicines.

Postnatal – newborn

Specifies essential medicines and commodities for postnatal-newborn, including:

WHO, Aga Khan University and PMNCH. Essential Interventions,

Clean delivery: cord clamp, scissors, clean birth kit. Resuscitation: Bag and mask, suction device. Vaccines (see infancy and childhood). Sepsis: thermometer, ampicillin and gentamicin or penicillin; HIV test kits and ARVs. Low birth weight/preterm: weighing scale; supplies for: KMC, extra support for small babies, management of respiratory distress syndrome, additional feeding needs and jaundice.

Infancy and childhood

Specifies essential medicines and commodities during infancy and childhood, including:

WHO, Aga Khan University and PMNCH. Essential Interventions,

Malaria: ITNs, rapid diagnostic tests, antimalarial drugs (local guidelines). HIV: test kits, ARVs. Vaccines: All routine vaccines plus H. influenza, meningococcal, pneumococcal and rotavirus vaccine, syringes, safety boxes, cold chain equipment. Management of severe acute malnutrition: ready to use therapeutic foods, micronutrient supplements, vitamin A capsules, antibiotics, therapeutic food formulations. Case-management of pneumonia: respiratory rate timers, vitamin A capsules, appropriate antibiotics, oxygen for severe pneumonia, pulse oximeters. Case-management of diarrhoea: zinc tablets, ORS, antibiotics for dysentery (according to guidelines). Case-management of meningitis: appropriate antibiotics, supportive treatment. Sets out standards for procurement and distribution including use of generic medicines. Sets out mechanisms for and timing of procurement, distribution and re-ordering.

Medicine and commodity security

UNFPA. Reproductive Health Essentials – Securing the Supply.

Global Strategy for Reproductive Health Commodity Security. 2002. http://www.unfpa.org/public/home/publications/pid/3204 Children. 2012. http://www.unfpa.org/public/home/publications/pid/12042

UN. Commission on Life-Saving Commodities for Women and

Specifies protocols for inventory control planning and storage of commodities at health-facility level. Sets out financing mechanisms to ensure essential medicines and supply chain.

UNFPA. Global Programme to Enhance Reproductive Health Commodity Security Annual Report 2011. http://www.unfpa.org/public/home/publications/pid/10416 http://www.who.int/medicines/publications/essentialmedicines/ Updated_sixteenth_adult_list_en.pdf and Procurement Mechanism for Reproductive Health Supplies. 2008. http://www.rhsupplies.org/fileadmin/user_upload/Final_Report_-_ June_2008.pdf Financing and Procurement. 2010. http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/ AssePoliPrac_HPI_UDP.pdf

WHO. Model List of Essential Medicines. 2010.

Reproductive Health Supplies Coalition. Designing a Global Financing

USAID. Assessing Policies and Practices that Affect Contraceptive

20 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

8. ARE THERE POLICIES TO ENSURE THAT RMNCH INTERVENTIONS ARE ACCESSIBLE AND DELIVERED TO A HIGH LEVEL OF QUALITY ACROSS THE CONTINUUM OF CARE? POLICY ON: Adapting RMNCH essential interventions for local use CONTENT

SUPPORTING DOCUMENTS / GUIDELINES Moran A, et al. Benchmarks to Measure Readiness to Integrate and

OVERVIEW

RMNCH essential interventions adapted for local context based on local epidemiological profile, systems and policy environment and formally adopted for national use by the government. Clinical guidelines for each period along the continuum of care include essential interventions; and are consistent with internationally agreed standards, protocols and evidence-based guidelines. Clinical guidelines using the RMNCH minimum package of interventions are incorporated into in-and pre-service training materials. Sets out how and where reproductive health counselling, education, nutrition and other services are provided. (Essential RMNCH interventions for the pre-pregnancy period including for adolescents are available in Annex 1).

Scale up Newborn Survival Interventions. Health Policy and Planning. 27:iii29–iii39. doi:10.1093/heapol/czs046. 2012. http://www.ncbi.nlm.nih.gov/pubmed/22692414

WHO. Adapting WHO normative HIV guidelines for national

programs. Essential principles and processes. Geneva, 2011. http://whqlibdoc.who.int/publications/2011/9789241501828_eng.pdf

Fervers B, et al. Adaptation of clinical guidelines: literature review

and propositions. Int J Qual Health Care. 18 (3): 167-176.2006. http://intqhc.oxfordjournals.org/content/18/3/167.full

APPROACH AND METHODS

Pre-pregnancy

WHO, Aga Khan University and PMNCH. Essential Interventions,

Clinical guidelines include:

Contraceptive services and counselling at community, primary and referral facilities. Prevention and management of STIs and HIV. Folic acid fortification and/or supplementation. Sets out requirements and standards regarding timing, WHO, Aga Khan University and PMNCH. Essential Interventions, Commodities and Guidelines for RMNCH. A Global Review of the number and core intervention content of antenatal Key Interventions Related to Reproductive, Maternal, Newborn and care visits. (Essential RMNCH interventions for the pregnancy period are available in Annex 1). Child Health (RMNCH). Geneva, PMNCH, 2011. http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html

HEALTH SECTOR POLICIES

Pregnancy

Clinical guidelines include:

Routine antenatal care (including iron and folic acid supplementation, and TT vaccine). Prevention and management of malaria in pregnancy. Screening and treatment of syphilis. Prevention and management of HIV and mother-tochild transmission of HIV. Prevention and management of hypertension in pregnancy. Management of preterm labour. Management of unintended pregnancy.

MULTISECTOR POLICIES ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

POLICY ON: Childbirth

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

WHO, Aga Khan University and PMNCH. Essential Interventions, Sets out standards for ensuring access to skilled delivery care, essential newborn care and emergency Commodities and Guidelines for RMNCH. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and obstetric and newborn care; and standards for Child Health (RMNCH). Geneva, PMNCH, 2011. ensuring that core intervention content is provided.

(Essential RMNCH interventions for childbirth are available in Annex 1). Midwives authorized to give life-saving interventions to mothers and newborns.

http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html

UNICEF/WHO/UNFPA. Guidelines for monitoring the availability

and use of obstetric services. New York, UNICEF, 1997. http://www.childinfo.org/files/maternal_mortality_finalgui.pdf

WHO. Pregnancy, childbirth, postpartum and newborn care: a Skilled delivery care and emergency obstetric and newborn care (EmONC) services provided 24 hours a guide for essential practice. Geneva, 2006. http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf day, 7 days a week at all delivery facilities.

Women and newborns authorized to stay a minimum of 24 hours at health facilities following delivery.

WHO. Pregnancy, childbirth, postpartum and newborn care: a

guide for essential practice. Geneva, 2006. http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf

Clinical guidelines include:

Management of normal birth. Caesarean section. Prevention and management of postpartum haemorrhage. Initiation or continuation of HIV therapy for HIV positive women. Sets out criteria for timing and location (home or facility) of postnatal care and standards for ensuring that core intervention content is provided. (Essential RMNCH interventions for Postnatal [mother and newborn] are available in Annex 1). Maternity Protection Convention 183 is enacted. International Code of Marketing of Breast-milk Substitutes is enacted (and all subsequent resolutions). Ten Steps to Successful Breastfeeding (facilities providing maternity services and care and in the home and community) and the Baby Friendly Hospital Initiative are endorsed. WHO, Aga Khan University and PMNCH. Essential Interventions,

Postnatal (mother and newborn)

Commodities and Guidelines for RMNCH. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, PMNCH, 2011. http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html recommendation, 2000 (no 191). Geneva, 2000. http://www.ilo.org/dyn/normlex/ en/f?p=NORMLEXPUB:12100:0::NO:12100:P12100_ INSTRUMENT_ID:312328:NO

ILO. Maternity protection convention, 2000 (no 183) and maternity

WHO. Resolution 34.22: The international code of marketing of

breast-milk substitutes. Geneva, 1981. http://www.ifm.net/international-frameworks/who-internationalcode-of-marketing-of-breast-milk-substitutes/ certain provisions. http://www.who.int/ nutrition/topics/ wha_nutrition_iycn/en/ index.html Geneva, 1998. http://www.tensteps.org/evidence.shtml

Clinical guidelines for postnatal mother include:

Subsequent WHA resolutions clarifying the code and extending

Family planning. Prevention, detection and management of anaemia. Detection and management of postpartum sepsis. Screening, initiation or continuation of therapy for HIV.

WHO. Evidence for the Ten Steps to Successful Breastfeeding.

Clinical guidelines for postnatal newborn include:

Essential newborn care. Promotion and support for early exclusive breastfeeding and hygienic cord care. Neonatal resuscitation with bag and mask. Newborn immunizations. Case-management of newborn sepsis, meningitis and pneumonia. ART for babies born to HIV +ve mothers and counselling and feeding support. Kangaroo mother care and extra feeding support for preterm babies. Management of acute respiratory distress syndrome and jaundice.

22 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON: Infancy and childhood

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

WHO, Aga Khan University and PMNCH. Essential Interventions, Sets out standards for ensuring access to and core Commodities and Guidelines for RMNCH. A Global Review of the technical content of case management of common Key Interventions Related to Reproductive, Maternal, Newborn and childhood illnesses, immunizations, infant and young Child Health (RMNCH). Geneva, PMNCH, 2011. child nutrition, care for development, and other http://www.who.int/pmnch/knowledge/publications/201112_ preventive and sick child services.

OVERVIEW

(Essential RMNCH interventions for Postnatal [Infancy and childhood] are available in Annex 1). Low osmolarity ORS and zinc adopted for management of watery diarrhoea. Community-based management of pneumonia adopted. Routine vaccination schedule regularly reviewed and updated. Policy recommendations for specific vaccines regularly reviewed and updated.

essential_interventions/en/index.html

WHO/UNICEF. Joint statement: clinical management of acute

diarrhoea. Geneva, WHO; New York, UNICEF, 2006. http://whqlibdoc.who.int/hq/2004/WHO_FCH_CAH_04.7.pdf community. Geneva, WHO; New York, UNICEF, 2006. http://www.unicef.org/publications/index_21431.html

WHO/UNICEF. Joint statement: management of pneumonia in the

WHO. Manual for the community health worker: caring for the sick

APPROACH AND METHODS

child in the community. Geneva, 2011. http://whqlibdoc.who.int/publications/2011/9789241548045_ Manual_eng.pdf

Clinical guidelines include:

WHO. WHO recommendations for routine immunization - summary

Exclusive breastfeeding and complementary feeding. Prevention of childhood pneumonia. Care of children exposed to HIV. Routine immunizations. Vitamin A supplementation. Management of severe acute malnutrition. Case-management of pneumonia, diarrhoea, malaria, meningitis, measles. RMNCH quality of care standards are established for referral, first and community level.

tables. 2013. http://www.who.int/immunization/policy/immunization_tables/en/ http://www.who.int/immunization/position_papers/en/ http://www.who.int/immunization/policy/en/

WHO. Vaccine Position Papers. 2013.

WHO. Catalogue of immunization policy recommendations. 2013.

HEALTH SECTOR POLICIES

Standards on quality of RMNCH care

WHO. Quality of Care: A Process for Making Strategic Choices in

Defines core standards for the delivery of quality care for each cadre of health worker based on clinical and UNHRC. Technical Guidance on the Application of Human Rights practice guidelines. Standards include: effectiveness, efficiency, accessibility, acceptability, equity and safety – with a focus on mother and child centred care.

Health Systems. Geneva, 2006. http://www.who.int/management/quality/assurance/QualityCare_B. Def.pdf Based Approach to the Implementation of Policies and Programmes to Reduce Preventable Maternal Morbidity and Mortality. UN, 2012. http://www2.ohchr.org/english/issues/women/docs/A.HRC.21.22_ en.pdf Health SB12. PMNCH. http://www.who.int/pmnch/knowledge/publications/strategybriefs/ sb12_qualityofcare/en/index.html Obstetric and Related Medical Services. Wellington, 2012. http://www.health.govt.nz/publication/guidelines-consultationobstetric-and-related-medical-services-referral-guidelines

PMNCH. Ensuring Quality of Care for Women’s and Children’s

MULTISECTOR POLICIES

Standards for RMNCH referral care Supportive supervision for all RMNCH health workers in the delivery of quality RMNCH care

Referral criteria for mothers, babies, infants and children are established. Standards include clinical standards for referral care; ensuring transportation and access to referral. Supportive supervision standards established for RMNCH clinical practice (referral, first level, community). Standards include: supervisory responsibilities for different levels of staff; frequency of visits; linkages with other technical programmes; content; use of observation of practice and checklists; feedback and problem solving; methods used.

New Zealand Ministry of Health. Guidelines for Consultation with

Social Care Institute for Excellence. Research Briefing 43: Effective

Supervision in Social Work and Social Care. 2012. http://www.scie.org.uk/publications/briefings/briefing43/ http://www.engenderhealth.org/pubs/quality/facilitativesupervision-handbook.php

Engender Health. Facilitative Supervision Handbook. 2001.

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

POLICY ON: Community participation

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

Sets out mechanisms for community involvement and Marston C, et al. Effects of community participation on improving broad stakeholder consultation on RMNCH strategies, uptake of skilled care for maternal and newborn health: a systematic review. Community Participation Systematic Review 2013, 8(2): 1-9. implementation and evaluation at different levels of http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal. the health system. Standards include financial, staffing, administration and McCoy D, et al. A systematic review of the literature for evidence infrastructure resources to support implementation. on health facility committees in low- and middle-income countries. Health Policy and Planning. 27:449-466. 2012. http://heapol.oxfordjournals.org/content/early/2011/12/08/heapol. czr077.full.pdf+html gap in a generation: health equity through action on the social determinants of health. Final report of the CSDH. Geneva, 2008. http://www.who.int/social_determinants/thecommission/ finalreport/en/index.html pone.0055012

WHO, Commission on Social Determinants of Health. Closing the

UN Women. A transformative stand-alone goal on achieving

gender equality, women’s rights and women’s empowerment: Imperatives and key components. New York, 2013. http://www.unwomen.org/wp-content/uploads/2013/06/post-2015case-forstandalone-gender-goal.pdf http://www.ohchr.org/EN/UDHR/Pages/UDHRIndex.aspx

Universal Declaration of Human Rights (UDHR). Article 26. 1948. WHO. Working with individuals, families and communities to

improve maternal and newborn health. Geneva, 2010. http://whqlibdoc.who.int/hq/2010/WHO_MPS_09.04_eng.pdf http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 381: 1736–46. 2013. http://www.who.int/woman_child_accountability/ierg/reports/30a_ Womens_groups_metaanalysis.pdf works to avert intrapartum-related deaths? International Journal of Gynecology & Obstetrics. 107: (S65-S88). 2009. http://www.ncbi.nlm.nih.gov/pubmed/19815201 improve maternal and newborn health. Geneva, 2010. http://whqlibdoc.who.int/hq/2010/WHO_MPS_09.04_eng.pdf http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ Landscaping Study: A Global Review. Baltimore: Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health. 2011. http://www.jhuccp.org/sites/all/files/ SBCInterventionsLandscapingStudy.pdf maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database of Systematic Reviews. 11: CD007754. doi: 10.1002/14651858.CD007754.pub2. 2010. http://www.ncbi.nlm.nih.gov/pubmed/21069697 Commodities and Guidelines for RMNCH. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, PMNCH, 2011. http://www.who.int/pmnch/knowledge/publications/201112_ essential_interventions/en/index.html improve access to key maternal and newborn health interventions through task shifting. Geneva, 2012. http://apps.who.int/iris/bitstream/10665/77764/1/9789241504843_ eng.pdf

The Ottawa Charter for Health Promotion.

Community mobilization and health education

Sets out key messages, key channels, key activities and key audiences based on priority areas of the RMNCH strategies. Standards include financial, staffing, administration and infrastructure resources to support implementation.

Prost A, et al. Women’s groups practising participatory learning and

Lee A, et al. Linking families and facilities for care at birth: What

WHO. Working with individuals, families and communities to

The Ottawa Charter for Health Promotion.

Storey D, et al. Social & Behaviour Change Interventions

Lassi et al. Community-based intervention packages for reducing

WHO, Aga Khan University and PMNCH. Essential Interventions,

WHO. WHO recommendations: optimizing health worker roles to

24 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

9. ARE THERE POLICIES TO ENABLE THE COLLECTION AND USE OF HIGH QUALITY DATA TO INFORM RMNCH PLANNING AND EVALUATION? POLICY ON: Birth registration CONTENT

SUPPORTING DOCUMENTS / GUIDELINES Health Metrics Network and WHO. Framework and Standards for

OVERVIEW

Specifies that all births must be registered by law within 24 hours of delivery or as soon as possible thereafter (up to one month), including notification of stillbirths.

Country Health Information Systems, Second Edition. Geneva, WHO, 2008. http://www.who.int/healthmetrics/documents/hmn_ framework200803.pdf

WHO, School of Population Health, University of Queensland.

Improving the quality and use of birth, death and cause of death information: guidance for a standards based review of country practices. Geneva, WHO, 2010. http://www.uq.edu.au/hishub/wp1 Accountability for Women’s and Children’s Health. http://www.everywomaneverychild.org/resources/accountabilitycommission

APPROACH AND METHODS

Every Women Every Child. Commission on Information and

Death notification

Health Metrics Network and WHO. Framework and Standards for Specifies the notification of all maternal, newborn Country Health Information Systems, Second Edition. Geneva, and child deaths within 24 hours of death with cause WHO, 2008. of death recorded using most updated ICD codes.

http://www.who.int/healthmetrics/documents/hmn_ framework200803.pdf

WHO, School of Population Health, University of Queensland.

Improving the quality and use of birth, death and cause of death information: guidance for a standards based review of country practices. Geneva, WHO, 2010. http://www.uq.edu.au/hishub/wp1 through the use of Information Technology (MOVE-IT). www.who.int/healthmetrics/move it

HEALTH SECTOR POLICIES

Source of data: HMN. Monitoring of Vital Events – including

Death reviews

Specifies that reviews require an analysis of the circumstances of each maternal, newborn and child death, identification of avoidable factors and action to improve care at all levels of the health system, from home to hospital.

WHO, School of Population Health, University of Queensland.

Improving the quality and use of birth, death and cause of death information: guidance for a standards based review of country practices. Geneva, WHO, 2010. http://www.uq.edu.au/hishub/wp1 complications to make pregnancy safer. Geneva, 2004. http://www.who.int/maternal_child_adolescent/ documents/9241591838/en/

WHO. Beyond the numbers: reviewing maternal deaths and

WHO. Maternal Death Surveillance and response – Technical

Guidance. Information for action to prevent maternal death. Geneva, 2013.

MULTISECTOR POLICIES

PMNCH. Death Reviews: Maternal, Perinatal and Child KS27. 2013.

http://www.who.int/pmnch/knowledge/publications/summaries/en/ complications to make pregnancy safer. Geneva, 2004. http://www.who.int/maternal_child_adolescent/ documents/9241591838/en/

WHO. Beyond the numbers: reviewing maternal deaths and

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

POLICY ON:

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES WHO, HMN. Assessing the national health information system; an

Well-functioning Specifies characteristics and frequency of routine data availability at all levels and quality of care health assessments for RMNCH. information systems, Set out process to collect data where existing data is including insufficient. logistics, and Sets out process to regularly review health surveillance information system data to improve health service system for effectiveness and efficiency, such as availability and RMNCH quality of care.

assessment tool (version 4). Geneva, WHO, 2008. http://www.who.int/healthmetrics/tools/hisassessment/en/

WHO, HMN, Countdown to 2015, UNICEF. Monitoring maternal,

newborn and child health: understanding key progress indicators. Geneva, WHO, 2011. http://www.who.int/healthmetrics/news/monitoring_maternal_ newborn_child_health.pdf and Children’s Health, Demographic and Health Surveys (DHS). Multiple Indicator Surveys (MICS), World Health Statistics, programme reviews.

Data sources: HMN, Commission on Accountability for Women’s

Specifies that data are used to track progress and to take immediate action to address programme gaps. Specifies privacy protection for client health information or confidentiality of personal health information.

Defining key RMNCH indicators

Specifies that national and subnational population-based WHO, HMN. Assessing the national health information system; an assessment tool (version 4). Geneva, WHO, 2008. household surveys include key RMNCH indicators. Sets out key RMNCH indicators such as those recommended by the Commission on Information and Accountability: indicators recommended: 1. 2. 3.

http://www.who.int/healthmetrics/tools/hisassessment/en/

WHO, HMN, Countdown to 2015, UNICEF. Monitoring maternal,

maternal mortality ratio (deaths per 100 000 live births); under-five child mortality (deaths per 1000 live births), with the proportion of newborn deaths; children under five who are stunted (percentage of children under five years of age whose height-forage is below minus two standard deviations from the median of the WHO Child Growth Standards); met need for contraception (proportion of women aged 15-49 years who are married or in union and who have met their need for family planning, i.e. who do not want any more children or want to wait at least two years before having a baby and are using contraception); antenatal care coverage (percentage of women aged 15-49 with a live birth who received antenatal care by a skilled health provider at least four times during pregnancy); prophylaxis among HIV-positive pregnant women to prevent vertical transmission of HIV, and antiretroviral therapy for women who are treatment-eligible; skilled attendant at birth (percentage of live births attended by skilled health personnel); care for mothers and babies s (percentage of mothers and babies who received postnatal care visit within two days of childbirth); exclusive breastfeeding for six months (percentage of infants aged 0-5 months who are exclusively breastfed); doses of the combined diphtheria, pertussis and tetanus vaccine (percentage of infants aged 12-23 months who received three doses of diphtheria/pertussis/tetanus vaccine); and treatment for pneumonia (percentage of children aged 0-59 months with suspected pneumonia receiving antibiotics).

newborn and child health: understanding key progress indicators. Geneva, WHO, 2011. http://www.who.int/healthmetrics/news/monitoring_maternal_ newborn_child_health.pdf Children’s Health. Keeping Promises, Measuring Results, Accountability Report. UN, 2011. http://www.everywomaneverychild.org/images/content/files/ accountability_commission/final_report/Final_EN_Web.pdf

Commission on Information and Accountability for Women’s and

Data sources: HMN, Commission on Accountability for Women’s

and Children’s Health, Demographic and Health Surveys (DHS). Multiple Indicator Surveys (MICS), World Health Statistics, programme reviews.

6. antiretroviral

8. postnatal

10. three

11. antibiotic

Each country might use specific indicators in addition to those above to address context-specific needs and monitoring of national RMNCH strategies.

26 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON:

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES

WHO, IHP+. Monitoring, evaluation and review of national health Specifies aspirational targets (based on desired National and changes over time and often in line with international strategies. Geneva, WHO, 2011. subnational http://www.who.int/classifications/ME_component_ RMNCH targets targets such as the MDGs) and/or rational targets nationalhealthplans_prepub_july2011.pdf (based on expected improvements in access, WHO. Managing Programmes to Improve Child Health. Geneva, availability, quality and demand) for key RMNCH 2009. indicators within clearly determined timeframes.

OVERVIEW

Targets can be defined as: 1.

absolute (reports a simple change in the level of an Data sources: WHO country monitoring and evaluation database. indicator (e.g. an increase of vaccination coverage http://www.who.int/healthinfo/topics_standards_tools/en/index.html from 70% to 85% in five years); Countdown to 2015 Country Profiles. relative to the baseline (reports a relative change that is independent of the initial value of the starting point (e.g. a reduction of the under-five mortality rate by one third); or a rate of change (e.g. the target could require that the annual rate of change increases from 2% per year to 4% per year). APPROACH AND METHODS

http://www.who.int/maternal_child_adolescent/ documents/9789241598729/en/

Targets should include equity distribution considerations. Specifies periodic review and update of indicators, data collection methods and data quality. Promotes the use of data to identify RMNCH priority areas for implementation through a clearly defined periodic review process at national as well as at local level. WHO, IHP+. Country Accountability Framework. A tool for

Data review process

Characteristics and frequency of reviews are specified e.g. sector reviews, health surveys, situational analysis. How data should be used to identify priority areas for implementation and to develop strategic and implementation plans is described.

assessing and planning implementation of the country accountability framework for health with a focus on women’s and children’s health. Geneva, WHO, 2012. http://www.who.int/woman_child_accountability/about/caf_tool_ uptd.pdf WHO, IHP+. Monitoring, evaluation and review of national health strategies. Geneva, WHO, 2011. http://www.who.int/classifications/ME_component_ nationalhealthplans_prepub_july2011.pdf

HEALTH SECTOR POLICIES

WHO, HMN. Assessing the national health information system; an How to undertake an equity analysis is specified assessment tool (version 4). Geneva, WHO, 2008. explains that data should be disaggregated by key http://www.who.int/healthmetrics/tools/hisassessment/en/ stratifiers such as wealth, geographic location, urban/ WHO, HMN, Countdown to 2015, UNICEF. Monitoring maternal, rural, education, ethnicity (where data is available), newborn and child health: understanding key progress indicators. age, gender, and any other stratifiers of relevance.

Geneva, WHO, 2011. http://www.who.int/healthmetrics/news/monitoring_maternal_ newborn_child_health.pdf

Data sources: HMN, Commission on Accountability for Women’s

MULTISECTOR POLICIES

and Children’s Health, Demographic and Health Surveys (DHS). Multiple Indicator Surveys (MICS), World Health Statistics, programme reviews.

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

MULTISECTORAL POLICIES MULTISECTORAL POLICIES THAT INFLUENCE RMNCH SERVICE DELIVERY AND OUTCOMES The Multisectoral Policies focuses on multisectoral policies that the health sector engages with across government and other development sectors of major impact for women’s and children’s health, to improve RMNCH and influence its determinants. It is divided into seven topic areas, informed by several key United Nations reports related to sustainable development and the Millennium Development Goals (MDGs). It is structured around the UN System Task Team’s proposed framework of four core dimensions of sustainable development in the post-2015 development agenda: inclusive economic development; environmental sustainability; inclusive social development; and peace and security.8

28 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

1. ARE THERE POLICIES RELATED TO INCLUSIVE ECONOMIC DEVELOPMENT, SUCH AS REDUCING INEQUALITIES? POLICY ON: CONTENT SUPPORTING DOCUMENTS / GUIDELINES OVERVIEW

ILO Declaration on Social Justice for a Fair Globalization. 2008. Eradicating Sets out regulations and strategies to: income poverty Promotes women’s abilities and opportunities to earn http://www.ilo.org/global/meetings-and-events/campaigns/voiceson-social-justice/WCMS_099766/lang--en/index.htm and hunger a decent income, including equal pay for equal work, UN Women. A transformative stand-alone goal on achieving and their capacity to retain control over that income.

Reduce the inequitable distribution of resources (including food and health care) within households by gender.

UN. Resolution adopted by the General Assembly. 66/288. The Ensure access to land, natural resources, energy inputs and services for smallholder farmers to support future we want. 2012. http://sustainabledevelopment.un.org/futurewewant.html sustainable food production and consumption.

APPROACH AND METHODS

Introduce food-related social safety nets such as early WHO, Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social warning systems, targeted cash- or food-for-work determinants of health. Final report of the CSDH. Geneva, 2008. programmes and emergency response systems. http://www.who.int/social_determinants/thecommission/ finalreport/en/index.html Declaration of the Forum for Food Sovereignty, Nyéléni. Sélingué,

Mali. 27 February 2007. ttp://www.foodsovereignty.org/Resources/Archive/Forum.aspx the future we want. End hunger and make the transition to sustainable agricultural and food systems. 2012. http://www.fao.org/docrep/015/an894e/an894e00.pdf

Food and Agriculture Organization of the United Nations. Towards

UN System Standing Committee on Nutrition. Climate Change and

Nutrition Security. Message to the UNFCCC negotiations. 2010. http://www.unscn.org/files/Statements/Bdef_NutCC_2311_final.pdf 1948. http://www.ohchr.org/EN/UDHR/Pages/Introduction.aspx Women (CEDAW). Articles 14(2)(g), 15 and 16. 1984. http://www.ohchr.org/EN/ProfessionalInterest/Pages/ CoreInstruments.aspx

HEALTH SECTOR POLICIES

Reducing inequalities

Sets out regulations and strategies to:

Universal Declaration of Human Rights (UDHR). Articles. 2 and 17.

Address social exclusion and the structural social, economic, cultural and physical inequalities that prevent men, women and children from enjoying basic human rights. Address legal, social or cultural barriers to female ownership of land, property and other assets, particularly for vulnerable groups, such as widows and orphans.

Convention on the Elimination of all forms of Discrimination against

CEDAW Committee. General Recommendation No 21. Equality in

marriage and family relations. 1994. http://www.un.org/womenwatch/daw/cedaw/recommendations/ index.html

UN Women. A transformative stand-alone goal on achieving

MULTISECTOR POLICIES ANNEXES AND REFERENCES

ILO Declaration on Social Justice for a Fair Globalization. 2008. Ensuring decent Sets out regulations and strategies to: http://www.ilo.org/global/meetings-and-events/campaigns/voicesworking Provide full and fair employment and decent working on-social-justice/WCMS_099766/lang--en/index.htm conditions and conditions and opportunities as central goals of social UN Women. A transformative stand-alone goal on achieving opportunities and economic development approaches. gender equality, women’s rights and women’s empowerment: and productive Strengthen science, technology and information Imperatives and key components. New York, 2013. employment capabilities to foster research and innovation, product http://www.unwomen.org/wp-content/uploads/2013/06/post-2015development and technology access, transfer and case-for-standalone-gender-goal.pdf adaptation. ESC. Draft ministerial declaration of the 2012 high-level segment,

Annual Ministerial Review, submitted by the President: Promoting productive capacity, employment and decent work to eradicate poverty in the context of inclusive, sustainable and equitable economic growth at all levels for achieving the Millennium Development Goals. 2012. http://www.un.org/en/ecosoc/newfunct/amr2012.shtml

ESC. Report of the Secretary-General on “Science, technology and

innovation, and the potential of culture, for promoting sustainable development and achieving the Millennium Development Goals” for the 2013 Annual Ministerial Review. 2013. http://www.un.org/en/ecosoc/docs/adv2013/13_amr_sg_report.pdf

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

2. ARE THERE POLICIES RELATED TO ENABLING INCLUSIVE SOCIAL DEVELOPMENT, SUCH AS NUTRITION AND EDUCATION? POLICY ON: Adequate nutrition CONTENT Sets out regulations and strategies to:

SUPPORTING DOCUMENTS / GUIDELINES WHO. Global nutrition policy review: What does it take to scale

Protect the right of all to have access to sufficient, safe, affordable, and nutritious food.

Provide a package of nutrition-specific and culturally WHO. Essential Nutrition Actions: improving maternal, newborn, sensitive, cost-effective, evidence-based interventions, infant and young child health and nutrition. Geneva, 2013. such as the promotion of exclusive breastfeeding, http://www.who.int/nutrition/publications/infantfeeding/essential_ access to supplements and fortification, and nutrition_actions/en/index.html therapeutic feeding for severe undernutrition. Secretariat of the Scaling Up Nutrition Movement. SUN Movement: Promote nutrition literacy from school age and ensure adequate information is available in communities about how to prepare adequately nutrient-dense food, particularly for children. Revised Road Map. 2012. http://scalingupnutrition.org/wp-content/uploads/2012/10/SUNMovement-Road-Map-Septemeber-2012_en.pdf Scaling Up Nutrition. A Framework for Action. 2010. http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_ Framework.pdf http://portal.pmnch.org/knowledge-summaries/ks18

up nutrition action? Geneva, 2013. http://www.who.int/nutrition/publications/policies/global_nut_ policyreview/en/index.html

PMNCH. Knowledge Summary 18: Nutrition. Geneva, 2012.

Quality education

Sets out regulations and strategies to:

Universal Declaration of Human Rights (UDHR). Article 26. 1948.

Protect the right of all children to education, including UNESCO World Declaration on Education for All. 1990. ensuring every child has access to and completes http://www.ncpcr.gov.in/Reports/UNESCO_World_Declaration_ pre-primary and primary education and access to on_Education_for_All%201990.pdf lower secondary education. World Education Forum. The Dakar Framework for Action.

http://www.ohchr.org/EN/UDHR/Pages/UDHRIndex.aspx

Improve availability and access to education services through for example: infrastructure, human resources, adequate financing, and addressing social, cultural and other barriers to attendance. Tackle skills gaps such as gender and urban/rural gaps in the use of new technologies.

Education for all. Meeting our collective commitments. France, UNESCO, 2000. http://unesdoc.unesco.org/images/0012/001211/121147e.pdf WHO. Education: shared interests in well-being and development. Geneva, WHO, 2011. http://apps.who.int/iris/handle/10665/44737 http://www.ohchr.org/EN/ProfessionalInterest/Pages/ CoreInstruments.aspx education for all. New York, 2007. http://www.unicef.org/publications/index_42104.html

Convention on the Rights of the Child (CRC). 1989.

UNESCO and UNICEF. A human rights based approach to

UN Women. A transformative stand-alone goal on achieving

Social Protection

See Health Sector Policies for information on policies WHO. The world health report: health systems financing: the path to universal coverage. Geneva, 2010. that promote the elimination of financial barriers to http://www.who.int/whr/2010/en/index.html RMNCH-related quality health services. WHO. Research for Universal Coverage. Geneva, 2013. Financial risk protection is an instrument of social http://www.who.int/whr/2013/report/en/index.html protection applied to health and which works alongside other mechanisms of social protection – unemployment and sickness benefits, pensions, child support, housing assistance, job-creation schemes, agricultural insurance etc. – many of which have indirect consequences for health.

30 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON:

CONTENT Enforce legislation and prevent and respond to violence against women and girls. Promote equal decision-making in households. Prevent discrimination against women in education, political, economic and public life.

SUPPORTING DOCUMENTS / GUIDELINES OHCHR. Technical guidance on the application of a human rights-

Gender equality Sets out regulations and strategies to:

based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality. Paragraphs 14, 15, 17. HRC: 2012. http://www2.ohchr.org/english/issues/women/docs/A.HRC.21.22_ en.pdf future we want. 2012. http://sustainabledevelopment.un.org/futurewewant.html Marriage and Registration of Marriages. 1964. http://www.ohchr.org/EN/ProfessionalInterest/Pages/ MinimumAgeForMarriage.aspx Women (CEDAW). 1979. http://www.ohchr.org/EN/ProfessionalInterest/Pages/ CoreInstruments.aspx

OVERVIEW

UN. Resolution adopted by the General Assembly. 66/288. The

UN. Convention on Consent to Marriage, Minimum Age for

APPROACH AND METHODS

Convention on the Elimination of all forms of Discrimination against

UN General Assembly Resolution 48/104. Declaration on the

Elimination of Violence against Women. 1993. http://www.un.org/documents/ga/res/48/a48r104.htm

CEDAW Committee. General Recommendation No 19. Violence

against women. 1992. http://www.un.org/womenwatch/daw/cedaw/recommendations/ index.html marriage and family relations. 1994. http://www.un.org/womenwatch/daw/cedaw/recommendations/ index.html Article 7 (political and public life). 1997. http://www.un.org/womenwatch/daw/cedaw/recommendations/ index.html and health. 1999. http://www.un.org/womenwatch/daw/cedaw/recommendations/ index.html the further implementation of the Programme of Action of the ICPD. 1999. http://www.unfpa.org/webdav/site/global/shared/documents/ publications/1999/key_actions_en.pdf

CEDAW Committee. General Recommendation No 21. Equality in

HEALTH SECTOR POLICIES

CEDAW Committee. General Recommendation No 23. Article 7

CEDAW Committee. General Recommendation No 24. Women

UN General Assembly Resolution (A/RES/S-21/2). Key actions for

MULTISECTOR POLICIES ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

3. ARE THERE POLICIES RELATED TO ENABLING ENVIRONMENT SUSTAINABILITY, SUCH AS WATER AND SANITATION? POLICY ON: Protecting biodiversity CONTENT Set out regulations, strategies and plans to:

SUPPORTING DOCUMENTS / GUIDELINES UN. Resolution adopted by the General Assembly. 66/288. The

Safeguard ecosystems, species and genetic diversity.

Sustainably manage natural resources and protect the UN. A new global partnership: Eradicate poverty and transform natural resource base. economies through sustainable development. The report of the

future we want. 2012. http://sustainabledevelopment.un.org/futurewewant.html

High-level panel of eminent persons on the post-2015 development agenda. New York, 2013. http://www.post2015hlp.org/the-report/ contribution. UNDP, 2012. http://www.preventionweb.net/english/professional/publications/v. php?id=16272 and poverty reduction. A good practice guide. 2010. http://www.unwater.org/downloads/cbd-good-practice-guide.pdf on the Least Developed Countries and Sub-Saharan Africa. 2012. http://www.undp.org/content/undp/en/home/librarypage/ environment-energy/sustainable_energy/energy-access-indeveloping-countries/

UNEP. Advancing the biodiversity agenda: a UN System-wide

Convention on Biological Diversity. Drinking Water, biodiversity

Stable climate

Sets out regulations, strategies and plans to:

UNDP. Energy Access in Developing Countries. A review focusing

Provide energy using clean sustainable sources to all population groups. Promote the diversification of production and ecologically sound and sustainable methods of agriculture. Promote appropriate technical and vocational education and training for environmental sustainability. Manage disaster risk and improve disaster response.

WHO. Housing. Shared interests in health and development. Social

determinants of health Sectoral Briefing. Geneva, 2011. http://whqlibdoc.who.int/publications/2011/9789241502290_eng.pdf http://www.unicef.org/education/bege_61668.html

UNICEF. Climate change and environmental education. 2013. UN General Assembly. Elaboration of an international convention

to combat desertification in countries experiencing serious drought and/or desertification, particularly in africa. A/AC.241/27. 1994. http://www.unccd.int/Lists/SiteDocumentLibrary/conventionText/ conv-eng.pdf Realizing the future we want for all. Report to the UN SecretaryGeneral. New York, 2012. http://www.un.org/millenniumgoals/pdf/Post_2015_UNTTreport.pdf contribution. 2010. http://www.preventionweb.net/english/professional/publications/v. php?id=16272 UN General Assembly. 2010. http://www.un.org/en/ga/64/resolutions.shtml

UN System Task Team on the post-2015 UN development agenda.

UNEP. Advancing the biodiversity agenda: a UN System-wide

Safe and affordable drinking water

Sets out regulations, strategies and plans to:

Resolution A/RES/64/292. The human right to water and sanitation.

Protect the right to water. Provide universal access to affordable safe drinking water in rural and urban areas, particularly at home, in schools, health centres and refugee camps. Track mortality and morbidity trends for waterborne diseases, especially for women and children.

UN Committee on Economic, Social and Cultural Rights. General

Comment No. 15. The right to water. 2002. http://www.unhchr.ch/tbs/doc.nsf/0/a5458d1d1bbd713fc1256cc400 389e94/$FILE/G0340229.pdf Environment: Global Plan of Action for Children’s Health and Environment 2010-2015. Geneva, 2009. www.who.int/ceh

WHO. Busan Pledge for Global Action on Children’s Health and

UN World Water Assessment Programme and UN-HABITAT. Water

for sustainable urban human settlements. 2010. http://www.unwater.org/downloads/WWAP_Urban_Settlements_ Web_version.pdf determinants of health approach. Joint statement of the UN Platform on Social Determinants of Health. 2013. http://www.who.int/social_determinants/advocacy/healthpost-2015_sdh/en/index.html

Health in the post-2015 development agenda: need for a social

UN Economic and Social Council. UNICEF water, sanitation and

hygiene strategies for 2006-2015. 2005. http://www.unicef.org/about/execboard/files/06-6_WASH_final_ ODS.pdf

32 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON: Adequate sanitation

CONTENT Sets out regulations, strategies and plans to:

SUPPORTING DOCUMENTS / GUIDELINES UN General Assembly Resolution A/RES/64/292. The human right

End open defecation and ensure universal access to http://www.un.org/en/ga/64/resolutions.shtml improved sanitation facilities in rural and urban areas, WHO. Busan Pledge for Global Action on Children’s Health and particularly at schools, at workplaces and in health Environment: Global Plan of Action for Children’s Health and facilities. Track mortality and morbidity trends for diseases www.who.int/ceh associated with poor sanitation, especially for women WHO, et al. Sanitation and hygiene promotion: programming and children. guidance. WSSCC and WHO, 2005. http://www.who.int/water_sanitation_health/hygiene/ sanitpromotionguide/en/index.html UN Economic and Social Council. UNICEF water, sanitation and

to water and sanitation. 2010.

OVERVIEW

Environment 2010-2015. WHO: Geneva, 2009.

hygiene strategies for 2006-2015. 2005. http://www.unicef.org/about/execboard/files/06-6_WASH_final_ ODS.pdf

APPROACH AND METHODS HEALTH SECTOR POLICIES

MULTISECTOR POLICIES ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

4. ARE THERE POLICIES RELATED TO ENABLING PEACE AND SECURITY, SUCH AS FREEDOM FROM VIOLENCE? POLICY ON: Freedom from violence and abuse CONTENT Sets out strategies and measures to:

SUPPORTING DOCUMENTS / GUIDELINES UN General Assembly Resolution 48/104. Declaration on the

Prevent discrimination and all forms of violence and http://www.un.org/documents/ga/res/48/a48r104.htm abuse, particularly all forms of violence against women The Commission on the Status of Women. Agreed conclusions on and children in the family and general community, the elimination and prevention of all forms of violence against including in conflict and post-conflict contexts. Ensure that justice institutions are accessible, independent, well-resourced and respect dueprocess rights.

Elimination of Violence against Women. 1993.

women and girls. E/2013/27. 2013. http://www.un.org/womenwatch/daw/csw/csw57/CSW57_Agreed_ Conclusions_(CSW_report_excerpt).pdf against women. 1992. http://www.un.org/womenwatch/daw/cedaw/recommendations/ index.html

CEDAW Committee. General Recommendation No 19. Violence

Convention on the Rights of the Child. General Comment No. 13

(2011). The right of the child to freedom from all forms of violence. CRC/C/GC/13. http://www2.ohchr.org/english/bodies/crc/comments.htm security). (S/Res/1325). 2000. http://www.un.org/events/res_1325e.pdf

UN Security Council Resolution 1325 (on women, peace and

UN Security Council Resolution 1820 (on Sexual Violence against

Civilians in Conflict). (S/Res/1820). 2008. http://www.securitycouncilreport.org/atf/cf/%7B65BFCF9B-6D274E9C-8CD3-CF6E4FF96FF9%7D/CAC%20S%20RES%201820.pdf reducing its impact: how development agencies and governments can help. Geneva, WHO, 2008. http://www.who.int/violenceprevention/publications/en/ future we want. 2012. http://sustainabledevelopment.un.org/futurewewant.html

WHO and Violence Prevention Alliance. Preventing violence and

Resilience to natural hazards

Sets out strategies and measures to:

UN. Resolution adopted by the General Assembly. 66/288. The

Strengthen governance and institutions, and the capacity of communities to become more resilient to emerging risks, crises and natural hazards.

UN System Task Team on the Post-2015 UN Development Agenda.

Building resilience to disasters through partnerships. Lessons from the Hyogo Framework for Action. 2013. http://www.zaragoza.es/ciudad/medioambiente/onu/en/detallePer_ Onu?id=595

UK Houses of Parliament. Parliamentary Office of Science and

Technology. Post note. Resilience to Natural Hazards in Developing Nations. No. 402. 2012. http://www.parliament.uk/briefing-papers/POST-PN-402.pdf. resilience to natural disasters: a framework for private sector engagement. WEF, 2008. http://www.unisdr.org/we/inform/publications/1392 community resilience. A framework for support. 2012. http://www.aifs.gov.au/cfca/pubs/papers/a141862/

UNISDR, World Bank and World Economic Forum. Building

Australian Institute of Family Studies. Natural disasters and

Conflict-free access to natural resources

Sets out strategies and measures to:

FIAN International and Economic and Social Rights Centre.

Expand the access and rights of marginalized people to natural resources. Minimize the human impact of environmental stress.

Voluntary Guidelines for good governance in land and natural resource tenure. Food and Agriculture Organization of the United Nations. 2009. ftp://ftp.fao.org/docrep/fao/011/ak280e/ak280e00.pdf Right to Food and Access to Natural Resources: Using Human Rights Arguments and Mechanisms to Improve Resource Access for the Rural Poor. 2009. http://www.fao.org/docrep/016/k8093e/k8093e.pdf

Food and Agriculture Organization of the United Nations. The

34 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

5. ARE THERE POLICIES RELATED TO THE REQUIRED INFRASTRUCTURE, SUCH AS INFORMATION AND COMMUNICATIONS TECHNOLOGY (ICT), ROADS AND TRANSPORTATION, FOR DEVELOPMENT? POLICY ON: Information and Communication Technologies and eHealth CONTENT Sets out regulations and strategies to develop key systems to support access to and implementation of eHealth including to:

SUPPORTING DOCUMENTS / GUIDELINES WHA Resolution 58/28 on eHealth. Geneva, WHO, 2005. WHO-ITU National eHealth Strategy Toolkit. WHO, Geneva, 2012.

OVERVIEW

Establish a coordinating body and mechanism for eHealth. Develop and finance a eHealth strategy and plan. Create policy and legislative environment to support eHealth implementation. Develop and finance a human workforce plan for improving eHealth capacity. Develop standards for interoperability and ensure use by all stakeholders. Ensure that adequate infrastructure to support eHealth is available. Ensure that services and applications to support delivery of eHealth to all stakeholders are available. Specifies essential infrastructure for development including:: -

http://www.itu.int/dms_pub/itu-d/opb/str/D-STR-E_HEALTH.052012-PDF-E.pdf

APPROACH AND METHODS

Essential Infrastructure

WHO. Everybody’s Business: strengthening health systems to improve

roads and transportation electricity improved drinking water sources improved sanitation facilities living and work spaces.

health outcomes: WHO’s framework for action. Geneva, 2007. http://www.who.int/healthsystems/strategy/everybodys_business.pdf

WHO. Primary health care, including health system strengthening.

Report by the Secretariat. Geneva, 2008. http://unpan1.un.org/intradoc/groups/public/documents/un/ unpan034096.pdf

HEALTH SECTOR POLICIES

PMNCH. Assure Quality Care. Knowledge Summary 7. Geneva,

PMNCH, 2010. http://www.who.int/pmnch/knowledge/publications/summaries/ knowledge_summaries_7_assure_quality_care/en/

Countdown to 2015. Decade report (2000-2010). Taking stock of

maternal, newborn and child survival. WHO and UNICEF, 2010. http://www.who.int/pmnch/topics/child/CountdownReportOnly.pdf to achieve the Millennium Development Goals. New York, 2005. http://www.unmillenniumproject.org/documents/ MainReportComplete-lowres.pdf

UN Millennium Project. Investing in development: a practical plan

MULTISECTOR POLICIES ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

6. ARE THERE POLICIES, AND IS THEIR IMPLEMENTATION MONITORED, TO ENSURE COUNTRIES MEET OBLIGATIONS AND DUTIES UNDER INTERNATIONAL HUMAN RIGHTS LAWS, TREATIES CONVENTIONS AND INTERNATIONAL DEVELOPMENT FRAMEWORKS, PARTICULARLY WITH RESPECT TO RMNCH? POLICY ON: The respect, protection and fulfilment of human rights CONTENT SUPPORTING DOCUMENTS / GUIDELINES

International human rights frameworks ratified; regular Universal Declaration of Human Rights. General Assembly Resolution. 217A (III), UN GAOR, 3d Sess., UN Doc. A/RES/3/217A. 1948. reporting to human rights monitoring bodies:

Universal Declaration of Human Rights (UDHR). Convention on the Rights of the Child (CRC). Convention on the Elimination of all forms of Discrimination against Women (CEDAW.) International Convention on the Elimination of all forms of Racial discrimination (ICERD). International covenant on Economic, Social and Cultural Rights (ICESCR) International Covenant on Civil and Political Rights (ICCPR). International Convention on the Protection of the Rights of all Migrant Workers and their Families (ICRMW). Convention on the Rights of Persons with Disabilities (CRPD). Convention against Torture and other Cruel, Inhuman and Degrading Treatments or Punishments (CAT). International Convention for the Protection of all Persons from Enforced Disappearance (CPED). Commitments made at International Conference on Population and Development adopted. International Health Regulations Programme of Action ratified. WHO Framework Convention on Tobacco Control ratified. In addition to the regulatory frameworks set out in Table 1.

http://www.ohchr.org/EN/UDHR/Pages/UDHRIndex.aspx monitoring bodies. 2013. http://www.ohchr.org/EN/ProfessionalInterest/Pages/ CoreInstruments.aspx

OHCHR. The core international human rights instruments and their

International standards of behaviour and practice particularly with respect to the right to the highest attainable standard of health

WHO. Resolution 34.22: The international code of marketing of

breast-milk substitutes. Geneva, 1981. http://www.ifm.net/international-frameworks/who-internationalcode-of-marketing-of-breast-milk-substitutes/ certain provisions. http://www.who.int/ nutrition/topics/ wha_nutrition_iycn/en/ index.html recommendation, 2000 (no 191). Geneva, 2000. http://www.ilo.org/dyn/normlex/ en/f?p=NORMLEXPUB:12100:0::NO:12100:P12100_ INSTRUMENT_ID:312328:NO

Subsequent WHA resolutions clarifying the code and extending

ILO. Maternity protection convention, 2000 (no 183) and maternity

UN. Report of the ICPD. A/CONF.171/13. 1994. International Health Regulations (IHR). 2005.

http://www.un.org/popin/icpd/conference/offeng/poa.html http://www.who.int/ihr/9789241596664/en/index.html http://www.who.int/fctc/en/

WHO Framework Convention on Tobacco Control. 2003.

36 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON: Efforts to improve development assistance and impact on development

CONTENT

SUPPORTING DOCUMENTS / GUIDELINES Paris Declaration on Aid Effectiveness. 2005. Accra Agenda for Action. 2008.

Paris Declaration on Aid Effectiveness ratified. Accra Agenda for Action ratified. Busan Pledge for Global Action on Children’s Health and Environment ratified.

http://www.oecd.org/development/effectiveness/34428351.pdf

OVERVIEW

http://www.oecd.org/development/effectiveness/34428351.pdf

Monterrey Consensus of the International Conference http://www.oecd.org/dac/effectiveness/busanpartnership.htm on Financing for Development ratified. Monterrey Consensus of the International Conference on Financing International Health Partnership (IHP+) adopted. for Development. 2002. http://www.un.org/esa/ffd/monterrey/MonterreyConsensus.pdf http://www.internationalhealthpartnership.net/en/ International Health Partnership (IHP+)

The Busan Partnership for Effective Development Co-operation. 2011.

APPROACH AND METHODS HEALTH SECTOR POLICIES

MULTISECTOR POLICIES ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

7. ARE THERE POLICIES FOR GOOD GOVERNANCE TO ENABLE DEVELOPMENT ACROSS ALL SECTORS, INCLUDING RMNCH? POLICY ON: Voice and accountability CONTENT Sets out regulations, strategies and guidance to :

SUPPORTING DOCUMENTS / GUIDELINES World Bank. Worldwide Governance Indicators. 2012.

Promote the participation of citizens in selecting their The International Bill of Human Rights. government and participation in public processes.

http://info.worldbank.org/governance/wgi/resources.htm http://www.ohchr.org/Documents/Publications/FactSheet2Rev.1en.pdf

Ensure the enjoyment of freedom of speech, peaceful OECD Public Management Policy Brief. Engaging Citizens in protest as well as freedom of expression, freedom of Policymaking. Information, Consultation and Public Participation. association, and a free media. 2001. http://www.oecd.org/governance/public-innovation/2384040.pdf Democratic Spaces’ for Citizen Participation. IDS Policy Briefing No. 27. Brighton, Institute of Development Studies, 2006. http://www.drc-citizenship.org/system/assets/1052734498/ original/1052734498-shankland.2006-making.pdf Conflict and Fragility. University of Birmingham, 2011. http://www.gsdrc.org/docs/open/CON88.pdf Shankland A. Making Space for Citizens: Broadening the ‘New

Haider H. State-Society Relations and Citizenship in Situations of

Political stability and absence of violence

Sets out regulations and strategies to:

World Bank. Worldwide Governance Indicators. 2012.

Prevent social unrest, armed conflict, politically motivated violence, and international tensions/threats. Geneva Declaration on Armed Violence and Development. 2006. Address the root causes and external stressors that lead to crime and violence.

http://info.worldbank.org/governance/wgi/resources.htm

http://www.genevadeclaration.org/the-geneva-declaration/what-isthe-declaration.html Topic Guide: Conflict. University of Birmingham, 2012. http://www.gsdrc.org/go/conflict

Haider H / Governance and Social Development Resource Centre.

WHO and Violence Prevention Alliance. Preventing violence and

reducing its impact: how development agencies and governments can help. Geneva, WHO, 2008. http://www.who.int/violenceprevention/publications/en/ http://info.worldbank.org/governance/wgi/resources.htm guide to best practice in transparency, accountability and civic engagement across the public sector. London, 2011. http://www.transparency-initiative.org/reports/opening-government

Government effectiveness

Sets out regulations, strategies and guidance to:

World Bank. Worldwide Governance Indicators. 2012.

Ensure the quality of public services. Ensure the quality of the civil service and independence from political interference. Ensure the quality of policy formulation, implementation and evaluation. Ensure the formulation and implementation of standards and regulations that permit and promote private sector development as well as ensure accountability of such actors.

Transparency Accountability Initiative. Opening Government. A

Regulatory quality

Sets out regulations, strategies and guidance to:

World Bank. Worldwide Governance Indicators. 2012.

http://info.worldbank.org/governance/wgi/resources.htm Implementing the United Nations “Protect, Respect and Remedy” Framework. UN. 2011. http://www.ohchr.org/Documents/Publications/ GuidingPrinciplesBusinessHR_EN.pdf http://www.oecd.org/gov/regulatory-policy/44124554.pdf Governance. 2012. http://www.oecd.org/gov/regulatory-policy/49990817.pdf

OHCHR. Guiding principles on business and human rights.

OECD. Improving the quality of regulations. Policy Brief. 2009. OECD. Recommendation of the Council on Regulatory Policy and

Investment Climate Advisory Services World Bank Group. Better

regulation for growth. Governance frameworks and tools for effective regulatory reform. Washington, 2010. https://www.wbginvestmentclimate.org/uploads/ CompPolicyRegRef.pdf

38 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

POLICY ON: Rule of law

CONTENT Sets out regulations and strategies to:

SUPPORTING DOCUMENTS / GUIDELINES World Bank. Worldwide Governance Indicators. 2012.

Ensure justice is fairly administered. Ensure personal security and private property protection. Ensure effective arrangements for the protection of intellectual property. Ensure the quality of contract enforcement.

http://info.worldbank.org/governance/wgi/resources.htm

UN. Resolution adopted by the General Assembly [on the report of

OVERVIEW

the Sixth Committee (A/62/454)] 62/70. The rule of law at the national and international levels. 2008. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N07/467/97/PDF/ N0746797.pdf?OpenElement

UN Security Council. Resolution 1325. (S/RES/1325). 2000.

http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N00/720/18/PDF/ N0072018.pdf?OpenElement against Civilians in Conflict. 2008. http://www.securitycouncilreport.org/atf/cf/%7B65BFCF9B-6D274E9C-8CD3-CF6E4FF96FF9%7D/CAC%20S%20RES%201820.pdf Outcome. 2005. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N05/487/60/PDF/ N0548760.pdf?OpenElement Geneva, 2008. http://www.wipo.int/about-ip/en/iprm/

UN Security Council Resolution (S/Res/1820). Sexual Violence

APPROACH AND METHODS

UN Security Council. Resolution 60/1. 2005 World Summit

UN. WIPO Intellectual Property Handbook: Policy, Law and Use.

OECD. Policy Framework for Investment Toolkit. Contract

Enforcement and Dispute resolution. 2006. http://www.oecd.org/investment/toolkit/policyareas/ investmentpolicy/contractenforcementanddisputeresolution.htm http://info.worldbank.org/governance/wgi/resources.htm

Control of corruption

Sets out regulations, strategies and guidance to:

World Bank. Worldwide Governance Indicators. 2012.

HEALTH SECTOR POLICIES

Ensure public power is not being exercised for private UN General Assembly resolution 58/4. UN Convention Against gain, including both petty and grand forms of Corruption. 2004. corruption. Prevent the influence of the state by elites and private interests.

http://www.unodc.org/documents/treaties/UNCAC/Publications/ Convention/08-50026_E.pdf Protocols Thereto. New York, 2004. http://www.unodc.org/unodc/treaties/CTOC/#Fulltext

UN Convention against Transnational Organized Crime and the

MULTISECTOR POLICIES ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

ANNEX 1 TWO PAGE SUMMARY OF ESSENTIAL INTERVENTIONS

ESSENTIAL, EVIDENCE-BASED INTERVENTIONS TO REDUCE REPRODUCTIVE, MATERNAL, CONTINUUM OF CARE ADOLESCENCE & PRE-PREGNANCY PREGNANCY (ANTENATAL) CHILDBIRTH

ALL LEVELS: COMMUNITY PRIMARY REFERRAL

Family planning (advice, hormonal and barrier methods) Prevent and manage sexually transmitted infections, HIV Folic acid fortification/ supplementation to prevent neural tube defects

Prophylactic uterotonics to Iron and folic acid supplementation prevent postpartum Tetanus vaccination haemorrhage (excessive Prevention and management of bleeding after birth) malaria with insecticide treated nets Manage postpartum and antimalarial medicines haemorrhage using uterine Prevention and management of massage and uterotonics sexually transmitted infections and HIV, including with antiretroviral medicines Social support during childbirth Calcium supplementation to prevent hypertension (high blood pressure) Interventions for cessation of smoking

PRIMARY AND REFERRAL

Screening for and treatment of syphilis Active management of third Family planning stage of labour (to deliver (hormonal, barrier Low dose aspirin to prevent the placenta) to prevent and selected surgical pre-eclampsia postpartum haemorrhage methods) Antihypertensive drugs (to treat high (as above plus controlled blood pressure) cord traction) Magnesium sulphate for eclampsia Management of postpartum haemorrhage (as above plus Antibiotics for preterm prelabour manual removal of placenta) rupture of membranes Corticosteroids to prevent respiratory Screen and manage HIV (if not already tested) distress syndrome in preterm babies Safe abortion Post abortion care Family planning (surgical methods) Reduce malpresentation at term with External Cephalic Version Induction of labour to manage prelabour rupture of membranes at term (initiate labour) Caesarean section for maternal/foetal indication (to save the life of the mother/baby) Prophylactic antibiotic for caesarean section Induction of labour for prolonged pregnancy (initiate labour) Management of postpartum haemorrhage (as above plus surgical procedures)

REFERRAL*

COMMUNITY STRATEGIES

Home visits for women and children across the continuum of care Women’s groups

40 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

OVERVIEW

NEWBORN AND CHILD MORTALITY, AND PROMOTE REPRODUCTIVE HEALTH1 POSTNATAL (MOTHER) POSTNATAL (NEWBORN) INFANCY & CHILDHOOD

Family planning advice and contraceptives Nutrition counselling

Immediate thermal care (to keep the baby warm) Initiation of early breastfeeding (within the first hour) Hygienic cord and skin care

Exclusive breastfeeding for 6 months Continued breastfeeding and complementary feeding from 6 months Prevention and case management of childhood malaria Vitamin A supplementation from 6 months of age Routine immunization plus H.influenzae, meningococcal, pneumococcal and rotavirus vaccines Management of severe acute malnutrition Case management of childhood pneumonia Case management of diarrhoea Comprehensive care of children infected with, or exposed to, HIV

APPROACH AND METHODS HEALTH SECTOR POLICIES

Screen for and initiate or continue antiretroviral therapy for HIV Treat maternal anaemia

Neonatal resuscitation with bag and mask (by professional health workers for babies who do not breathe at birth) Kangaroo mother care for preterm (premature) and for less than 2000g babies Extra support for feeding small and preterm babies Management of newborns with jaundice (“yellow” newborns) Initiate prophylactic antiretroviral therapy for babies exposed to HIV

MULTISECTOR POLICIES

Detect and manage postpartum Presumptive antibiotic therapy for Case management of meningitis sepsis (serious infections after newborns at risk of bacterial birth) infection Use of surfactant (respiratory medication) to prevent respiratory distress syndrome in preterm babies Continuous positive airway pressure (CPAP) to manage babies with respiratory distress syndrome Case management of neonatal sepsis, meningitis and pneumonia * Family planning interventions at Referral level include those provided at the Primary level

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

ANNEX 2 OPPORTUNITIES FOR USING THE RMNCH POLICY COMPENDIUM AS A TECHNICAL REFERENCE The Policy Compendium provides core content for RMNCH policies. It can be used to identify critical gaps in the RMNCH policy agenda and inform the response to these problems. Table 3 lists different entry points in the policy dialogue, planning and implementation processes and indicates ways the compendium could be used to inform decisions and next steps via these entry points.

TABLE 3: USE OF THE RMNCH POLICY COMPENDIUM TO INFORM POLICY DIALOGUE, PLANNING AND IMPLEMENTATION ENTRY POINTS TO POLICY DIALOGUE, PLANNING AND IMPLEMENTATION

USE OF THE POLICY COMPENDIUM - Identifying key RMNCH policies that need to be in place. - Identifying gaps in national health policy/strategy that impact RMNCH. - Informing priority setting and resource allocation for systems that support RMNCH services. - Identifying key policies to be considered in RMNCH situational analysis. - Identifying policy gaps in health systems or RMNCH technical policies. - Informing systems requirements for RMNCH and identifying systems gaps.

Broad health sectoral reviews e.g. Joint Assessment of National Health Strategies and Plans (JANS) RMNCH situation analyses and programme reviews e.g. Country Countdowns and Country Profiles, RMNCH Programme Reviews Stakeholder policy dialogue focusing on RMNCH Stakeholder policy dialogue to negotiate integration of RMNCH policies into other technical programmes or sectors Priority setting Planning Resource allocation Monitoring policy implementation progress Evaluation Advocacy for RMNCH Accountability within the health sector, across sectors and stakeholders

- Informing both policies needed and policy content required – in order to identify areas where action is needed, and the types of actions that should be taken. - Providing technical basis for allocation of responsibilities. - Informing both policies needed and policy content required – in order to identify areas where action is needed, and the types of actions that should be taken. - Providing technical basis for allocation of responsibilities. - Providing content to inform allocation of priorities between systems and technical areas. - Supporting implementation planning by identifying core policies needed to strengthen health systems to improve coverage and quality of RMNCH interventions. - Providing a basis for resource allocation based on policy commitments. - Informing cost analyses of programme impact based on policy inputs. - Providing content for monitoring of policy implementation (who, where, when, how) at national, regional and global levels. - Providing content for evaluating progress; and for understanding changes in RMNCH impact and outcome measures. - Providing technical basis for key RMNCH policy messages and priorities – within and outside the health sector. - Informing both policies needed and policy content required – in order to identify areas where action is needed, the types of actions that should be taken, and who should be responsible.

42 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

ANNEX 3 OVERVIEW

TOOLS AND METHODS FOR REVIEWING, DEVELOPING AND IMPLEMENTING POLICIES FOR RMNCH The Policy Compendium provides a technical reference for RMNCH policies and their content. It can therefore serve as the content guide for policy reviews, planning and development. A number of tools to support these processes are available or under development. A summary of some of these tools and methods is presented alphabetically in this section. BENCHMARKS FOR WHOLE OF GOVERNMENT POLICY PRACTICE (PMNCH) (SEE TABLE A ON PAGE 54)

APPROACH AND METHODS

DESCRIPTION: The ‘benchmarks for whole of government policy practice’ serves as a guide to enable best practice policy-making across government. PROCESS: It can be used by government departments and other stakeholders to benchmark current policy-making against key evidence-based standards and identify where change is required to strengthen the policy-making process. It can also be used as part of a broader policy dialogue process to support the development of an inclusive, flexible and innovative approach to policy design and review, implementation, accountability and evaluation and learning. The benchmarks can be used as a checklist to identify strengths, weaknesses and areas where action is needed. It is designed to be part of a multi-stakeholder process – and to inform implementation planning. Whole of government benchmarks are summarized in Table 4. Policies in key areas revised, developed or strengthened and used to inform implementation.

HEALTH SECTOR POLICIES

OUTPUTS:

COUNTRY CASE-STUDY PROTOCOL: REVIEWING IMPLEMENTATION OF RMNCAH PROGRAMMES (RMNCH ALLIANCE, WHO, PMNCH)

DESCRIPTION: This protocol describes an approach to developing case-studies on the current status of RMNCAH programme implementation. It is designed to assist countries to determine programme successes and ongoing implementation challenges for scaling-up evidence-based RMNCAH interventions. PROCESS: Existing assessments, surveys, plans and reviews are used to summarize the current status of implementation of essential RMNCAH interventions with an emphasis on policy and systems barriers that have been addressed or that need to be addressed. The process is conducted by a local programme coordinator in collaboration with a local or outside consultant. A one-day meeting with a stakeholder group is convened. Case-studies are developed for two successful policy, systems or intervention areas that have shown improvements; and two that have not responded to national strategies or programmes. Case-study findings are used to identify key actions and resource inputs required to address remaining barriers and gaps to inform implementation plans and resource allocation. Country case-study documents (two successes and two areas where more work is needed) that describe key strategies or actions needed to improve delivery of RMNCAH interventions.

MULTISECTOR POLICIES

OUTPUTS:

Further information is available at: http://www.who.int/pmnch/media/news/2013/partnership_asiapacific/en/ COUNTRY COUNTDOWN TOOLKIT AND COUNTRY PROFILES (COUNTDOWN TO 2015)

ANNEXES AND REFERENCES

DESCRIPTION: This toolkit includes a guide for conducting a Country Countdown, PowerPoints for each of the 75 Countdown countries based on the Countdown country profile, and other related materials. It describes an approach for assessing which RMNCH interventions are being delivered effectively and which are not, identifying the geographic areas and population groups where coverage levels are lagging, analysing the impact of policies and health systems factors on coverage levels and trends, and assessing financial flows to RMNCH. Findings are used to identify areas for priority action, refine national strategies and plans, improve service quality and coverage across all subgroups, increase awareness of – and political commitment to – women’s and children’s health, and to promote accountability for progress. PROCESS: The Countdown process engages all key stakeholders and involves compiling, analysing, and discussing the

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

policy and programmatic implications of available evidence on RMNCH and nutrition. Countdown country profiles present in one place the best and latest available evidence to enable an assessment of a country’s progress in improving RMNCH and nutrition. The range of indicators on the profile includes demographic measures, and measures of coverage, equity, health systems and policies, and financial flows. Countdown profiles provide information across the continuum of care on where success has been achieved and where gaps remain, which can inform national reviews and other prioritization processes. Summary findings and key messages in Countdown reports and analyses can help decision-makers identify where resources should be directed to strengthen policies, programmes and scale-up efforts. The Country Countdown process is designed to be repeated regularly in countries. OUTPUTS: Countdown findings are used to promote evidence-based decisions, leading to stronger and more equitable RMNCH policies and programmes. Country profiles are used at global and national levels for tracking progress and holding stakeholders accountable for progress over time.

Further information is available at: http://www.countdown2015mnch.org/country-countdown GUIDE FOR MULTI-STAKEHOLDER POLICY DIALOGUE PROCESS (PMNCH AND OTHER PARTNERS)

DESCRIPTION: This guide presents tools and methods to assist conveners and facilitators in managing multi-stakeholder dialogue processes on policy issues related to the implementation of essential interventions to promote women’s and children’s health. PROCESS: The guide will focus on multi-stakeholder dialogue for developing an Aligned Stakeholder Action Programme (ASAP)—a shared workplan at the national or subnational level that aligns stakeholder policy actions for implementation of essential RMNCH interventions. The process includes an analysis of priorities, development of a strategy to address problem areas, and development of an implementation plan. The guide is aimed at actors and organizations who will be designing and facilitating the multi-stakeholder dialogue process for developing an ASAP. It provides a step-by-step process for how to lay the groundwork for convening the dialogue process, design and facilitate it, and monitor it in the post-dialogue phase. Improved capacity to develop a shared ASAP to support implementation of national health plans and accelerate progress towards improving women’s and children’s health.

OUTPUTS:

IMPLEMENTATION READINESS TOOL FOR ACHIEVING HIGH COVERAGE OF RMNCH INTERVENTIONS (USAID/MCHIP)

DESCRIPTION: This tool provides a framework for assessing the status of implementation of essential RMNCH interventions (from the pre-introduction phase to the mature implementation phase when the intervention has become institutionalized). It identifies the key implementation tasks that must be completed to achieve sustainable improvements in coverage of essential interventions. PROCESS: Scale-up maps and a change effort checklist are used to determine progress and gaps in the process of scaling up implementation. Local data and reports from programme staff are used to determine implementation status of selected interventions or intervention packages. Scaling up an intervention is recognized as a political as well as a technical process that must be done in the context of existing systems and policies. Policies are an essential component of scaling up interventions and are reviewed along with health systems. The tool is used by all stakeholders including ministries of health, donor agencies and implementing partners. Implementation scale-up maps for selected interventions that identify systems and policy areas where progress is satisfactory and areas where there are gaps. Findings are used to support improved planning and implementation.

OUTPUTS:

INFORMATION, COMMUNICATIONS AND TECHNOLOGY (ICT) READINESS WORKBOOK AND ‘TO DO’ LIST (PMNCH AND OTHER PARTNERS)

DESCRIPTION: The ICT Readiness Workbook and ‘To Do’ list is an aid for stakeholders who are considering scaling up the use of technology for delivering RMNCH interventions. This workbook is not intended to replace existing guidelines, but instead seeks to identify existing standards, guidance or best practice(s) and promote their use. It is based on a synthesis of research and the expert opinion of an advisory panel made up of both PMNCH Partners and other industry specialists. PROCESS: The workbook and ‘do-list’ has been designed to be used as part of a stakeholder dialogue. A list of key standards and best practices is reviewed; stakeholders make decisions about what has already been done,

44 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

and the remaining gaps, for each stage of scale-up (pre-pilot, pre-scale-up and pre-operations). There are two options for use: a ‘short’ option for those constrained by time (e.g. two to four hours), where the critical questions are tabled for each phase of scale-up, and a longer version appropriate for a multi-day workshop. OUTPUTS: A review of ICT needs for scaling up technology to support RMNCH, with areas that need work identified and consensus between stakeholders. OVERVIEW

JOINT ASSESSMENT OF NATIONAL HEALTH STRATEGIES AND PLANS (JANS): COMBINED JOINT ASSESSMENT TOOL AND GUIDELINES (IHP+)

DESCRIPTION: The joint assessment is a shared approach to assessing the strengths and weaknesses of a national strategy, which is accepted by multiple stakeholders, and can be used as the basis for technical and financial support. The presumed benefits of joint assessment include enhanced quality of national strategies and greater partner confidence in those strategies, thereby securing more predictable and better-aligned funding. The inclusion of multiple partners in a joint assessment is also expected to reduce transaction costs associated with separate assessment processes. PROCESS: The JANS can be used to assess an overall national health strategy or specific subsectoral and multisectoral strategies such as RMNCH. The method examines the strengths and weaknesses of five sets of attributes considered the foundation of any ‘good’ and comprehensive strategy including: situation analysis; process used for development; costs and budgetary framework, implementation and management arrangements, and monitoring, evaluation and review mechanisms. RMNCH policies are reviewed as part of the situation analysis. The way a joint assessment is carried out will be unique to each country, but based on some key principles: it should be country demand driven; be country led and build on existing processes; include an independent element, and engage civil society and other relevant stakeholders. An assessment of the strengths and weaknesses of the RMNCH strategy, with recommendations. Findings can be discussed by national stakeholders and partners and may be used to revise the strategy.

APPROACH AND METHODS HEALTH SECTOR POLICIES

OUTPUT:

Further information is available at: http://www.internationalhealthpartnership.net/en/tools/jans-tool-and-guidelines/ PROGRAMME REVIEW FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH TOOL (WHO)

DESCRIPTION: This is an approach for systematically reviewing all aspects of RMNCH programming and determining how well activities have been implemented. Main problems are identified, and recommendations for the next workplan are developed. The method is designed to build on the existing process of routine programme planning and can be applied at any level. PROCESS: RMNCH programme activities conducted in key policy and systems areas are reviewed along the continuum of care for the mother and child. The review is undertaken by a team including health staff from all levels, different departments of the ministry of health and partners. Data from a number of sources are synthesized, including input from staff working in the field. Since staff from different technical areas are involved, as well as stakeholders, it emphasizes integrated planning and coordination of activities. Recommendations for action to improve programme implementation and coverage of RMNCH interventions that can be implemented in national or subnational workplans.

MULTISECTOR POLICIES

OUTPUTS:

RAPID PROGRAMME REVIEW FOR ADOLESCENT HEALTH (WHO)

DESCRIPTION: The tool provides guidelines for a rapid review of selected national public health programmes to examine how well they are addressing adolescents; and to provide guidance on what can be done to build on strengths and tackle weaknesses. PROCESS: The tool can be used by government departments and other stakeholders. It is a sequential process that reviews and synthesizes data and programme information using a structured approach – and can be used for all or selected programme areas (such as RMNCH). Strengths, weaknesses and opportunities are identified and actions for improvements are recommended. The process can also be used to advocate for adolescent health and to secure stakeholder consensus around actions needed. Identifies clear directions on actions by the health sector and other sectors to improve adolescent health and development outcomes.

ANNEXES AND REFERENCES

OUTPUTS:

Further information is available at: www.expandnet.net/PDFs/2.%20Rapid%20programme%20Review.doc

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

TABLE A: BENCHMARKS FOR WHOLE OF GOVERNMENT POLICY PRACTICE IDENTIFYING NEEDS / OPPORTUNITIES FOR POLICY CHANGE DEFINING POLICY PROBLEMS DESIGNING POLICY SOLUTIONS IMPLEMENTING POLICY

Regular reviews11,12

Situational analysis11-17

Planning11,12,16, 18

Implementation11,19-21

Policy performance and processes are periodically reviewed against annual/ long-term goals/measures, to ensure it deals with problems designed to solve and accounts for associated effects. Existing research is reviewed and new research commissioned.

Policy requires a comprehensive and participatory analysis of the context (political, sociocultural, gender, human rights, epidemiological, governance, ethical and institutional). Analysis includes review of the legal and institutional framework for enactment, modification or rescission of laws, policies, regulations and guidelines. Analysis examines stakeholder positions, interests and networks. Analysis is required to use disaggregated data and trends; vital registration data.

Policy requires development of different policy options. Policy identifies key systems issues for implementation including financial, human resource, and technical constraints. Policy requires establishment of monitoring and evaluation framework.

Policy is agreed-upon through a process of deliberation and procedures. Policy’s operational plans collaboratively developed according to policy objectives. Policy requires resources are deployed to achieve outcomes, including allocation to subnational level and state/non-state actors. Policy specifies that institutional capacity and individuals’ capabilities assessed; with plans developed to address gaps. Policy’s financial management and procurement arrangements meet national/international standards; clarifies how resources/funds will reach beneficiaries. Policy specifies governance, accountability, management and coordination mechanisms. Policy requires information on policy decisions and their rationales is publicly available. Policy specifies that regulated mechanisms are available to challenge and dispute decisions.

Forecasting12,13

Policy specifies that a long-term view is formulated, based on statistical trends and informed predictions of sociopolitical, economic and cultural trends, to assess likely impact of policy.

Scenarios & models11,14,17

Policy stipulates draft plans are assessed in view of projected costs, implementation and impact (on beneficiaries and other stakeholders). Opportunities and potential risks are identified in the policy and mitigation strategies assessed.

Contingency and future planning11-13

Priority and strategy selection11

Policy requires that different possible futures are explored and alternative solutions considered for most important pending technological, societal, or regulatory uncertainties.

Policy sets out clear priorities, goals, objectives, interventions, and expected results, informed by evidence and good practice. Policy objectives clearly defined, measurable, realistic/time bound.

Budgeting

Policy’s expenditure framework includes comprehensive budget/ costing of programme areas.

Policy includes a realistic budgetary framework, Goals, objectives and interventions of the policy with funding projections. address identified priorities and equity issues Communication11 across all population subgroups, especially Policy has a strategy to vulnerable groups. communicate policy with the public, and ascertain preferences.

46 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

ACCOUNTABILITY AND PARTICIPATION ACROSS ALL POLICY PROCESSES

POLICY NORMS, INNOVATION AND LEARNING

INTERSECTORAL POLICY CONSIDERATIONS

ALIGNING GLOBAL, REGIONAL AND NATIONAL POLICIES

OVERVIEW

Accountability11-15

Norms11-15

Policy includes a comprehensive monitoring and evaluation framework across all policy areas. Policy requires that an independent accountability mechanism is set up to review use of resources and achieved results, and discharge of legal obligations; review provides basis for policy dialogue. Policy includes mechanism for remedial action; the follow-up of diagnosed problems and the identification of proposed remedial responses. Participation11-15,22

Policy addresses the needs of disadvantaged individuals, communities and populations. Policy is evidenced-based, transparent and inclusive. Policy fosters accountability in accordance with human rights standards. Policy promotes nondiscrimination – data are appropriately disaggregated. Policy takes into account individual and public health ethics issues, including confidentiality and privacy issues.

Policy underpinned by an intersectoral approach, that is ‘joined up’; looks beyond institutional boundaries to strategic, cross-cutting objectives.12 Policy requires space is established for systematic dialogue and coordination between sectors early in policy processes.23 Policy specifies the establishment of appropriate management and organizational structures to deliver crosscutting objectives through systematic governance processes including:12 -

Policy processes are required to be consistent with national/ international legal obligations.13 Policy must be aligned with the Paris Principles and Accra Agenda for Action.24 Policy must be consistent with relevant higher- and/ or lower-level strategies, financing frameworks and plans; meets national and global commitments.11 Policy-making process is required to take account of influencing factors in the national, regional and international situation; draws on experience in other countries.15

APPROACH AND METHODS

HEALTH SECTOR POLICIES

Cross-cutting objectives clearly defined at outset; Joint working arrangements clearly defined and understood; Barriers to effective collaboration identified with a strategy to overcome them; Implementation considered part of policy-making process.

Innovation and Learning12,13

Policy requires high level of political commitment. Policy specifies that institutional arrangements are established to support active and informed participation of relevant stakeholders, including disadvantaged communities. Policy requires that all stakeholders are involved, and their perspectives taken into account, in identifying overall strategy, implementation and accountability.

Policy supports innovation and creativity and questions established ways of acting to encourage new ideas. Policy requires documentation and dissemination of lessons learned, action and good practice. Policy requires a distinction be drawn between failure of policy to impact on the problem intended to resolve and managerial/operational failures of implementation.

MULTISECTOR POLICIES

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

ENDNOTES 1. The Partnership for Reproductive, Maternal, Newborn & Child Health. Essential Interventions, Commodities and Guidelines for RMNCH. A

Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, PMNCH, 2011.

2. WHO, UNICEF, UNFPA, the World Bank. Trends in maternal mortality: 1990-2010. WHO, UNICEF, UNFPA and The World Bank Estimates.

WHO, 2012.

3. WHO, UNICEF, the World Bank and UN. Levels and Trends in Child Mortality. New York, UNICEF, 2013. 4. Countdown to 2015. Building a better future for women’s and children’s health. The 2012 Report. WHO and UNICEF, Geneva, 2012. 5. United Nations Secretary-General. Global Strategy for Women’s and Children’s Health. New York, 2010. 6. Every Woman Every Child. 2012. Available at: http://www.everywomaneverychild.org/ 7. WHO. Health Policy. 2013. Available at: http://www.who.int/topics/health_policy 8. UN System Task Team on the post-2015 UN development agenda (2012). Realizing the future we want for all. Report to the UN Secretary-General.

http://www.un.org/millenniumgoals/pdf/Post_2015_UNTTreport.pdf; United Nations (1987). Report of the World Commission on Environment and Development: Our Common Future. http://conspect.nl/pdf/Our_Common_Future-Brundtland_Report_1987.pdf; UN General Assembly (2005). 2005 World Summit Outcome. A/60/L.1. http://www.who.int/hiv/universalaccess2010/worldsummit.pdf; UN Millennium Project (2005). Investing in development: a practical plan to achieve the Millennium Development Goals. New York. http://www.unmillenniumproject.org/ documents/MainReportComplete-lowres.pdf

9. WHO. Key components of a well-functioning health system. Geneva, 2010. Available at: http://www.who.int/healthsystems/EN_HSSkeycomponents.pdf 10. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, WHO, 2010.

http://www.who.int/healthsystems/strategy/everybodys_business.pdf

11. IHP+ (International Health Partnership). Joint Assessment of National Health Strategies and Plans. Joint Assessment Tool: the attributes of a

sound national strategy. 2011.

12. Bullock H, Mountford J and Stanley R. Better Policy Making. Centre for Management and Policy Studies. London, 2001. 13. Strategic Policy Making Team, Cabinet Office. Professional policy making for the twenty first century. London, 1999. 14. Human Rights Council. Seventh session. Promotion And Protection of all Human Rights, Civil, Political, Economic, Social and Cultural Rights.

Report of the special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt. A/HRC/7/11. January 2008.

15. Human Rights Council. Twentieth session. Annual report of the United Nations High Commissioner for Human Rights and reports of the Office

of the High Commissioner and the Secretary-General. Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development. Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality. A/HRC/21/22. July 2012.

16. WHO. Supporting the contextualization of recommendations at a national level: A workbook for implementing health systems guidance. (n.d). 17. PoliMap. PolicyMaker: Computer Assisted Political Analysis. (n.d). Available at: http://www.polimap.com/default.html 18. Buse K, Mays N, and Walt G. Making Health Policy. Second Edition. Maidenhead, Open University Press, 2012. 19. Kuruvilla S and Dorstewitz P. There is no “point” in decision-making: a model of transactive rationality for public policy and administration.

Policy Sci, 2010, 43:263–287. Available at: http://link.springer.com/article/10.1007%2Fs11077-009-9098-y

20. Sen A. Capability and well-being. In: Nussbaum M, Sen A, eds. The quality of life. New York, Oxford University Press, 1993. pp. 30-53. 21. Daniels N, and Sabin J. The ethics of accountability in managed care reform. Health Aff. 1998, 17(5):252-3. 22. Dietz T. What is a good decision? Criteria for environmental decision-making. Human Ecology Review, 2003, 10(1):33-9. 23. WHO. Intersectoral action to tackle the social determinants of health and the role of evaluation. Report of the first Meeting of the WHO Policy

Maker Resource Group on Social Determinants of Health. Viña del Mar, Chile, 27-29 January 2010.

24. Organisation for Economic Co-operation and Development (OECD). The Paris Declaration on Aid Effectiveness and the Accra Agenda for

Action: 2005/2008. Available at: http://www.oecd.org/development/effectiveness/34428351.pdf

48 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

ACRONYMS USED IN THIS DOCUMENT OVERVIEW

ASAP ART AU ECOSOC EmONC EU GHWA GSDRC HIV HMN ICPD IHP+ ILO ITNs ITU IWG JANS M&E MoH OECD OHCHR ORS PAHO PMNCH RMNCH STI UN UNDP UNEP UNFCCC UNHRC WHA WHO WIPO WSSCC

Aligned Stakeholder Action Programme Antiretroviral Therapy African Union Economic and Social Council Emergency Obstetric and Newborn Care

CARMMA Campaign for Accelerated Reduction of Maternal Mortality in Africa

APPROACH AND METHODS

European Union Global Health Workforce Alliance Governance and Social Development Resource Centre Human Immunodeficiency Virus Health Metrics Network International Conference on Population and Development International Health Partnership International Labour Organization Insecticide-Treated Nets International Telecommunication Union Innovation Working Group (in support of Every Woman Every Child) Joint Assessment of National Health Strategies Monitoring and Evaluation Ministry of Health Organisation for Economic Co-operation and Development Office of the United Nations High Commissioner for Human Rights Oral Rehydration Salts

HEALTH SECTOR POLICIES MULTISECTOR POLICIES

Pan American Health Organization Partnership for Maternal, Newborn & Child Health Reproductive, Maternal, Newborn and Child Health Sexually Transmitted Infection United Nations United Nations Development Programme United Nations Environment Programme United Nations Framework Convention on Climate Change United Nations Human Rights Council World Health Assembly World Health Organization World Intellectual Property Organization Water Supply and Sanitation Collaborative Council

RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health

ANNEXES AND REFERENCES

A MULTISECTORAL POLICY COMPENDIUM FOR RMNCH

ACKNOWLEDGEMENTS The Policy Compendium is the result of collaborative work among key partner organizations and constituencies working on policies which affect the health of women, newborns, children and adolescents. The process was led by the World Health Organization and the Partnership for Maternal, Newborn & Child Health (PMNCH). An Advisory Group, reflecting networks of partners from various constituencies and consisting of experts in maternal, newborn and child health, participated in a review meeting in June 2013, follow up calls and emails, and provided inputs into the development and finalization of the document. A range of constituencies shared the document throughout their networks and consulted for inputs into the final document, including governments, donors and foundations, multilateral organisations, academic institutions, health care professional associations including gynaecological and obstetrics, and midwifery associations, the private sector, and civil society. The contributions of partners and invited experts are gratefully acknowledged.

We would like to thank the following individuals for their contribution: Technical Working Group: Sharon Arscott-Mills, Bernadette Daelmans, Andres de Francisco Serpa, Rachael Hinton, Shyama Kuruvilla, Blerta Maliqi, John Murray, Giorgio Tamburlini. Advisory Group Members: Taghreed Adam, Lara Brearley, Rafael Cortez, Kim Dickson, Claire Glenton, Metin Gulmezoglu, David Hagan, Jill Keesbury, Karusa Kiragu, Joy Lawn, Lori McDougall, Victor Mukonka, Jesca Nsungwa-Sabiliti, Lucinda O’Hanlon, Jennifer Requejo, Priyanka Saksena, Joanna Schellenberg, Gerard Schmets, Tim Shorten, Anand Sivasankara Kurup, Kate Somers, Marleen Temmerman, Steven Uggowitzer, John Worley. WHO Colleagues: Valentina Baltag, Marie-Noel Bruné, Flavia Bustreo, Carmen Casanovas, Thomas Cherian, Carmen Dolea, Carlos Dora, Joan Dzenowagis, Jane Ferguson, Mario Festin, Lisa Hedman, Sowmya Kadandale, Elizabeth Mason, Matthews Mathai, Gerlin Naidoo, Chizuru Nishida, Mikael Ostergren, Annie Portela, Nigel Rollins, Marcus Stahlhofer, Nicole Valentine, Adriana Velazquez Berumen, Eugenio Villar Montesinos. PMNCH Colleagues: Henrik Axelson, Vaibhav Gupta, Carole Presern. Also thanks to the project interns: Alexander De Ville, Elizabeth Noble.

Photos: Front cover, UN Photo/UNFPA/William Ryan, UN Photo/Albert González Farran and Pippa Ranger/Department for International Development; page iv, The World Bank/Ray Witlin; page 4, The World Bank/Athit Perawongmetha; page 6, UN Photo/ Stuart Price; page 10, WHO; page 14, The World Bank; page 16, UN Photo/Isaac Billy; page 18, UN Photo/Mark Garten; page 21, WHO/Harold Ruiz; page 25, Gates Foundation; page 27, WHO/Evelyn Hockstein; page 28, UN Photo/Albert González Farran; page 31, UN Photo/Evan Schneider; page 33, The World Bank/Caroline Suzman; page 35, The World Bank/Bart Verweij; page 37, The World Bank/John Hogg; page 39, UN Photo/Marco Dormino; page 51, UN Photo/Marco Dormino; back cover, Pippa Ranger/ Department for International Development, WHO/H. Bower and UN Photo/Olivier Chassot. Editing: Richard Cheeseman, Robert Taylor Communications. Design: Roberta Annovi.

50 A POLICY GUIDE FOR IMPLEMENTING ESSENTIAL INTERVENTIONS FOR REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)

The Partnership for Maternal, Newborn & Child Health World Health Organization 20 Avenue Appia, CH-1211 Geneva 27 Switzerland Fax: + 41 22 791 5854 Telephone: + 41 22 791 2595 pmnch@who.int www.pmnch.org

ISBN 978 92 4 150685 4

Together with RMNH Alliance and the Office of the High Commissioner for Human Rights (OHCHR).