The Global strategy for women’s, children’s and adolescents’ health (2016–2030) provides
a roadmap for ending preventable deaths of women, children and adolescents by 2030
and helping them achieve their potential for and rights to health and well-being in
all settings.
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The global strategy has three objectives: survive (end preventable deaths); thrive
(ensure health and well-being); and transform (expand enabling environments). These
objectives are aligned with 17 targets within nine of the sustainable development
goals (SDGs),
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including SDG 3 on health and other SDGs related to the political, social, economic
and environmental determinants of health and sustainable development.
Like the SDGs, the global strategy is universal in scope and multisectoral in action,
aiming for transformative change across numerous challenging areas for health and
sustainable development (Box 1).
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The strategy was developed through evidence reviews and syntheses and a global stakeholder
consultation,
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and draws on new thinking about priorities and approaches for health and sustainable
development.
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Particular attention was given to experience gained and lessons learnt by countries
during implementation of the previous Global strategy for women’s and children’s health
(2010–2015)
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and achieving the millennium development goals (MDGs).
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A five-year operational framework with up-to-date technical resources has also been
developed to support country-led implementation of the global strategy. This framework
will be regularly updated until 2030.
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Box 1
The Global strategy for women’s, children’s and adolescents’ health (2016–2030)
Objectives of the global strategy:
Survive: end preventable mortality;
Thrive: promote health and well-being; and
Transform: expand enabling environments.
Five drivers of change to achieve the objectives based on the global strategy action
areas:
People: individual potential and community engagement;
Political effectiveness: country leadership, financing, accountability;
Programmes: health system, multisector, humanitarian, research and innovation;
Partnerships: Every Woman Every Child Partnerships, including the Global Financing
Facility, the United Nations and multilateral H6 partnership, Unified Accountability
Framework and Independent Accountability Panel, Innovation Marketplace and other national,
regional and global partnerships; and
Principles: country-led, universal, sustainable, human-rights based, equity-driven,
gender-responsive, evidence-informed, partnership-driven, people-centred, community-owned,
accountable, aligned with development effectiveness and humanitarian norms.
Evidence shows that progress is required across a set of overlapping and mutually
reinforcing areas to improve the health, dignity and well-being of women, children
and adolescents.
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Key areas for action were set out in the first global strategy (2010–2015), including
health financing; the health system and workforce; access to essential interventions
and life-saving commodities; national leadership; and accountability.
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Based on emergent evidence, sociopolitical and environmental changes and the SDGs,
the current global strategy (2016–2030) includes new strategic areas, for example
adolescent health; humanitarian and fragile settings; an integrated life-course approach
to health recognizing the links across different stages; multisector approaches; and
guiding principles such as universality, human rights, equity and development effectiveness.
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Evidence indicates that countries can accelerate progress in health and sustainable
development through integrated action within the health sector and across social,
economic and environmental sectors.
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For example, through investments across sectors, the Chinese government lifted 439
million people out of poverty between 1990 and 2015, reduced child and maternal mortality
by over 80% and 72%, respectively, and raised secondary school enrolment to over 99%,
with equal numbers of boys and girls enrolled. Rural access to clean water and sanitation
also improved to over 85% and 74%, respectively.
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In Ethiopia, a similar approach reduced poverty from 48% in 1990 to 23% in 2015, and
the country experienced improvements in education, roads, water, sanitation and hygiene.
Over the same period, child and maternal mortality declined by 71% and 72%, respectively.
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The actions and approaches required to achieve the objectives of the global strategy
(2016–2030)
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converge around five main drivers of change: people; political effectiveness; programmes;
partnerships; and principles. The following sections highlight how some countries
have already begun achieving these transformative changes (Box 1).
The global strategy (2016–2030) emphasizes the importance of measures to help all
women, children and adolescents to realize their rights and full potential for health
and well-being. These measures include policies and programmes for early childhood
development and adolescent health. Removing barriers to enjoyment of rights– such
as those to gender-equality and women’s socioeconomic and political participation
are also important measures.
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Evidence shows that early childhood development programmes have significant long-term
health and socioeconomic advantages. Parenting resources for early childhood development,
school-community outreach and health services have measureable physical, intellectual
and socioeconomic benefits for children, their families and communities. Such actions
can reduce health, special schooling and criminal justice expenditures.
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Healthy, educated adolescents can better realize their potential, contribute to the
demographic dividend and economic growth, as seen in east Asia in the 1980s and 1990s.
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Evidence shows that with investment and political commitment for adolescent health
and development, rapid progress can be made.
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Now, countries such as Argentina, Colombia, Estonia, Ethiopia, India, the Republic
of Moldova, Senegal and Uganda are investing in large-scale adolescent health and
development programmes to gain similar dividends. Investments could help countries
in sub-Saharan Africa realize annual dividends of at least 500 billion United States
dollars (US$), equal to about one third of the region’s current gross domestic product,
for as many as 30 years.
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Women’s social, political and economic participation is associated with better health
outcomes for women and children.
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In Rwanda, where 64% of parliamentarians are women and where the parliament has committed
to and invested in health and development, maternal and child mortality declined by
78% and 72%, respectively, between 1990 and 2015.
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At community level, women’s groups in Bangladesh, India, Malawi and Nepal contributed
to better access to quality health services and improved maternal and newborn health.
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Leadership at all levels of society is a proven prerequisite for progress.
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In Kyrgyzstan, committed political leadership, clear policy, management capacity and
low staff turnover in the health ministry contributed to sustained financing, improved
health services and a reduction of child mortality by almost two thirds since 1990.
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Political effectiveness can also drive cross-sector action to address diverse determinants
of health. Collaboration across sectors during the MDG era helped some countries to
accelerate progress to reduce mortality, malnutrition and gender inequality, to strengthen
health and education systems and to improve water quality, sanitation and infrastructure.
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Robust data and analysis are essential to enable accountability through a cycle of
monitoring, independent review and action to ensure that programmes and policies are
achieving their desired objectives. For example, in Mozambique a coalition of partners
invested in the country’s civil registration and vital statistics system, increasing
registered deaths by 18% from 2012 to 2014 and enabling routine reporting of causes
of death by sex and age for the first time since 1975 (Commission on Information and
Accountability, Mozambique, unpublished data, December 14, 2015).
To strengthen accountability, at least 50 countries with a high burden of maternal
and child mortality had regular national health sector review processes that met basic
accountability criteria in 2015, and another 36 countries had adopted the good governance
for medicines approach to battle corruption.
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Quality programmes in health and other sectors, and for research and innovation, can
catalyse change, even in humanitarian and fragile settings. While resilient health
systems and universal coverage of quality care are gold standards for women’s, children’s
and adolescents’ health, catastrophic events can swiftly undo hard-won health gains,
particularly where existing health systems are weak. For example, during the 2013–2016
Ebola disease outbreak in Liberia, skilled birth attendance fell from 52% to 38%,
vaccination rates dropped and 64% of health facilities were not operational.
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Experience shows that quality care is possible even under extreme circumstances. In
Jordan, humanitarian and development partners have collaborated to give all residents
of Za’atari refugee camp access to maternal and child health centres, while additional
health centres serve Syrian refugees who are not living in camps.
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The global strategy (2016–2030) highlights the importance of expanding such collaborative
practices and improving emergency preparedness at all levels of the health system.
While the health sector remains central for people’s health, there is evidence that
in low- and middle-income countries about 50% of gains in women’s and children’s health
since 1990 have resulted from progress in non-health sectors.
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Investments in nutrition, water and sanitation were essential in eradicating polio
in India, which was certified as polio-free in 2014. Previous efforts, focused on
vaccination alone, were insufficient because malnourishment and diarrhoea from unsafe
water and inadequate sanitation limited vaccine effectiveness.
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Education is also critical to improving health and well-being. In Malawi, conditional
cash transfers to encourage school attendance by girls were associated with reductions
in teenage pregnancies, early marriage and human immunodeficiency virus infections.
Evidence shows that knowledge and innovation are at least as important as economic
resources in improving health and well-being and driving development. Research to
help countries understand and overcome barriers is required in areas such as: policy,
implementation and operational research; clinical research and systematic evidence
reviews; disaster risk reduction and preparedness; social, behavioural, anthropological
and community research; and political and social sciences.
Multistakeholder and cross-sector partnerships are critical drivers of change. In
the United Republic of Tanzania, the White Ribbon Alliance for Safe Motherhood united
civil society members, health professionals, academics, donors and United Nations
(UN) partners in a successful three-year campaign to improve access to comprehensive
emergency obstetric and newborn care at health centres.
Effective global partnerships can catalyse and support country efforts. For example,
the Every Woman Every Child movement attracted more than US$60 billion dollars to
women’s and children’s health between 2010 and 2015, with commitments from over 300
partners.
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The movement has spurred partnership mechanisms to support country-led implementation
of the global strategy (2016–2030) – including the Global Financing Facility in support
of Every Woman Every Child, the Innovation Marketplace, Unified Accountability Framework
and the UN system’s health agencies’ H6 partnership.
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The global strategy (2016–2030) recognizes that human rights and other fundamental
development principles – such as equity, community ownership and development effectiveness
– are drivers of transformative change.
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In Peru, principles of equity underpinned a programme of poverty mapping to identify
and prioritize reaching poor, rural and indigenous populations with social protection
programmes and culturally appropriate, affordable care.
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In Kenya, the institutionalization of human rights principles is benefiting women’s
health following complaints alleging systematic violation of women’s reproductive
health rights in health facilities.
The global strategy (2016–2030) provides knowledge for integrated actions both within
the health sector and with other sectors, based on country experience and current
evidence. With its accompanying operational framework, the strategy serves as a roadmap
for collective action to advance the health and well-being of women, children and
adolescents, which will be central to achieving the SDGs.