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The Member States of the World Health Organization (WHO) are committed to achieve quality, equity and dignity for women, newborns and children as reflected in the four World Health Assembly [...]

Most low-and middle-income countries face financing pressures if they are to adequately address the recommendations of the Global Strategy for Women's, Children's and Adolescent's Health. Negotiations between government ministries of health and finance are a key determinant of the level and effectiveness of public expenditure in the health sector. Yet ministries of health in low-and middle-income countries do not always have a good record In obtaining additional resources from key decision-making institutions. This is despite the strong evidence about the affordability and cost-effectiveness of many public health interventions and of the economic returns of investing in health. This article sets out 10 attributes of effective budget requests that can address the analytical needs and perspectives of ministries of finance and other financial decision-makers. We developed the list based on accepted economic principles, a literature review and a workshop in June 2015 involving government officials and other key stakeholders from low-and middle-income countries. The aim is to support ministries of health to present a more strategic and compelling plan for investments In the health of women, children and adolescents. La plupart des pays a revenu faible et Intermediaire font face a des contraintes de financement pour pouvoir suivre correctement les recommandations de la Strategie mondiale pour la sante de la femme, de l'enfant et de l'adolescent. Les negociations entre le ministere de la Sante et celui des Finances sont un determinant cle de l'importance et de l'efficacite des depenses publiques en matiere de sante. Or, dans les pays a revenu faible et Intermediaire, le ministere de la Sante ne parvient pas toujours a obtenir des ressources supplementaires de la part des grandes institutions decisionnalres, en depit d'elements demontrant l'abordabilite et la rentabilite de nombreuses actions de sante publique et du rendement economique des investissements dans le domaine de la sante. Cet article presente 10 caracteristiques convaincantes de demandes de credits permettant de tenircompte des besoins analytiques et des perspectives des ministeres des Finances et d'autres decisionnaires financiers. Nous avons etabli cette liste a partir des principes economiques courants, d'une analyse documentaire et d'un atelier organise en juin 2015, auquel ont participe des representants de gouvernements et d'autres acteurs cles de pays a revenu faible et intermediaire. L'objectif est d'aider les ministeres de la Sante a presenter un plan d'investissement plus strategique et plus convaincant dans le domaine de la sante de la femme, de l'enfant et de l'adolescent. La mayoria de los paises con ingresos bajos y medios afrontan presiones de financiacion para poder abordar de forma adecuada las recomendaciones de la Estrategia Mundial para la Salud de la Mujer, el Nino y el Adolescente. Las negociaciones entre los ministerios de sanidad y economia son un determinante fundamental del nivel y eficacia del gasto publico en el sector sanitario. Aun asi, los ministerios de salud de paises con Ingresos bajos y medios no siempre cuentan con una buena trayectoria a la hora de obtener recursos adicionales de Instituciones fundamentales para la toma de decisiones. Esto se produce a pesar de la fuerte prueba acerca de la asequibllldad y rentabilidad de muchas intervenciones de salud publica y de los beneficios economicos de la Inversion en sanidad. Este articulo presenta 10 caracteristicas de solicitudes presupuesta rias eficacesque pueden abordar las necesidades analiticas y las perspectivas de los ministerios de economia y otros responsables de la toma de decisiones financieras. La lista se desarrollo en base a los principios economicos aceptados, una revision bibliografica y un taller realizado en junio de 2015 en el que participaron funcionarlos del gobierno y otras partes Interesadas fundamentales de paises con Ingresos bajos y medios. El objetivo es dar apoyo a los ministerios de salud para que presenten un plan mas estrategico y completo para Invertir en la salud de mujeres, ninos y adolescentes., Introduction Most low-and middle-income countries face financing pressures if they are to adequately address global goals for improving the health of women, children and adolescents. Only six of the 75 [...]

The sustainable development goals (SDGs) and updated Global strategy for women's, children's and adolescents' health (2016-2030) call upon countries and the global community to transform health systems and society. (1,2) [...]

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches In addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector Investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results overtime. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond. La reduction de la mortalite maternelle et infantile est une priorite des objectlfs du Millenaire pour le developpement (OMD) et le restera probablement apres l'echeance de 2015. Il existe des donnees sur les investissements, les interventions et les politiques habilitantes necessaires. On comprend mal pourquoi certains pays ont realise des progres plus rapidement que d'autres pays comparables. Les Facteurs de reussite des etudes sur la sante des femmes et des enfants ont cherche a combler ce manque de connaissances en utilisant les analyses statistiques et econometriques des donnees provenant de 144 pays a faible revenu et a revenu intermediaire et recueillies depuis 20 ans: une analyse comparative qualitative booleenne; une etude bibliographique et des etudes specifiques a chaque pays pour les 10 pays a progression rapide pour les points 4 et 5a des OMD. Il n'existe pas de formule standard--les pays a progression rapide ont deploye des strategles personnalisees et se sont adaptes rapidement auxchangements. Cependant, ces pays ont en commun des approches efficaces visant 3 grands axes afin de reduire la mortalite maternelle et infantile. Premierement, ils impliquent de nombreux secteurs pour traiter les facteurs determinants et cruciaux pour la sante. Pres de la moitie de la reduction de la mortalite infantile dans les pays a faible revenu et a revenu intermediaire depuis 1990 resulte des investissements dans le secteur de la sante, l'autre moitie etant attribuee aux investissements realises dans les secteurs exterieurs a la sante. Deuxiemement, ces pays utilisent des strategies pour mobiliser les partenaires dans la societe, en utilisant des donnees solides et opportunes pour la prise de decisions et la responsabilisation, ainsi qu'une approche de planificaron triple pour prendre en consideration les besoins immediats, la vision a long terme et l'adaptation aux changements. Troisiemement, ces pays etablissent des principes directeurs qui orientent les progres, harmonisent les actions des parties prenantes et generent des resultats dans le temps. Cette synthese de donnees contribue a l'ensemble des connaissances requises pour accelerer les amellorations sur la sante des femmes et des enfants en vue de l'echeance de 2015 et au-dela. La reduccion de la mortalidad materna e infantil es una prioridad en los Objetivos de Desarrollo del Milenio (ODM), y probablemente lo seguira siendo despues de 2015. Existen evidencias sobre las inversiones, las intervenciones y las politicas necesarias, pero se sabe menos acerca de por que algunos paises logran un progreso mas rapido que otros paises comparables. Los estudios relativos a los Factores de Exito en la Salud de las Mujeres y los Ninos han tratado de abordar esta brecha de conocimiento por medio de analisis estadisticos y econometricos de datos de 144 paises de ingresos bajos y medianos (PIBM) a lo largo de mas de 20 anos, analisis comparativos cualitativos booleanos, revision de la literatura y revisiones especificas de cada pais en 10 paises bien encarrilados para los ODM 4 y 5a. No existe una formula estandar, estos paises despliegan estrategias a medida y se adaptan rapidamente a los cambios. Sin embargo, comparten ciertos enfoques eficaces a la hora de abordar tres areas principales para reducir la mortalidad materna e infantil. En primer lugar, involucran a numerosos sectores para hacer frente a los factores sanitarios decisivos. Alrededor de la mitad de la reduccion de la mortalidad infantil en los PIBM desde 1990 es el resultado de Inversiones en el sector de la salud, y la otra mitad se atribuye a las inversiones realizadas en sectores fuera del ambito sanitario. En segundo lugar, estos paises utilizan estrategias para movilizara socios a traves de la sociedad, utilizando evidencias oportunas y solidas para la toma de decisiones y la rendicion de cuentas, asi como un enfoque de planificacion triple para considerar las necesidades inmediatas, la vision a largo plazo y la adaptacion al cambio. En tercer lugar, los paises establecen principios rectores que orientan el progreso, armonizan las acciones de las partes interesadas y logran resultados en el tiempo. Este compendio de evidencias contribuye al aprendizaje global sobre como acelerar las mejoras en la salud de mujeres y ninos hacia el 2015 y mas adelante., Introduction Worldwide, accelerated progress is required to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) as highlighted in the United Nations Secretary-General's Global Strategy [...]

Background: Although several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Care (PCMC) scale and obstetric complications. Methods: We used data from four cross-sectional surveys conducted in Kenya (rural: N = 873; urban: N = 531), Ghana (N = 531), and India (N = 2018) between August 2016 and October 2017. The pooled sample included 3953 women aged 15–49 years who gave birth within 9 weeks prior to the survey. Experience of care was measured using the PCMC scale. Univariate, bivariate, and multivariable analyses were conducted to examine the associations between the composite and 31 individual PCMC indicators with (1) obstetric complications; (2) severity of complications; and (3) delivery by cesarean section (c-section). Results: 16% (632) of women in the pooled sample reported obstetric complications; and 4% (132) reported having given birth via c-Sect. (10.5% among those with complications). The average standardized PCMC scores (range 0–100) were 63.5 (SD = 14.1) for the full scale, 43.2 (SD = 20.6) for communication and autonomy, 67.8 (SD = 14.1) for supportive care, and 80.1 (SD = 18.2) for dignity and respect sub-scales. Women with complications had higher communication and autonomy scores (45.6 [SD = 20.2]) on average compared to those without complications (42.7 [SD = 20.6]) (p < 0.001), but lower supportive care scores, and about the same scores for dignity and respect and for the overall PCMC. 18 out of 31 experience of care indicators showed statistically significant differences by complications, but the magnitudes of the differences were generally small, and the direction of the associations were inconsistent. In general, women who delivered by c-section reported better experiences. Conclusions: There is insufficient evidence based on our analysis to suggest that women with obstetric complications report consistently better or worse experiences of care than women without. Women with complications appear to experience better care on some indicators and worse care on others. More studies are needed to understand the relationship between obstetric complications and women's experience of care and to explore why women who deliver by c-section may report better experience of care. Plain language summary: In several studies and reports, women have described mistreatment by health providers during childbirth in health facilities. Particularly in low- and middle-income countries, such mistreatment has negative effects on women's decisions to seek maternity care in health facilities. It is unclear if women with complications are more or less likely to experience some forms of mistreatment compared to women without complications. In this study, we examined 31 experience of care indicators in three domains: (1) Supportive Care; (2) Respect and Dignity; and (3) Communication and Autonomy from the validated Person-Centered Maternity Care (PCMC) questionnaire. We compare these experience of care indicators between women who report obstetric complications and those who don't report complications, by the reported severity of the complications, and by their mode of delivery. The study included data from three countries: Ghana, Kenya, and India. The results showed that the experience of care among women who reported obstetric complications was not consistently better or worse than that of those who did not have complications. Therefore, efforts should be made to improve the experience of care in health facilities for every birthing woman. Additionally, women who delivered via c-section had consistently better experiences than women who delivered vaginally. More studies are needed to understand the relationship between mode of delivery and women's experience of care. [ABSTRACT FROM AUTHOR]

Abstract Background There is increasing attention, globally and in countries, to monitoring and addressing the health systems and human resources inputs, processes and outputs that impede or facilitate progress towards achieving the Millennium Development Goals for maternal and child health. We reviewed the situation of human resources for health (HRH) in 68 low- and middle-income countries that together account for over 95% of all maternal and child deaths. Methods We collected and analysed cross-nationally comparable data on HRH availability, distribution, roles and functions from new and existing sources, and information from country reviews of HRH interventions that are associated with positive impacts on health services delivery and population health outcomes. Results Findings from 68 countries demonstrate availability of doctors, nurses and midwives is positively correlated with coverage of skilled birth attendance. Most (78%) of the target countries face acute shortages of highly skilled health personnel, and large variations persist within and across countries in workforce distribution, skills mix and skills utilization. Too few countries appropriately plan for, authorize and support nurses, midwives and community health workers to deliver essential maternal, newborn and child health-care interventions that could save lives. Conclusions Despite certain limitations of the data and findings, we identify some key areas where governments, international partners and other stakeholders can target efforts to ensure a sufficient, equitably distributed and efficiently utilized health workforce to achieve MDGs 4 and 5.

The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort. INSETS: Panel 1: Countdown data sources and methods.;Panel 2: With adequate focus and financing, coverage can and...;Panel 3: Criteria of quality data for accountability.. [ABSTRACT FROM AUTHOR]