Acknowledgement

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SRHR Commodity Security Strategies

Namibia has promoted intersector cooperation to help reduce stock-outs.
Although SRHR commodity security strategies and action plans are in place, their operation is still a challenge, sometimes because of inadequate or delayed funding. This results in stock-outs especially in rural areas. Many countries recommended that reproductive health commodities be included in the essential medicines list. Government ownership – or the lack thereof – is sometimes a challenge, as external partners support commodity supply in some countries (Table 5). The Pharmaceutical Manufacturing Plan for Africa provides a framework for promoting local or regional production and should be explored.
Table 5: Commodity security for SRH

Indicators	Done	In progress	Not done
National RH commodity security strategy & action plans in place	33 (78.6%)	7 (16.7%)	2 (4.8%)
RH commodities in essential medicines list	38 (90.5%)	3 (7.1%)	1 (2.4%)
National budget line for SRH commodity security	21 (50%)	3 (7.1%)	18 (42.9%)

Prolonged reproductive health commodity stock-outs were reported by seven (16.7%) countries. Ten (23.8%) had occasional stock-outs and 25 (59.5%) did not experience stock-outs (indicator 31).

Monitoring, Evaluation and Coordination Mechanisms

Many countries have institutionalized monitoring and evaluation (M&E) systems or are in the process of doing so. Competing priorities, inadequate supervision and coordination, and limited human resources are some of the challenges countries face in this area. It was recommended that a Coordination Committee be put in place in the Ministries of Health if such does not exist. Heath information systems in African countries should be developed and managed properly for effective M&E and information sharing (Table 6); data should be disaggregated by gender and age.

Table 6: Monitoring, evaluation and coordination mechanism

Indicator	Done	In progress	Not done
Censuses, DHSs, and maternal and neonatal death reviews conducted regularly	29 (69%)	6 (14.3%)	7 (16.7%)
A monitoring and evaluation system institutionalized	28 (66.7%)	12 (28.6%)	2 (4.8%)
Operational research findings utilized	19 (45.2%)	18 (42.9%)	5 (11.9%)
Resource allocation and utilization regularly monitored	21 (50%)	10 (23.8%)	11 (26.2%)
Best practices documented	19 (45.2%)	11 (26.2%)	12 (28.6%)
Functional coordination and harmonization	23 (54.8%)	13 (31%)	6 (14.3%)

Action Undertaken by AU and Partners (2007–2010)

A 2008/09 assessment by UNFPA found an unprecedented effort in Africa to revise, update and develop policies, strategies and plans related to the different components of SRHR highlighted in the Maputo Plan of Action.

Following its adoption, the Maputo POA was disseminated to the Member States. They were urged to put it into operation at national level. Further, Members were encouraged to work in close collaboration with all relevant stakeholders and partners. The UNFPA, IPPF and other partners facilitated regional workshops to scale up and monitor progress towards this end.
As a follow-up to the Maputo POA, the April 2008 African Continental Workshop to Harmonize, Develop, and Institutionalize the Maternal, Newborn and Child Mortality Reviews and Accelerate the Implementation of Recommendations towards Meeting MDG 4 and 5 was organized by the Government of South Africa, in collaboration with the AUC, WHO, UNFPA and UNICEF. Action in this area was deemed very important because if deaths are not registered, the underlying causes of death cannot be addressed. It was recommended that an AU Goodwill Ambassador and Champion for “Africa’s Movement to Improve Maternal Health and Promote Child Survival and Development beyond 2015” be appointed. This recommendation was duly endorsed by the 2008 Special Session of the AU Conference of Ministers of Health.
In 2008/09, UNFPA conducted an assessment of the status of development of the Maputo POA, including the National Maternal Newborn Health Road Maps (UNFPA, 2008). The main highlights from that assessment generally concur with the findings in this progress report on the Maputo POA.
The UNFPA assessment noted that an unprecedented effort is ongoing in Africa to revise, update and develop policies, strategies and plans related to the different components of SRHR as highlighted by the Maputo Plan of Action. Specifically on the maternal and neonatal health (MNH) road maps, however, the assessment found a number of issues needing attention and action. Among these were the following:

The quality of the situation analyses was generally poor and could have negatively affected the identification of strategies and activities to be implemented.
Family planning programmes are not clearly integrated with the MNH plans.
Human resources development and management plans for EmONC are not well developed.
Community involvement/mobilization is addressed, but not all countries have defined detailed interventions for newborn/child health and HIV at community level.
Complications of abortion, which constitute one of the major causes of maternal death and disability in most African countries, are poorly addressed in general, even in countries where abortion is legal.
Although many countries have developed MNH road maps, a significant number do not have plans for scaling-up the key strategies and interventions.
Many MNH plans have been costed, but responses to the budget issues were generally poor.
One of the lessons learnt during the implementation of MPOA is that incentives are needed to motivate staff, especially those in rural areas. This also contributed to reverse the health workforce crises.
Although the maternal and newborn health initiative requires massive investments, available resources are limited. Only a few countries had developed strategies for resource mobilization.

Monitoring and evaluation of the implementation of MNH road maps requires a work plan, budget and a multi-disciplinary team, but not all countries had these requirements in place.
While key MNH indicators are included in the national health management information system (HMIS) in many countries, integrating these plans within national health plans and financing processes is now a challenge the majority of countries are facing.

The UNFPA report concluded that although planning is important, real progress in newborn, child and women’s health will be made by implementing and scaling up cost-effective, well-defined priority interventions and monitoring them to track progress and improve the plans in a cyclical planning process. Immediate and long-term activities are necessary, to be implemented at the same time with strong political support and appropriate investments. UNFPA, UNICEF, WHO and the World Bank (H4), working together with donor countries, global funds and foundations, and regional and international NGOs, can be instrumental in providing the necessary support to countries toward the achievement of MDGs 4 and 5.

No woman should die while giving life!

The deliberations of the 4th Session of the AU Conference of Ministers of Health, held in Addis Ababa in May 2009 with the theme Universal Access to Quality Health Services: Improve Maternal Neonatal and Child Health, served as a reminder to Member States to scale up implementation of the Maputo POA and other relevant commitments. Recommendations for promoting universal access to health services and improving maternal, neonatal and child health were adopted. The Campaign on Accelerated Reduction of Maternal Mortality (CARMMA) was also launched, with the slogan No woman should die while giving life! The goal set for CARMMA is to “contribute to further advancement of social development in the continent through proactive support to national efforts aimed at reducing maternal mortality in Africa” (AUC, 2009a). CARMMA was welcomed as an important advocacy tool and subsequently launched in many Member States. It is also well-supported by the international community.

In line with the AU Gender Policy, the African Women Decade was extended to 2010–2020. One of its objectives is to continue raising awareness and mobilizing support and political will for implementing the agreed international, continental, regional and national commitments on gender equality. Implementation is focusing on the following priorities, among others: Education; health and maternal mortality; and gender-based violence including harmful practices, which covers early marriage and female genital mutilation (FGM).
Action to implement the Maputo POA at national level is supported by the UN agencies, bilateral and multilateral partners, intergovernmental agencies, and foundations. The immense support is commendable, but should well-coordinated and harmonized, and in line with national priorities and programmes.
It will be recalled that the Road Map for Accelerating the Attainment of MDGs related to Maternal and Newborn Health was adopted in 2004 by the WHO Regional Committee for Africa. The Road Map’s key intervention for reversing maternal and newborn mortality is to give special attention to emergency obstetric and newborn care, and to skilled attendance. Its implementation is directly linked to that of the Maputo POA.
The annual progress reports on the status of implementation of the MDGs indicate that Africa is making forward strides on some of the goals, but unfortunately the worst performance is still on MDG 5 – Improve maternal health. In line with the Continental Policy Framework, the WHO Regional Committee for Africa launched Women’s Health Day in the Africa Region in September 2009. A Commission on Women’s Health has also been established to coordinate and follow up on recommended advocacy and action. The whole continent should join hands and support this important initiative.
In the framework of the increasing partnerships between Africa and other regions, as well as with specific developed countries and their development agencies, action to promote maternal, newborn and child health in Africa is being undertaken both at the AU and in Member States: Bilateral and multilateral cooperation, Africa–EU cooperation, Africa–USA cooperation and Africa–G8 parliamentarians. With all that, in the framework of the Regional Coordination Mechanism (RCM) of UN agencies and organizations working in Africa in support of the AU, the AU and partners should avoid duplication through joint planning, implementation and coordination of strategies.

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