By Karthik Shankar:
Vinita Devi, a ward member of the north Panchayat of Sitamarhi district, Bihar, comes from a humble background. She did not receive formal education and her husband sells vegetables to make ends meet. Yet this did not stop her from affecting change in her community. After learning about her rights as a ward member, under the women’s leadership program supported by the NGO, Centre for Catalyzing Change, she started to mobilise her community members on women’s issues. She has been pushing women in her village to ensure they get timely immunisation, antenatal check-up at the VHSND and avail family planning services from the Health Sub Centre monitoring service delivery through standardized checklists.
A similar primer on her rights inspired Meera Kumari, a ward member from Muzaffarpur to press her community on different issues like health and hygiene, immunization, education, right age of marriage etc.
Vinita and Meera’s cases are examples of how ordinary citizens and elected representatives can play a significant role in ensuring service delivery and uptake. Their roles become critical especially in the context of communities that continue to grapple with high maternal and neonatal deaths.
India has made significant strides in lowering the maternal mortality rates and the National Health Mission (erstwhile NRHM) has made both financial and service commitments to ensure safe birthing and better neonatal health, in sync with the UN supported Millennium Development Goals (MDGs). While the MDG Framework looked at broad targets around reducing maternal mortality and neo-natal mortality (MDG 4 and MDG 5), the post 2015 agenda that brings in a new set of international targets called the Sustainable Development Goals (SDGs)which are envisioned to have disaggregated targets specific to countries and regions. There are already a list of proposed SDGs from poverty eradication, gender equality and sustainable development. Essentially, the SDGs will become the new flag bearer for development agendas everywhere and will define the UN agenda for several initiatives including the ambitious $40 billion Global Strategy for Women and Children’s Health.
All these are noble endeavours but they raise as many questions as answers. What do the proposed targets on women and children’s health actually mean in the national context? The proposed list of seventeen goals uses the word ‘inclusive’ six times. In such an instance the only way in which such targets can become inclusive is if they involve the general public through various strategies.
With the development of the Sustainable Development Goals agenda, 2015 marks a critical opportunity to establish frameworks to accelerate action on maternal, newborn and child health. Within these frameworks, global and national accountability systems which both monitor and drive the delivery of promises on women’s and children’s health, should be put in place to support targets on maternal, newborn and child health. Such accountability mechanisms must include the direct engagement of citizens.
White Ribbon Alliance is working with World Vision International, IPPF, Save the Children and many other partners to organise national and district level Citizen’s Hearings in at least 30 countries in the first half of 2015. These hearings provide a structure for civil society to give recommendations on national mechanisms for accountability, which must be addressed in the updated Global Strategy and the SDGs.
The concept of a National Citizens Hearing is based on the key recommendation relating to civil society from the Independent Expert Review Group (iERG). ‘From 2015 onwards, hold a civil-society-led World Health Forum adjacent to the World Health Assembly to strengthen political accountability for women’s and children’s health. The purpose of the Forum would be to bring all parties with an interest in global health together at the time of the World Health Assembly—to hold the intergovernmental process accountable to the citizens of countries, and to facilitate and coordinate action by non-government actors. This World Health Forum would be an important contribution to the democratisation of global health.’
While the MDGs were instrumental in the coalescing of development goals worldwide, they were less successful when it came to the implementation of these goals. One of the shortcomings of the MDGs was that it did not take into account the harshly different realities of various countries, from an economic, social and political point of view. The SDGs must rectify that error by making citizens and civil society an integral part of the accountability process for these goals. Given that equity is one of the cruxes of the SDGs, what better way to ensure that than bring in the general public into the process of consensus building for women and children health goals?
Accountability to the public will ensure that these goals truly become a participatory process in which citizens have as much say as governments, corporations and NGOs
In carrying forward its legacy of people led advocacy and bringing together a diverse range of stakeholders to ideate, deliberate and constructively dialogue to further women’s and children’s health in India, the White Ribbon Alliance in India and collaborating partners Centre for Catalyzing Change, Save the children, IPPF, FPAI, RMNCH+A coalition, World Vision India, Plan India are hosting a National Meeting on Citizen’s Participation and Engagement for Improving Women’s and Children’s health under the global campaign banner of “Nothing About Us, Without Us”.
Time is limited to ensure that people like Vinita and Meera have a say but it could make all the difference between setting the goals and achieving them.