2020 REPORT women’s, children’s, and adolescents’ health in the context of UHC and the SDGs REPORT LAUNCH VERSION 2020 Report: Caught in the COVID-19 storm: women’s, children’s and adolescents’ health in the context of UHC and the SDGs. © World Health Organization (acting as the host organization for the Independent Accountability Panel for Every Woman, Every Child, Every Adolescent) 2020 Suggested citation. Independent Accountability Panel for Every Woman, Every Child, Every Adolescent. 2020 Report: Caught in the COVID-19 storm: women’s, children’s and adolescents’ health in the context of UHC and the SDGs. Geneva: World Health Organization, 2020. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. 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CONTENTS FOREWORD 4 ACKNOWLEDGEMENTS 5 ABBREVIATIONS 7 EXECUTIVE SUMMARY 8 CHAPTER 1: Status of women’s, children’s and adolescents’ health in the context of UHC and SDGs, and implications of COVID-19 14 CHAPTER 2: Fast lane, slow lane – countries with similar resources achieve different results 26 CHAPTER 3: Unique contexts, global challenges – accountability to accelerate country progress 44 CHAPTER 4: Revitalizing accountability – a framework and recommendations to accelerate progress 58 REFERENCES 69 ANNEXES 75 FOREWORD This report comes at a time of global crisis, with to protect women, children and adolescents, not just COVID-19 killing hundreds of thousands of people, during this pandemic, but through to 2030 and beyond. and infecting many more, the world over. The direct effects on those who contract the disease, and their Wherever they live, however hard they may be to families, are huge. But so are the indirect effects on so reach, women, children and adolescents are all, many millions more women, children and adolescents. without exception, entitled to high-quality healthcare. The world was already lagging behind 2030 targets This should never be regarded as a luxury, but a life- to protect them. Now, the pandemic is making the saving resource. To ensure they get it, we do, indeed, situation far worse. need the Decade of Action that the UN Secretary- General, António Guterres, has called for to deliver on As a result of COVID-19, health systems in both rich the commitments world leaders have made to ensure and poor nations are struggling, with services for universal health coverage and primary health care, to women, children and adolescents’ is simply crumbling. follow International Health Regulations and achieve Access to life-saving vaccines for children is declining, the Sustainable Development Goals and human rights. sexual and reproductive health services are being disrupted putting millions lives at risk – including Our report shows the vital importance of accountability during childbirth, adolescents are suffering from – to connect commitments to progress. Accountability social isolation and mental health issues, and risks of allows us to learn from mistakes, build on achievements abuse and violence for all these groups is increasing. and strengthen our resilience to crises and pandemics. Inequities and racial and ethnic discrimination are rife. Accountability means delivering prompt, effective, high- Women, children and adolescents and others in fragile quality results, transforming commitments into action. situations are least able to access the financial and social support to mitigate these risks. Our report sets out an accountability framework and give key recommendations as to how countries can COVID-19 is demonstrating the centrality of health succeed, so long as accountability is truly embedded. to social, political and economic imperatives. Yet, at Every leader and government must do what they say the same time, it is revealing how weak our health, they will, with citizens fully able to participate and social and financial systems are at protecting women, claim their rights. children and adolescents. In fact, we are reaching a point where decades of progress to realize their health The IAP reviews the progress and accountability and and rights could be reversed. recommends what needs to be done. The accountability cycle now requires governments, private sector, donors, This, our 2020 report, looks closely at what we can learn civil society, development partners and all stakeholders from countries’ responses to COVID-19, while distilling to decide how to remedy and then act ensure progress. lessons from a decade of Every Woman Every Child accountability. It reviews progress, and shows how, Then, we will finally live up to our promise to the world’s as a global community, we can uncover the means women, children and adolescents. The Independent Accountability Panel Joy Phumaphi, Elizabeth Nicholas Kojo Carol Kidu Brenda Killen Giorgi Jovana Rios Gita Sen Alicia Ely Yamin co-chair Mason, co-chair Alipui Papua New Ireland Pkhakadze Cisnero India USA Botswana United Kingdom Ghana Guinea Georgia Panama 4 2020 REPORT ACKNOWLEDGEMENTS The IAP extends our appreciation to the United to inform the forward recommendations. Rachael Nations Secretary-General, António Guterres, and Hinton of RHEdit provided technical and editorial his Executive Office with Amina Mohammed, assistance for the country case studies. Richard Deputy Secretary-General and Nana Taona Kuo, for Cheeseman, Robert Taylor and Lorraine Forrest- entrusting us with the important task of contributing Turner of Robert Taylor Communications provided to strengthening accountability to drive progress writing and editorial support. We also would like on women’s, children’s and adolescents’ health and to thank Claudia Quiros and Kalyani Mohan for rights. We thank all partners in the global Every their inputs on communicating the accountability Woman Every Child (EWEC) movement for their framework and recommendations. collective commitments and efforts towards this goal. Special thanks to the Partnership for Maternal, We extend special thanks to the country teams and Newborn & Child Health (PMNCH) for hosting, funding over two hundred participants in the IAP 2020 report and operational support for the IAP’s work on behalf case studies – women and girls, men and boys, civil of EWEC, with PMNCH Board Chair Helen Clark and society, community leaders, academia, governments, Helga Fogstad, Executive Director. the UN family, health workers, private sector, media and others. They participated in the process, shared Both PMNCH and the IAP are hosted at WHO, and our their experiences, and suggested innovative and sincere appreciation for WHO’s ongoing support to the practical actions to advance progress, and most IAP and for global health leadership that is invaluable, importantly committed to take forward country ever more so during the COVID-19 pandemic. We efforts to strengthen accountability and accelerate express our deepest gratitude to Tedros Adhanom progress. Their work was significantly disrupted by the Ghebreyesus, WHO Director-General, Zsuzsanna pandemic, but they were able to produce great results Jakab, WHO Deputy Director-General, and the greatly by reverting to alternative arrangements such as missed, late Peter Salama, Executive Director Universal convening virtual multistakeholder dialogue sessions Health Coverage and Life Course for supporting the at short notice. The country case study teams are: IAP’s work, including the loan of Shyama Kuruvilla as 1) Papua New Guinea, under the leadership of Carol Director a.i. IAP Secretariat for the past year. Kidu with the Burnet