When we set up our programme in 2011, we had high ambitions – to use up-to-the-minute data to really push for positive change for women and babies across six countries in sub-Saharan Africa. Not only making sure governments, health-workers and many other high level actors understand the evidence, but also to engage with the African public- women and their families themselves. We aimed to be the very quintessence of accountability in action across localities- whether urban centres, rural backwaters or far flung rural towns within each country.
When we started, the E4A programme felt like quite a leap of faith. We knew from other sectors – smoking and malaria, for example – that a strategic combination of evidence, advocacy and accountability could be just the answer to achieving big outcomes. But would it work in maternal and newborn health?
The UK Department of International Development proved itself ground-breaking in funding this programme – it showed that they were serious about investing in women, and making a significant contribution to our six countries in relation to MDGs 4 and 5. Other funders are now seeing the value of making accountability real.
We are now two years into implementation and the occasion is marked by a series of papers published in the International Journal of Gynaecology and Obstetrics, papers which describe what we have been doing and why. Included is tangible evidence of how data affects decision-making and how political will can change with increased accountability.
The papers feature an update on MamaYe, our public action campaign, which focuses on better health, survival and seeks to make the survival of mothers and their babies everyone’s business.
Through MamaYe, we showcase the latest evidence base, and demonstrate what we have always known – that investing in good quality services for all pregnant women and babies is the way to make sure the continuing toll of avoidable deaths can end. Already the African public are driving demand for high quality maternal and newborn care which compels the political establishment to respond with investment and action.
A core part of the series is our papers direct from teams in Africa.
In Sierra Leone, Dr Mohamed Yilla demonstrates how we worked with non-government organisations and civil society partners on a health budget tracking exercise by developing citizens’ health budget scorecards for each district that provided information on health finances for the financial year 2011–2012. The latest government shows an increase from 7.4% in 2012 to 10.5% for 2013.
From Nigeria, Dr Aminu Magashi Garba reports on the establishment of a national accountability mechanism for maternal and newborn survival and initiates the monitoring that can prove its effect. For the first time, civil society has a formal role in monitoring the implementation of Nigeria’s road map for maternal and newborn health – and they have grabbed this opportunity with commendable passion, intelligence and integrity.
We are already busy writing the next set of papers, due in spring next year, where we will focus on quality of care from around Africa, including the story of supportive supervision in Ghana, district dashboards in Malawi as well as the global MDSR Action Network.
Each of these stories describe the importance of systematically measuring quality of care in maternity facilities – for us, improving the availability and reliability of the data is a big part of communicating the evidence.
As we pass the last 500 days before the deadline for the MDGs and as New York plays host to the 69th United Nations General Assembly, our evidence is building on how a revolution in accountability can be the engine for change. Our future issues will take that learning to 2015 and beyond as we build the accountability framework for the new era in development.
Maybe a little knowledge can be a dangerous thing – but a lot of knowledge can certainly be dangerous enough to shake up our health systems and make a permanent change for the better .