Global Business Plan for Millennium Development Goals 4 & 5 Advocacy Plan Phase I: Assessment, Mapping and Analysis Final Report By Rachel Grellier (Team Leader) Ann Pettifor Katie Chapman Elizabeth Ransom Devjit Mittra Sarah Javeed Justin Nguma October 2007
EXECUTIVE SUMMARY The development of the Global Business Plan (GBP) represented a new-found determination among development cooperation agencies and international stakeholders to get Millennium Development Goals 4 (reducing maternal mortality) and 5 (reducing child mortality) on track. The GBP for MDGs 4 & 5 had six objectives, including developing an Advocacy Plan to generate global political support and mobilise resources and demand among both donor and developing countries. Given that more than 14 million children, babies and their mothers die unnecessarily each year, a much larger number than deaths from either cancer or HIV/AIDS, this is a timely initiative. The GBP echoed the frustration that after twenty years of the safe motherhood initiative, little progress has been made, and the sense of urgency expressed by maternal, newborn and child health stakeholders for strong, coordinated and compelling advocacy on MDGs 4 and 5. The Global Business Plan has now been superseded by the newly launched Global Campaign for the Health MDGs, led by the leaders of Norway, Great Britain and Canada. Advocacy efforts to get MDGs 4 & 5 back on track will be led by the Partnership for Maternal, Newborn and Child Health (PMNCH), which recently launched Deliver Now for Women and Children, a global campaign to reduce maternal and child deaths. While this report refers to the Global Business Plan, the research findings are applicable to the newer campaign. This report covers the first phase of the Advocacy Plan. This involved, in conjunction with the Advocacy Working Group of the GBP, identifying three donor countries (Norway, UK and Japan) and three developing countries/states (Pakistan, Orissa State in India, and Tanzania) to provide information on key issues necessary for the development of a global campaign. This report presents the findings of research and mapping capacity and resources for advocacy; audiences and stakeholders for advocacy; identification of lessons learned from earlier advocacy processes; and analysis of advocacy messages that have/have not worked in the past. The findings of this first phase will be used to develop the advocacy campaign (Phase 2), which will be launched in September 2007 and then put into action (Phase 3). The research and mapping took place through face-to-face interviews with a wide range of stakeholders (government, donor, media, NGO and civil society) during one week visits to three developing countries/states: Pakistan, Orissa (India), and Tanzania. Information on donor country perspectives was gathered by telephone interviews with stakeholders in Japan, Norway and the UK. The report presents country case studies which cover the situation at present i.e. levels of priority given to MDGs 4 and 5, mapping advocacy, and analysis of previous successful advocacy campaigns; the case studies also provide information on what needs to be done to optimise successful advocacy for MDGs 4 and 5 i.e. advocacy messages and, and advocacy opportunities over the next 1 3 years. This executive summary presents a summary of the findings, together with a synopsis of the conclusion and key recommendations.
Key advocacy challenges: It is important to communicate key issues on MNCH to civil society as part of social mobilisation. This will mean using less exclusive language than that used often by development professionals, experts, and practitioners. It will be important to avoid using language and acronyms (such as MDGs ) commonly understood by the development community Raising the priority of MDGs 4 ad 5 to an equal footing with current geo-political concerns will be challenging, but essential to ensure Provincial and District governments prioritise maternal, newborn and child mortality (Pakistan, Orissa and Tanzania). This is likely to be challenging in many developing countries, like India, Pakistan and Tanzania, where floods, drought and terrorism threaten far more lives than maternal and child mortality. It will also be challenging in donor countries such as the US and the UK, where presidential and general elections are imminent; in Pakistan, facing a presidential election; in Europe and the US, where the threat of economic recession looms; and in Japan which has still to recover from the recession of 1990 to date, and where government spending is a major concern. It will not be easy to persuade the major development NGOs, including the child-centred NGOs, to prioritise MDGs 4 & 5. The development NGOs are important communication centres, both nationally, but also internationally, and very few prioritise MDGs 4 & 5. Firing up these NGOs, through direct advocacy is important, because they will in turn mobilise their memberships and increase awareness with civil society and media. Few of the most influential NGOs, in Tanzania, Pakistan and Orissa had prioritised this issue. One commented that they would only do so in the broader context of a campaign around poverty. Donor governments need to monitor expenditure on MDGs 4 and 5 against their commitments. We were made aware in the three poor countries we visited of the need for harmonisation and coordination of donor-inspired global health initiatives. Increasing the prioritisation of MNCH objectives within policy documents (Pakistan, Orissa and Tanzania) An important challenge will be to develop approaches for channelling policy commitments into budget support for interventions that will impact on maternal, newborn and child mortality (Pakistan, Orissa and Tanzania) Perhaps the most daunting challenge is how to change cultural beliefs in relation to the importance of the role of healthy mothers and children in equipping communities and nations to face the future; (Pakistan, Orissa and Tanzania)
Mapping advocacy In all countries a limited number of committed NGOs are working at a practical level, to reduce maternal, newborn and child mortality. However, at present advocacy efforts tend to be small-scale and uncoordinated. Priority audiences for advocacy are parliamentarians and government officials, civil society and the media. In all countries a number of potential champions were identified, from royalty and celebrities to eminent researchers. However, interviewees in the developing countries also highlighted the need to identify non-celebrity potential champions to emphasise the relevance of MDGs 4 and 5 to all individuals, households and communities. Advocacy messages The majority of stakeholders agree on the need for immediate action if MDGs 4 and 5 are to be brought on track, and that advocacy has an important role to play. There is an urgent need, however, for messages to be stronger, clearer and more coordinated, and for greater use to be made of national and international events as opportunities to highlight the unacceptably high levels of mortality among mothers, newborns and children. In all countries data on the scale of the problem and also on progress and success stories is essential for effective political advocacy and public campaigning. Journalists demand statistics to give impact to their stories, just as politicians want to communicate clear results on what difference their donor funds have made. Contrasting the child, newborn and maternal mortality data of developing countries with domestic figures is seen to be a powerful way of highlighting the injustices of the situation, although the developing countries also highlighted the need to bring the message back home by making south-south comparisons as well as highlighting district or provincial disparities in mortality rates. Although there was no dispute that MDGs 4 and 5 are intrinsically linked to basic human rights, there was a consensus of opinion that the advocacy campaign should focus strongly on the loss of actual (in the case of mothers) and potential (in the case of newborns and children) human capital, and emphasise the importance of women s domestic and economic labour to maintaining healthy households. For both civil society and media, simple, powerful understandable messages are urgently required, plus human interest stories to demonstrate how resources save the lives of mothers and children. The complex issues that underlie maternal, newborn and child mortality, for example the links with weak health systems, meant that no interviewees were able to come up with a single, unifying message that clearly presented itself as a potential statement which could lead the advocacy campaign.
Conclusion Many organisations and strong individuals are working to reduce maternal, newborn and child mortality in the developing countries. There is, however, a need for a single institution to take on the role of effective leadership to coalesce the network of concerned individuals. There is also a need for a clear and strong externally resonating frame, a public positioning of the issue that inspires external audiences, especially political leaders who control resources, to act. None of those interviewed offered a clear and strong externally resonating frame for advocacy although most talked about the need to stress the injustice; and the scale of the tragedy. Some also challenged a perceived concern about mothers and children, while in everyday life little regard is given to their welfare and life chances. Several advocates highlighted the lack of funding available for advocacy initiatives on MDGs 4 and 5. Advocacy requires dedicated resources and can be very cost-effective, yet this is not necessarily recognised by development cooperation agencies. If advocacy is to be led successfully within developing countries (as opposed to pressure being imposed externally by development cooperation agencies) then there is an urgent need to build advocacy capacity in developing countries. This requires a mix of aid instruments, including financing mechanisms that channel donor funds direct to civil society groups as a complement to budget support to government. There is also a need for immediate provision of specialist support and strengthening of advocacy skills if further delay of powerful advocacy messages is to be avoided, and if forthcoming national and international events are to be used as effective platforms for advocacy on MDGs 4 and 5. This could be achieved by donor funding for specialist technical assistance, including linking advocacy specialists (from global through to community based advocacy) with country-based organisations and individuals. Recommendations The majority of these recommendations arose out of the interviews conducted; a few are drawn from the team s wider advocacy experience: Combining maternal, newborn and child mortality data is essential in order to draw attention to the scale of the tragedy affecting mothers and their children (as would including morbidity rates associated with pregnancy and delivery). Official statistics frequent exclude stillbirths but for most people stillbirths represent the loss of a life, and thus they should be included. In poor counties, the advocacy debate (directed at government) needs to be framed around the economic wastage, the opportunity cost of lives lost or damaged by childbirth, and by poor health. In rich countries, the debate could be framed around the injustice of the drastically reduced life chances of women, babies and children in poor countries, compared to women and children in rich countries. This could be framed in the context of resources devoted to providing military hardware to those countries (Pakistan is a striking example) in comparison to resources provided by rich countries to reduce poverty/save and enhance the lives of mothers and children. There is a need for an international research institute or collaborative forum to provide a strong institutional lead, prioritise collection of data at national, regional and district level data, and disseminate this information in a way that supports and promotes effective advocacy.
Donor agencies need to undertake sophisticated, sensitive and low-key advocacy aimed at a range of constituencies within developing countries, including encouraging greater coordination between ministries. Donor coordination and technical assistance to increase country-based advocacy capacity is also essential. Developing country advocacy must be led by local, independent champions including faith groups, prominent journalists, NGO representatives and elected politicians. Children are the mothers and fathers of tomorrow. Young people should be explicitly targeted, and involved in advocacy. Development cooperation agencies and governments should include professional councils, universities, principals and faculty of colleges and universities as both targets of advocacy and champions of advocacy. Communication on maternal, newborn and child mortality needs to be more direct and much harder-hitting than in the past. The advocacy campaign should draw on the expertise of advocacy/communication specialists as well as development professionals. An important audience are faith groups and leaders in order to build on positive aspects of already deeply embedded values. Men need to be key targets of advocacy. Getting men whose mothers died in childbirth to tell their stories on TV, radio or film would attract the attention of other men and invest the issue with emotional power absent in formal reports. Fathers and sons who play a positive role in supporting and caring for their wives and children should be showcased and celebrated. A singular, positive brand and associated messaging is essential for the advocacy campaign. This needs to be based on overarching messages which encompass mothers, children and newborns and led by an independent, inclusive and intellectually effective organisation/partnership/coalition. Advocacy initially needs to be directed at those most likely to be allies. These allies should then be supported to increase their capacity to marshal arguments, rebut challenges and focus their advocacy efforts towards the media, the private sector and influential opinion-formers and decision-makers. Journalists in developing countries should be encouraged to mount sustained campaigns on MDGs 4 and 5. To achieve this, the lead advocacy organisation in each country should be pro-active in providing a constant stream of compelling stories, data and briefings to journalists, rather than depending on journalists to think up or investigate new stories.