Community participation for transformative action on women's, children's and adolescents' health.

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.

La Stratégie mondiale pour la santé de la femme, de l'enfant et de l'adolescent (2016-2030) reconnaît que les individus jouent un rôle central dans l'amélioration de leur propre santé. Nous pensons que la participation communautaire, et notamment des communautés qui travaillent avec les services de santé (coproduction en matière de soins de santé), sera essentielle pour atteindre les objectifs de la stratégie mondiale. La participation communautaire répond plus particulièrement au troisième objectif clé: transformer les sociétés afin que les femmes, les enfants et les adolescents puissent exercer leur droit de jouir du meilleur état de santé et de bien-être possible. Dans le présent rapport, nous examinons ce que ceci suppose dans la pratique. Nous analysons trois domaines interdépendants dans le cadre d'une action visant une plus grande participation du public en matière de santé: améliorer la capacité de participation des individus et des groupes, développer et assurer la pérennité des services de santé axés sur l'être humain, et favoriser la responsabilisation sociale. Nous donnons par ailleurs un aperçu des difficultés liées à la mise en œuvre et fournissons aux décideurs, aux administrateurs de programmes et aux professionnels de la santé des exemples illustrant les différents types d'approches participatives nécessaires dans chaque domaine pour atteindre les objectifs liés à la santé et au développement.

La Estrategia Mundial para la Salud de la Mujer, el Niño y el Adolescente (2016-2030) reconoce que las personas tienen un papel fundamental a la hora de mejorar su propia salud. Proponemos que la participación comunitaria, concretamente las comunidades que trabajan junto con los servicios sanitarios (coproducción de atención sanitaria), sea fundamental para lograr los objetivos de la estrategia mundial. En particular, la participación comunitaria aborda el tercer objetivo fundamental: transformar las sociedades de modo que las mujeres, los niños y los adolescentes puedan ejercer sus derechos de salud y bienestar en la mayor medida posible. En este artículo se examina lo que esto implica en la práctica. Se debaten tres ámbitos de acción interdependientes que se encaminan hacia una mayor participación del público en la sanidad: mejorar las capacidades para la participación individual y en grupo; desarrollar y mantener servicios sanitarios centrados en las personas; y contabilidad social. Se repasan los desafíos para su implementación, y se ofrece a los responsables políticos, gestores de programas y médicos ejemplos ilustrativos de los tipos de enfoques de participación necesarios en cada ámbito para contribuir a alcanzar los objetivos sanitarios y de desarrollo.

Closing the health and nutrition gap in Odisha, India: A case study of how transforming the health system is achieving greater equity.

Health equity is high on the international agenda. This study provides evidence of how health systems can be strengthened to improve health equity in a low-income state. The paper presents a case study of how the Government of Odisha in eastern India is transforming the health system for more equitable health and nutrition outcomes. Odisha has a population of over 42 million, high levels of poverty, and poor maternal and child health concentrated in its Southern districts and among Scheduled Tribe and Scheduled Caste communities. Conducted between 2008 and 2012 with the Departments of Health and Family Welfare, and Women and Child Development, the study reviewed a wide range of literature including policy and programme documents, evaluations and studies, published and grey material, and undertook secondary analysis of state level household surveys. It identifies innovative and expanded provision of health services, reforms to the management and development of human resources for health, and the introduction of a number of cash transfer and entitlement schemes as contributing to closing the gap between maternal and child health and nutrition outcomes of Scheduled Tribes, and the Southern districts, compared to the state average. The institutional delivery rate for Scheduled Tribes has risen from 11.7% in 2005-06 to 67.3% in 2011, and from 35.6% to 79.8% for all women. The social gradient has also closed for antenatal and postnatal care and immunisation. Nutrition indicators though improving are proving slower to budge. The paper identifies how political will, committed policy makers and fiscal space energised the health system to promote equity. Sustained political commitment will be required to continue to address the more challenging human resource, health financing and gender issues.

The Global Nutrition Report 2014: actions and accountability to accelerate the world's progress on nutrition.

In 2013, the Nutrition for Growth Summit called for a Global Nutrition Report (GNR) to strengthen accountability in nutrition so that progress in reducing malnutrition could be accelerated. This article summarizes the results of the first GNR. By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light. Nearly every country in the world is affected by malnutrition, and multiple malnutrition burdens are the "new normal." Unfortunately, the world is off track to meet the 2025 World Health Assembly (WHA) targets for nutrition. Many countries are, however, making good progress on WHA indicators, providing inspiration and guidance for others. Beyond the WHA goals, nutrition needs to be more strongly represented in the Sustainable Development Goal (SDG) framework. At present, it is only explicitly mentioned in 1 of 169 SDG targets despite the many contributions improved nutritional status will make to their attainment. To achieve improvements in nutrition status, it is vital to scale up nutrition programs. We identify bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlight actions to accelerate coverage and reach. Holding stakeholders to account for delivery on nutrition actions requires a well-functioning accountability infrastructure, which is lacking in nutrition. New accountability mechanisms need piloting and evaluation, financial resource flows to nutrition need to be made explicit, nutrition spending targets should be established, and some key data gaps need to be filled. For example, many UN member states cannot report on their WHA progress and those that can often rely on data >5 y old. The world can accelerate malnutrition reduction substantially, but this will require stronger accountability mechanisms to hold all stakeholders to account.