New Delhi just witnessed the conclusion  of the Partnership for Maternal, Newborn and Child Health (PMNCH) Forum meeting.  Started in 2005,  the Partnership, as it is referred to, was formed to strengthen consensus building to support the achievement of the MDGs (especially MDG 4 & 5) and to focus on the importance of the continuum of care especially for sexual and reproductive health and rights of women and adolescents.  The Partnership also seeks to focus on the first few weeks of the life.  With a mission to increase the engagement, alignment and accountability of partners, the Partnership seeks to create a multi-stakeholder platform to support the implementation of the Global Strategy for Women’s, Children and Adolescent’s health to enable partners to achieve more through the power of the collective.

It is worthwhile to examine whether the recently concluded PMNCH Forum meeting made progress on the themes that it sought to explore: putting people at the centre, cross sectoral action to bend the curve for women’s, children’s and adolescent’s health and the power of the Partnership as an accelerator for action.  The meeting certainly did achieve the last of the three themes and saw participation from all 10 PMNCH constituencies ( i.e. partner countries; donors and foundations; intergovernmental organisations; non-governmental organizations; academic, research and training institutions; adolescents and youth; healthcare professional associations; private sector partners, UN agencies and global financing mechanisms).  Representatives of various countries shared the programmes and schemes that they had undertaken to improve sexual and reproductive health of women, children and adolescents, as did UN Agencies, civil society organisations and  private sector players.  However, it is essential to closely and critically examine whether people, especially the marginalised were at the centre of these programmes and schemes. As revealed in a concurrent session on data, marginalised populations such as indigenous people are often left out of programmes. It was pointed out that the ‘country aggregate approach’ to data does not answer the need for robust monitoring to identify marginalized and excluded groups, which is critical for applying human rights based approaches and ensuring that all women, children and adolescents are reached.  

It’s time to start worrying, I feel, when GAVI is considered as some sort of equity “role model” by reducing the immunisation gap between rich and poor nations (even if I admit GAVI is doing valuable work). The fact that GAVI is making available cheap vaccines on a large scale in Africa was highlighted as one of the ways in which the equity gap is being closed.  I worried even more when I heard one of the Ministers of India talk about the steps that are being taken to influence the adverse sex ratio, mentioning that planting a tree and offering it as a gift  to each girl born is a positive step, as it will ensure that the girl is no longer a burden (as resources for her dowry are already being collected)! Thus the ultimate goal, it seems, is to get the girl married, rather than ensuring that she is empowered to chart the course of her life and future.

Throughout the plenary and concurrent sessions, failures and negative experiences were not mentioned at all, as if everything tried had been successful.  The more I attend such international events and conferences, the more I feel we are deluding ourselves.  The more we feel the pressure to appear successful (and who does not want to be successful?), the less we like the failures, the less we like the questioning, and the less we like demands for transparency and accountability. Hence, we get together to create ever more structures to purportedly promote rights and replicate already existing relevant treaty bodies such as the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), the Convention on the Rights of the Child (CRC) and the Universal Periodic Review (UPR) where governments regularly report and are held accountable by their peers. Arguably, International Human Rights law has been most used by NGOs in India and Latin America to litigate, perhaps less elsewhere.  And true, International Human Rights instruments  are increasingly criticized by governments and political leaders, as not being applicable because of their so called “Western” origins, but that’s not exactly a trend to encourage further, I feel.

One needs to recognise the fact that the new initiatives talk of ‘voluntary reporting agreements’ which undermine accountability.  The very term accountability implies the binding nature of ‘answerability’ and enforcement which is possible under international law but cannot be guaranteed within voluntary reporting agreements. This also means that if there are rights violations, no corrective remedial action can be taken.  The main method of ensuring accountability is the preparation of a status report (which is really part of a ‘monitoring component’ of accountability) with a managerial component of verification. Human rights accountability requires independent reviews, remedies and redress, which are neither made explicit nor possible within a non-binding framework.

While some progress has been made in terms of SRHR accountability in recent years, “Accountability” in such international forums still feels more like a global donor-led (and techno-managerial) accountability system instead of a human rights-based accountability system where the duty bearers are held accountable to uphold the entitlements of the rights holders, to provide remedy and redress. This absence of an intergovernmental accountability system and the promotion of public-private partnerships and ‘advisory boards’ whose constitution includes for-profit players and international NGOs, runs the risk of being susceptible to agenda-setting by governmental/private donors who may have vested interests, thereby neglecting the marginalised populations. Are we washing off our hands from the responsibility to give back what we have taken from society, by setting up such mechanisms?