Offline: The urgent need to protect global health accountability

Abstract

“The conclusions of this evaluation point to a range of ways that the IAP has so far failed to deliver on its potential.” It's a devastating verdict. A leaked draft report of an evaluation of the UN Secretary-General's Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP) describes a catalogue of extraordinary negligence and missed opportunities. The likely outcome of this assessment—led by the UNFPA Evaluation Office, together with a Reference Group that included representatives from WHO, UNICEF, the Partnership for Maternal, Newborn and Child Health (PMNCH), and the Executive Office of the UN Secretary-General—is that the idea of independent accountability for political promises to deliver the SDGs will die. The burial of independent accountability would be a crime against women, children, and adolescents worldwide. The notion of independent accountability has its roots in human rights. In 2011, when the UN Commission on Information and Accountability recommended the creation of an independent Expert Review Group (iERG; full disclosure: I co-chaired the iERG with Joy Phumaphi from 2012 to 2015) to assess progress towards achieving MDGs 4 (child health) and 5 (reproductive and maternal health), the model was that of the Special Rapporteur on the right to health. Special Rapporteurs are independent experts appointed by the Human Rights Council to investigate and report on specific human rights themes. The iERG was mandated to investigate and report to the UN Secretary-General and WHO Director-General on women's, children's, and adolescents’ health. We wrote four annual reports and made 21 recommendations. The IAP was established in 2016 to fulfil the iERG's request to continue the independent accountability mechanism into the SDG era. But the draft evaluation leaked to The Lancet draws three damning conclusions. First, that “The IAP has faced a range of organisational, institutional, budgetary, and operational challenges that have affected the extent to which it has been able to firmly establish its position and role as a leading voice on accountability in a crowded global health space.” Second, “The effectiveness of the IAP has been limited by weak recommendations, the lack of institutional response among key stakeholders to its recommendations, and the absence of methodical follow-up to their implementation…These failings belong in different ways to all [Every Woman Every Child] partners, not the IAP alone.” And third, “In the context of its limited progress and uneven effectiveness, IAP influence has not yet been strong enough to break through in a crowded global health arena. The need remains acute and the IAP is needed as much as ever. Yet its voice is not sufficiently heard in ways that will guide EWEC stakeholders towards making faster progress on Global Strategy priorities.” The recommendations of the IAP evaluation have yet to be written. It would not be surprising if the conclusions provided a convenient justification for termination. Convenient for WHO, UNICEF, UNFPA, and PMNCH—the same organisations that have oversight of the IAP's evaluation. The UN system has always been suspicious of independent accountability. It never wanted to cede ground to a group free to criticise and praise countries, agencies, or individuals. It never wished to lose control of what it saw as its mandate and its mandate alone. And it disliked giving legitimacy to those who represented a threat to its authority. The result has been that WHO and PMNCH in particular have marginalised, excluded, and strangled the IAP's capacity and voice. To be sure, the IAP should have taken a stronger role in tracking progress for women, children, and adolescents. But with limited staff, resources, and time, it is remarkable that the IAP was able to produce the respected assessments that it did—notably, for example, on the private sector in 2018. The draft evaluation does acknowledge that “The IAP is an important and unique resource in the global health system.” There are fair questions about the scope of the IAP. But what is urgently needed now is the support of the WHO Director-General to retain and strengthen the IAP. Women, children, and adolescents need advocates. But they also need those who can ensure that commitments made by those with political power are delivered. Global health needs more independent accountability, not less. It's time not only to resuscitate the IAP, but also to examine how independent accountability can be applied to other domains within the SDGs.