ROUND TABLE
ROUND TABLE DISCUSSION
Collaboration and coordination: progress on implementation of recommendations from the World health report 2005
Elizabeth Mason
Child and Adolescent Health and Development, World Health Organization, 1211 Geneva 27, Switzerland (email: masone@who.int)
In his discussion of the World health report 2005 Make every mother and child count, David McCoy challenges the global community and WHO to maintain follow-up on the policy recommendations made in the report and to ensure their translation into meaningful changes. We applaud Dr McCoy's challenge to WHO and its development partners to take a more prominent role in shaping the global political economy with the view to protecting health, in particular that in the most deprived populations. We also welcome his proposal for concrete recommendations for immediate action. Here, I describe how WHO is already taking forward relevant actions.
WHO has been proactive in follow-up of the recommendations from the report's policy briefs. In May 2005, Member States adopted the resolution Working towards universal coverage of maternal, newborn and child health interventions at the 58th World Health Assembly (WHA58.31). The resolution calls on WHO to strengthen coordination, collaboration and synergies of WHO programmes, including those for health systems development.
The Organization at all levels is now strengthening mechanisms to provide coordinated support to countries. The country cooperation initiative ensures that WHO technical support to countries is coordinated and in line with national priorities. In the European and American Regions, WHO is promoting the functional collaboration between relevant technical units and work areas, resulting in joint work-plans and planning missions to countries. Following the 2005 Regional Committee meeting in Maputo, Mozambique, a process has been started in the African Region to develop a coherent institutional strategy across all levels of WHO will promote universal coverage and access to essential health interventions. The initiative is starting in 13 countries, and has maternal, neonatal and child health central to the agenda.
We share Dr McCoy's concern about the limitations of vertical programmes. Application of the continuum-of-care concept as promoted in the World health report 2005 will fundamentally change the way in which programmes should be planned, implemented and supported. The recommendation moves us away from vertical programmes that are focused on an intervention, a population group or a condition. It also forces us to consider the interlinked functions of different levels of the health system, revolving from communities through primary-care services to emergency and referral care.
Promotion of the continuum of care calls for vision, long-term planning, and investment in solutions that are sustainable within the framework of national health systems in which publicprivate partnership are taking root and developing. This approach requires focus, not only on the interventions and their delivery, but also (and perhaps most strongly) on the development of the systems in which the provision of quality services can be institutionalized.
We also share Dr McCoy's concern about coordination between partners. As he correctly highlights, investments in human resources, financial protection mechanisms, district health management and infrastructure, are urgently needed to increase access to health services and to achieve universal coverage of essential maternal, neonatal and child health services in countries. Without such investments, sustainable delivery will remain a challenge and short-term gains will erode when priorities shift or sources of funding dry up. Thus, WHO is taking costing of maternal, neonatal and child health services to country level, so as to better quantify the gap between current provision and needs.
To help secure coordination, and to strengthen the long-term commitment of different actors, the new global Partnership for Maternal, Newborn and Child Health (http://www.pmnch.org), of which WHO is a founding member, seeks to improve partner coordination, advocate globally for more resources, and monitor progress towards achieving the Millennium Development Goals for maternal and child mortality reduction. WHO is also fully committed to the global Child Survival Countdown effort (http://www.childsurvivalcountdown.com), which seeks to track progress in the reduction of child mortality, highlight inequity, and promote greater accountability. These partnerships are resulting in new dialogues, including talks with well established global health partnerships such as the Global Alliance for Vaccines and Immunization and the Global Fund to fight Tuberculosis, AIDS and Malaria, which like WHO have also been challenged to strengthen health systems to scale-up the most effective interventions.
The World health report 2005 provides an in depth and systematic analysis of the issues that affect the scale-up of effective interventions and the achievement of universal coverage of maternal, newborn and child health interventions. As the first World health report to share a theme with and be launched on World Health Day, the 2005 report has greatly expanded the audience of its messages. Also, being the first report to be followed by a set of policy briefs, the 2005 report has been complemented by a clear set of tangible actions. I thank Dr McCoy for adding to the report's call on us all to take up the challenge to build stronger and more equitable health systems. Systems that can then be the conduit for the delivery of high quality services with universal coverage that will make an important difference to the lives of mothers and children. 
Competing interests: none declared.