Opening Remarks at the Fourth Stakeholder Meeting Accountability for Women’s and Children’s Health – Now and in the Post-2015 Agenda

在第四次利益攸关方会议上的开幕词：妇幼健康问责制——当前和2015年后议程

Dr Margaret Chan, Director-General of the World Health Organization

世界卫生组织总干事陈冯富珍博士

Geneva, Switzerland

瑞士 日内瓦

14 January 2014

2014年1月14日

Colleagues in public health, development partners, representatives of sister agencies and civil society organizations, ladies and gentlemen,

各位公共卫生界同仁、各位发展伙伴、姊妹机构和民间社会组织各位代表、女士们、先生们：

Welcome to this fourth meeting of stakeholders as we continue our efforts to improve accountability for women’s and children’s health. I thank all of you for coming to Geneva. We have a good mix of perspectives, experiences, and contributions at many levels represented in this room.

欢迎在我们继续努力加强妇幼健康问责制之际出席第四次利益攸关方会议。我感谢你们所有人莅临日内瓦。在本会议室，我们汇聚了多种视角、经验和贡献。

We are at the midpoint in a time-bound process of improving accountability. This is a good time to take stock of where we stand, the lessons we have learned, and how we can institutionalize these lessons as the international community moves into the post-2015 era.

我们正处于有时间限制的加强问责制进程的中点。此时此刻，我们应该总结一下我们的现状、我们的经验教训，以及在国际社会走向2015年后时代时，我们如何将这些经验教训制度化。

When I was asked to serve as a vice-chair for the Commission on Information and Accountability for Women’s and Children’s Health, I knew we were embarking on a journey into largely uncharted territory.

当我应邀担任妇幼健康信息和问责委员会副主席时，我知道，我们正在踏上征途，进入一个大体上未经探索的领域。

Accountability for resources and results has long been deeply desired, but rarely tackled in a rigorous and systematic way. I also knew that establishing an accountability framework specifically for women’s and children’s health would be an especially hard test case, perhaps even the hardest test case imaginable.

人们早已很希望建立对资源和结果的问责制，但对这个问题，始终没有进行严格和系统的处理。我还知道，专门针对妇幼健康建立问责框架将是一个极其严峻的考验，甚或是人们能够想象的最为严峻的考验。

As we all know, maternal and child mortality cannot be brought down without addressing fundamental weaknesses in health systems that have been neglected for decades. Addressing accountability for women’s and children’s health means addressing long-standing problems with health infrastructures and services, inadequate numbers of appropriately trained and motivated staff, and the absence in most countries of reliable systems for civil registration and vital statistics.

大家都知道，如果几十年来始终被忽略的卫生系统的基本薄弱环节得不到处理，就无法降低母婴死亡率。妇幼健康问责制意味着解决长期以来的卫生基础设施和服务问题、经适当培训和有积极性的工作人员数量短缺问题，以及在大多数国家缺乏进行民事登记和生命统计的可靠系统问题。

Accountability means counting. Transparency is impossible in the absence of reliable data. It means improving the way donors and recipient countries work together, the way information is collected and used, and the capacity to track resource flows throughout the health sector.

问责意味着计算。没有可靠的数据，就没有透明度。它意味着改进捐助者和受惠国的合作方式，改进信息的搜集和使用方式，并提高在整个卫生部门跟踪资源流动的能力。

It means ensuring equitable access to services, fair financing for care, and, as the independent Expert Review Group so clearly reminds us, high quality care that is person-centred, not intervention-centred.

它意味着确保服务的平等享有、卫生保健的公平筹资，以及如独立专家审查小组非常明确地提醒我们注意的，以人为本而不是以干预为本的高质量的卫生保健。

I have visited countries that removed fees for maternal and child health services, saw an immediate surge in the use of these services, but did not see improved health, because the quality of care remained poor.

我访问过一些取消了孕产妇和儿童卫生服务费用的国家，目睹对这些服务的使用急剧增加，但却没有看到人们的健康有所改善，因为保健服务的质量仍然很低下。

Last year, The Lancet published the largest study to date, coordinated by WHO, on severe complications and “near misses” in pregnancy. The study concluded that having life-saving interventions available in health facilities will not reduce maternal mortality in the absence of overall improvements in the quality of maternal care and emergency services.

去年，《柳叶刀》杂志与世卫组织合作，发表了迄今为止篇幅最长的一份研究报告，涉及妊娠中的严重并发症和“临近死亡”问题。研究报告得出结论认为，如果没有孕产妇保健和急诊服务质量的整体改善，卫生设施中挽救生命的干预措施并不能减少孕产妇死亡率。

These are just some of the challenges before us. During this meeting, you will be considering recommendations from the first two iERG reports. How much progress has been made in meeting recommendations from the first report And how should we prioritize recommendations from the second report

这只是我们面临的一些挑战。在本次会议期间，大家将审议头两份独立专家审查小组报告的建议。自第一份报告以来，会议建议取得了哪些进展？我们如何设定第二份报告建议的重点？

The Commission on Information and Accountability envisioned accountability as a cyclical process involving monitoring, review, and remedial action. We depend on the iERG to uncover problems and make recommendations for remedial action.

信息和问责制委员会设想问责制是一个包含监测、审查和补救行动的周期性进程。我们依赖独立专家审查小组发现问题，并提出补救行动建议。

The iERG reports encourage all stakeholders to think in very concrete terms. What are the barriers that have slowed down progress What tools are missing or underutilized Which innovations can be seized and applied for immediate gains The iERG has also given us some very useful guidance as we think about ways to institutionalize the lessons learned and maintain the momentum in the post-2015 era.

独立专家审查小组的报告鼓励所有利益攸关方非常具体地去考虑问题。有哪些障碍拖延了进展？有哪些工具缺少或利用不足？可以掌握和适用哪些立竿见影的干预措施？我们在思索如何将有关经验教训制度化，并保持2015年后时代的势头时，独立专家审查小组也可以给我们一些非常有用的指导意见。

In my view, rigorous and independent mechanisms for accountability hold great promise as a way of spending resources wisely, honouring commitments, fine-turning programme strategies in line with evidence of results, maintaining the confidence of donors, and winning the support of parliamentarians and ministers of finance.

我认为，严密和独立的问责机制是一种大有希望的方式，有助于我们合理地使用资源、履行承诺、根据成果证据调整规划战略、维持捐助者的信任以及赢得国会议员和财政部长的支持。

Also in my view, our joint work on accountability is a grand experiment. Can an accountability framework expedite progress If ways can be found to get and use better information, will this start a chain of events, with better health outcomes as the endpoint If the answer to these questions turns out to be “yes”, I believe that accountability will become a permanent feature on the development agenda.

我还认为，我们关于问责制的联合工作是一次规模宏大的实验。问责制框架能否加快进展？如果能设法搜集和利用更加精准的信息，是否可触发一系列行动，并以改进卫生成果为终点？如果对这些问题的答复是肯定的，我相信，问责制将成为发展议程的恒定特征。

The iERG reports have given us a good inventory of challenges and remedial actions. But I think we also have some things to celebrate, some good reasons to continue to build momentum. Stimulated by the Commission’s 10 recommendations, we are seeing some progress, and also some new ways of dealing with some very old and stubborn problems.

独立专家审查小组的报告帮我们全面清点了所面临的挑战和补救行动。但我认为，我们还有一些事情让人欢欣，一些很好的理由来继续加强有关势头。受信息和问责制委员会10项建议的激励，我们看到了一些进展，也看到了一些处理根深蒂固的老问题的新方式。

Of the 75 targeted countries, 70 have developed country accountability frameworks through a process which brings together government and donors and includes civil society, parliamentarians, and the media. More and more countries are introducing scorecards to track progress.

在75个目标国家中，有70个国家通过政府，包括民间社会的捐助者、议员和媒体携手合作的进程，建立了国家问责框架。越来越多的国家采用记分卡来跟踪进展。

Some 53 countries have received full or partial catalytic funding to stimulate implementation of the recommendations. We have witnessed an upsurge in health sector interventions to track vital events, notably births, deaths, and causes of death.

有大约53个国家得到了全部或部分催化资金，推动落实有关建议。我们目睹了卫生部门用以跟踪重大事件，主要是出生、死亡和死亡原因的干预措施急剧增加。

Work on accountability has brought a shift from maternal death reviews to maternal death surveillance and response, an approach which aims to identify all maternal deaths and make each one a notifiable event. This new approach also investigates causes of death, paving the way for targeted interventions to prevent maternal deaths and improve the quality of care. More than 50 countries have adopted the new approach and are taking steps to implement it.

问责制方面的工作促使人们从孕产妇死亡审查转向孕产妇死亡监督和应对，这一方针的目的是查明所有孕产妇死亡，使每一例死亡都成为法定报告事件。这一新的方针还将调查死亡原因，为采取有的放矢的干预措施，预防孕产妇死亡，提高卫生保健质量铺平道路。有50多个国家采纳了这一新方针，并采取步骤加以执行。

National eHealth strategies have been developed and mHealth solutions are being scaled up in more and more countries. But more needs to be done to tap the full power of innovations in information and communication technology.

越来越多的国家制定了国家电子卫生战略，并加强移动卫生解决办法。但仍有很多事情有待去做，以充分利用在信通技术领域干预措施的力量。

The Commission’s recommendations have stimulated the use of National Health Accounts as a standard platform for tracking resource flows throughout the health sector. You will be hearing more about this today.

该委员会的建议促使利用国家卫生账户作为标准平台，跟踪整个卫生部门的资源流动。今天，大家将获悉这方面的更多情况。

To better harmonize and coordinate funding streams and activities, a Steering Committee has been established. An investment framework was launched last November. Above all, accountability is becoming part of the mindset of donors and countries alike as commitment to mutual accountability takes root.

为更好地理顺和协调筹资来源和活动，设立了指导委员会。去年11月启动了投资框架。尤其是，随着对共同责任的承诺深入人心，问责制已经成为捐助者和各国思维的一部分。

The latest iERG report describes the International Health Partnership Plus as “probably the most advanced and successful accountability tool for partners.” This meeting can also take guidance from IHP+ efforts to streamline and strengthen country systems for information and accountability, and the tools that have been developed for this purpose.

最新一份独立专家审查小组的报告认为，国际卫生伙伴关系后续程序“对合作伙伴而言可能是最先进和最成功的问责手段”。本次会议也可以从国际卫生伙伴关系后续程序努力中获得启发，理顺和加强国家信息和问责制度，以及为此目的而开发的工具。

In my experience, countries want capacity, not charity. They want self-determination, and they want self-reliance. Self-reliance is by far the best exit strategy for development assistance.

就我的经验而言，各国希望的是提高能力，而不是领取施舍。它们希望自决，它们希望自力更生。自力更生显然是发展援助的最佳退出战略。

Among its aims, IHP+ seeks to minimize the reporting burden on countries and strengthen country capacities by using and improving existing infrastructures and systems, not bypassing them with parallel single-purpose systems. As a recent IHP+ report concluded, countries have moved further in putting the principles of effective aid into practice than have their development partners.

国际卫生伙伴关系后续程序的目的之一，是尽量减轻各国的报告负担，加强各国利用和改进现有基础设施和系统的能力，而不是通过平行的单一用途系统来绕开这些基础设施和系统。正如最近的一份国际卫生伙伴关系后续程序报告的结论中提到的，相对于发展伙伴而言，各国已经更深入地将有效援助原则付诸实施。

The agenda for this meeting includes an opportunity to learn more about the IHP+ experience. The first meeting of the recently established Steering Committee for IHP+ coincides with this stakeholder meeting. We are most pleased that a joint session with the Steering Committee is scheduled for tomorrow.

本次会议的议程包括一次机会，借以更多地了解国际卫生伙伴关系后续程序的经验。近来为国际卫生伙伴关系后续程序设立的指导委员会的第一次会议与本次利益攸关方会议同时召开。我们非常高兴定于明日与指导委员会举行联席会议。

As I said, this meeting is a good opportunity to take stock of where we stand. The number of deaths among young children has declined from 12 million in 1990 to 6.6 million in 2012. This is a stunning reduction of nearly 50%.

如我前面说过的，本次会议是总结我们目前状况的一次很好的机会。婴幼儿的死亡数字从1990年的1200万人减少到2012年660万人。这就令人惊奇地降低了将近50%。

On the big-picture scale, this achievement tells us that targeted commitment and investments work. They do bring results. But they need to work much better, and in ways that ensure that gains are sustained.

从宏观的角度上看，这一成就告诉我们，有针对性的承诺和投资行之有效。它们确实带来成果。但它们应当更有成效，并能够确保这些成果持之以恒。

What I hear from discussions with countries, partners, donors, and sister agencies is an overwhelming desire to do more. Recent striking declines in maternal mortality have opened up opportunities to do much more to reduce pregnancy and childbirth-related morbidities and, in many cases, disabilities that can ruin a young woman’s life.

我从与各国、合作伙伴、捐助者和姊妹机构的讨论中得知，大家有一种想要做更多事情的急切愿望。最近孕产妇死亡率的大幅度下降创造了机会，可以借此作出更多努力，减少与怀孕和生育有关的发病率，以及在许多时候，可能毁灭青年妇女一生的残疾。

I agree entirely with the latest iERG report. Doing so requires much more attention to the health and reproductive needs of adolescents and a human-rights based approach. It requires greater use of laws and policies as part of efforts to prevent early or forced marriage, address violence against young women, and remove barriers to family planning services.

我完全赞同最近的一份独立专家审查小组的报告。这样去做就要求我们更加关注青少年的健康和生殖需要，以及一种基于人权的方针。它要求在我们的努力中，更多地利用法律和政策来防止早婚或强迫婚姻，打击危害青年妇女的暴力，消除计划生育服务面对的障碍。

The accountability framework placed accountability firmly at the country level, with the active engagement of national governments, parliaments, communities, and civil society organizations. The lion’s share of the credit for recent achievements must go to countries. Countries are the owners, and the leaders, of any efforts to improve the health of their women and children.

问责框架将责任明确地落实在国家一级，同时有政府、议会、社区和民间社会组织的积极参与。近来取得的成就，主要应当归功于各国。国家是增进其妇女和儿童健康的各项努力的发起者和领导者。

Donors and development partners must never forget that recipient countries absorb development assistance through a tremendous mobilization of their own, often very limited, resources for health. They deserve first say in how these resources are used. In some cases, donors and development partners are undermining already limited resources and capacity.

捐助者和发展伙伴必须铭记，受援国是通过大力调动其自身往往非常有限的卫生资源来吸纳发展援助。它们拥有对如何使用这些资源的首要发言权。在一些情况下，捐助者和发展伙伴破坏了本已有限的资源和能力。

These stakeholder meetings have always produced useful guidance that has helped us move forward. During this meeting, we are concerned about ensuring that the current momentum continues to build, and that accountability frameworks become fully operational in a growing number of countries. We need to think about what needs to be done to support fragile states. We may need to create new models especially tailored to their needs.

这些利益攸关方会议已经产生了有益的指南，帮助我们继续前行。在本次会议期间，我们关心的是确保继续强化目前的势头，并在更多的国家充分运作问责框架。我们应当考虑需要做哪些事情来支持弱势国家。我们或许应当特别针对它们的需要创造新的模式。

In the interest of minimizing the demands on countries, we need to consider the feasibility of having a single accountability framework that links together and monitors the impact of a number of new initiatives, including the Commission on Life-Saving Commodities, the Global Vaccine Action Plan, and Family Planning 2020.

为了尽量减少对各国的种种要求，我们需要考虑建立单一问责框架的可行性，整合一系列新的举措，并监测其影响，包括拯救生命产品委员会、全球疫苗行动计划和计划生育2020愿景。

As you review the six recommendations from the iERG report, I would like to hear your ideas about which stakeholders should take the lead in following up on individual recommendations. I thank all stakeholders for their courage in embarking on a journey into largely uncharted territory, and for participating in what I consider to be a grand experiment with major implications for the future of public health.

在大家审查独立专家审查小组报告的六项建议时，我想听听大家想法，即应当由哪些利益攸关方来领导对具体建议的后续行动。我要感谢所有利益攸关方勇敢地踏上征途，进入一个基本上未经探索的领域，并参与在我看来将对公共卫生的前途产生莫大影响的一次宏大实验。

Let me conclude with a success story that offers many lessons. It is also a source of inspiration. It reinforces the reasons why all of us are here, committed to improving the health of every woman and every child, and committed to using an accountability framework as an innovative tool for doing so.

最后，请允许我讲述一个提供了许多经验教训的成功事例。这也将对我们有所启迪。它给出了更好的理由，说明我们为什么要会聚在这里，承诺增进每一名妇女和每一个儿童的健康，并承诺在此过程中利用问责框架来作为一种创新手段。

In 2012, Niger surprised the world with a research paper, published in The Lancet, documenting striking reductions in child mortality. In Niger, one of the poorest countries in the world, child mortality was reduced by 43% between 1998 and 2009 through a government-led initiative, supported by donors. Compared with baseline data from 1990, child deaths dropped by a remarkable 65%.

2012年，尼日尔在《柳叶刀》杂志上发表的一份研究文件轰动世界，该文件记载了儿童死亡率的惊人下降。尼日尔是世界上最贫穷的国家之一，在尼日尔，通过政府主导并有捐助者支持的举措，儿童死亡率在1998年至2009年之间下降了43%。相对于1990年的基准数据，儿童死亡率引人注目地下降了65%。

As the latest iERG report has noted, the country’s ability to collect and use high-quality data was critical to this success. Quality of care was also important. The government built nearly 2000 community health posts, staffed with trained and paid health workers, and stocked with essential medicines.

如独立专家审查小组最近一份报告指出的，该国搜集和使用高质量数据的能力对这一成功至关重要。卫生保健的质量也很重要。政府建立了将近2000个社区卫生站，配备了经过培训和领取工资的卫生工作者，并储备了基本药物。

User fees for children and pregnant women were abolished and use of services soared. Dramatic reductions in child mortality were seen across all income levels, in rural as well as urban areas, for girls and for boys.

取消了儿童和孕妇的服务使用费后，对卫生服务的使用激增。在所有收入阶层，在城乡各地，在女童和男童二者中，儿童死亡率都大幅度降低。

In a commentary published together with the study, the Minister of Health expressed the enormous pride of the Government of Niger for having moved the country from its position in 1990, of having the highest child mortality rate in the world, to a current rate of annual decline that puts MDG 4 in reach.

在与该研究报告同时发表的评论文章中，卫生部长表示，尼日尔政府倍感自豪的是，它推动该国从1990年在世界上儿童死亡率最高这种状态走向目前接近实现千年发展目标4的年度下降率。

The government made a deliberate decision not to wait for education to improve, or for poverty to go down, or for nutrition to get better. While all of these improvements are important, their achievement in a very poor country can take several generations. The estimated 59,000 lives saved in 2009 alone were considered proof of the value of immediate action.

政府审慎地决定，不必坐等教育改善、贫穷减少或营养加强。虽然所有这些改善都很重要，但在一个积贫积弱的国家，这些目标的实现总要经历几代人才行。仅在2009年，估计就有5.9万人的生命得到挽救，这就证明了起而行之的价值。

This example shows the importance of building country capacity to gather and analyze data, of leadership at the highest level of government, of the significance of health achievements for national pride, and of donor support in a situation where the chances of success were by no means assured.

这一例子显示了建立搜集和分析数据的国家能力的重要性，政府最高层面领导的重要性，卫生成就对国家自豪感的意义，以及在一种成败莫测的情况下捐助者支持的重要性。

You will be hearing more success stories today and tomorrow. If the components of an accountability framework can bring success on this scale, public health does indeed have a powerful new tool for the future.

今天和明天，大家将会听到更多的成功事例。如果问责框架的各个组成部分可以带来如此规模的成功，公共卫生就确实掌握了一种面向未来的强有力的新工具。

Thank you.

谢谢大家。

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