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

在第四次利益攸關方會議上的開幕詞：婦幼健康問責制——當前和2015年后議程

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

世界衛生組織總干事陳馮富珍博士

Geneva, Switzerland

瑞士 日內瓦

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,

各位公共衛生界同仁、各位發展伙伴、姊妹機構和民間社會組織各位代表、女士們、先生們：

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.

歡迎在我們繼續努力加強婦幼健康問責制之際出席第四次利益攸關方會議。我感謝你們所有人蒞臨日內瓦。在本會議室，我們匯聚了多種視角、經驗和貢獻。

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.

我們正處于有時間限制的加強問責制進程的中點。此時此刻，我們應該總結一下我們的現狀、我們的經驗教訓，以及在國際社會走向2015年后時代時，我們如何將這些經驗教訓制度化。

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.

當我應邀擔任婦幼健康信息和問責委員會副主席時，我知道，我們正在踏上征途，進入一個大體上未經探索的領域。

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.

人們早已很希望建立對資源和結果的問責制，但對這個問題，始終沒有進行嚴格和系統的處理。我還知道，專門針對婦幼健康建立問責框架將是一個極其嚴峻的考驗，甚或是人們能夠想象的最為嚴峻的考驗。

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，如果幾十年來始終被忽略的衛生系統的基本薄弱環節得不到處理，就無法降低母嬰死亡率。婦幼健康問責制意味著解決長期以來的衛生基礎設施和服務問題、經適當培訓和有積極性的工作人員數量短缺問題，以及在大多數國家缺乏進行民事登記和生命統計的可靠系統問題。

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.

問責意味著計算。沒有可靠的數據，就沒有透明度。它意味著改進捐助者和受惠國的合作方式，改進信息的搜集和使用方式，并提高在整個衛生部門跟蹤資源流動的能力。

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.

它意味著確保服務的平等享有、衛生保健的公平籌資，以及如獨立專家審查小組非常明確地提醒我們注意的，以人為本而不是以干預為本的高質量的衛生保健。

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.

我訪問過一些取消了孕產婦和兒童衛生服務費用的國家，目睹對這些服務的使用急劇增加，但卻沒有看到人們的健康有所改善，因為保健服務的質量仍然很低下。

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，《柳葉刀》雜志與世衛組織合作，發表了迄今為止篇幅最長的一份研究報告，涉及妊娠中的嚴重并發癥和“臨近死亡”問題。研究報告得出結論認為，如果沒有孕產婦保健和急診服務質量的整體改善，衛生設施中挽救生命的干預措施并不能減少孕產婦死亡率。

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

這只是我們面臨的一些挑戰。在本次會議期間，大家將審議頭兩份獨立專家審查小組報告的建議。自第一份報告以來，會議建議取得了哪些進展？我們如何設定第二份報告建議的重點？

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.

信息和問責制委員會設想問責制是一個包含監測、審查和補救行動的周期性進程。我們依賴獨立專家審查小組發現問題，并提出補救行動建議。

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.

獨立專家審查小組的報告鼓勵所有利益攸關方非常具體地去考慮問題。有哪些障礙拖延了進展？有哪些工具缺少或利用不足？可以掌握和適用哪些立竿見影的干預措施？我們在思索如何將有關經驗教訓制度化，并保持2015年后時代的勢頭時，獨立專家審查小組也可以給我們一些非常有用的指導意見。

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.

我認為，嚴密和獨立的問責機制是一種大有希望的方式，有助于我們合理地使用資源、履行承諾、根據成果證據調整規劃戰略、維持捐助者的信任以及贏得國會議員和財政部長的支持。

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.

我還認為，我們關于問責制的聯合工作是一次規模宏大的實驗。問責制框架能否加快進展？如果能設法搜集和利用更加精準的信息，是否可觸發一系列行動，并以改進衛生成果為終點？如果對這些問題的答復是肯定的，我相信，問責制將成為發展議程的恒定特征。

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.

獨立專家審查小組的報告幫我們全面清點了所面臨的挑戰和補救行動。但我認為，我們還有一些事情讓人歡欣，一些很好的理由來繼續加強有關勢頭。受信息和問責制委員會10項建議的激勵，我們看到了一些進展，也看到了一些處理根深蒂固的老問題的新方式。

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個目標國家中，有70個國家通過政府，包括民間社會的捐助者、議員和媒體攜手合作的進程，建立了國家問責框架。越來越多的國家采用記分卡來跟蹤進展。

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.

有大約53個國家得到了全部或部分催化資金，推動落實有關建議。我們目睹了衛生部門用以跟蹤重大事件，主要是出生、死亡和死亡原因的干預措施急劇增加。

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.

問責制方面的工作促使人們從孕產婦死亡審查轉向孕產婦死亡監督和應對，這一方針的目的是查明所有孕產婦死亡，使每一例死亡都成為法定報告事件。這一新的方針還將調查死亡原因，為采取有的放矢的干預措施，預防孕產婦死亡，提高衛生保健質量鋪平道路。有50多個國家采納了這一新方針，并采取步驟加以執行。

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.

越來越多的國家制定了國家電子衛生戰略，并加強移動衛生解決辦法。但仍有很多事情有待去做，以充分利用在信通技術領域干預措施的力量。

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.

該委員會的建議促使利用國家衛生賬戶作為標準平臺，跟蹤整個衛生部門的資源流動。今天，大家將獲悉這方面的更多情況。

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.

為更好地理順和協調籌資來源和活動，設立了指導委員會。去年11月啟動了投資框架。尤其是，隨著對共同責任的承諾深入人心，問責制已經成為捐助者和各國思維的一部分。

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.

最新一份獨立專家審查小組的報告認為，國際衛生伙伴關系后續程序“對合作伙伴而言可能是最先進和最成功的問責手段”。本次會議也可以從國際衛生伙伴關系后續程序努力中獲得啟發，理順和加強國家信息和問責制度，以及為此目的而開發的工具。

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.

就我的經驗而言，各國希望的是提高能力，而不是領取施舍。它們希望自決，它們希望自力更生。自力更生顯然是發展援助的最佳退出戰略。

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.

國際衛生伙伴關系后續程序的目的之一，是盡量減輕各國的報告負擔，加強各國利用和改進現有基礎設施和系統的能力，而不是通過平行的單一用途系統來繞開這些基礎設施和系統。正如最近的一份國際衛生伙伴關系后續程序報告的結論中提到的，相對于發展伙伴而言，各國已經更深入地將有效援助原則付諸實施。

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.

本次會議的議程包括一次機會，借以更多地了解國際衛生伙伴關系后續程序的經驗。近來為國際衛生伙伴關系后續程序設立的指導委員會的第一次會議與本次利益攸關方會議同時召開。我們非常高興定于明日與指導委員會舉行聯席會議。

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%.

如我前面說過的，本次會議是總結我們目前狀況的一次很好的機會。嬰幼兒的死亡數字從1990年的1200萬人減少到2012年660萬人。這就令人驚奇地降低了將近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.

從宏觀的角度上看，這一成就告訴我們，有針對性的承諾和投資行之有效。它們確實帶來成果。但它們應當更有成效，并能夠確保這些成果持之以恒。

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.

我從與各國、合作伙伴、捐助者和姊妹機構的討論中得知，大家有一種想要做更多事情的急切愿望。最近孕產婦死亡率的大幅度下降創造了機會，可以借此作出更多努力，減少與懷孕和生育有關的發病率，以及在許多時候，可能毀滅青年婦女一生的殘疾。

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.

我完全贊同最近的一份獨立專家審查小組的報告。這樣去做就要求我們更加關注青少年的健康和生殖需要，以及一種基于人權的方針。它要求在我們的努力中，更多地利用法律和政策來防止早婚或強迫婚姻，打擊危害青年婦女的暴力，消除計劃生育服務面對的障礙。

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.

問責框架將責任明確地落實在國家一級，同時有政府、議會、社區和民間社會組織的積極參與。近來取得的成就，主要應當歸功于各國。國家是增進其婦女和兒童健康的各項努力的發起者和領導者。

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.

捐助者和發展伙伴必須銘記，受援國是通過大力調動其自身往往非常有限的衛生資源來吸納發展援助。它們擁有對如何使用這些資源的首要發言權。在一些情況下，捐助者和發展伙伴破壞了本已有限的資源和能力。

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.

這些利益攸關方會議已經產生了有益的指南，幫助我們繼續前行。在本次會議期間，我們關心的是確保繼續強化目前的勢頭，并在更多的國家充分運作問責框架。我們應當考慮需要做哪些事情來支持弱勢國家。我們或許應當特別針對它們的需要創造新的模式。

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.

為了盡量減少對各國的種種要求，我們需要考慮建立單一問責框架的可行性，整合一系列新的舉措，并監測其影響，包括拯救生命產品委員會、全球疫苗行動計劃和計劃生育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.

在大家審查獨立專家審查小組報告的六項建議時，我想聽聽大家想法，即應當由哪些利益攸關方來領導對具體建議的后續行動。我要感謝所有利益攸關方勇敢地踏上征途，進入一個基本上未經探索的領域，并參與在我看來將對公共衛生的前途產生莫大影響的一次宏大實驗。

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，請允許我講述一個提供了許多經驗教訓的成功事例。這也將對我們有所啟迪。它給出了更好的理由，說明我們為什么要會聚在這里，承諾增進每一名婦女和每一個兒童的健康，并承諾在此過程中利用問責框架來作為一種創新手段。

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，尼日爾在《柳葉刀》雜志上發表的一份研究文件轟動世界，該文件記載了兒童死亡率的驚人下降。尼日爾是世界上最貧窮的國家之一，在尼日爾，通過政府主導并有捐助者支持的舉措，兒童死亡率在1998年至2009年之間下降了43%。相對于1990年的基準數據，兒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.

如獨立專家審查小組最近一份報告指出的，該國搜集和使用高質量數據的能力對這一成功至關重要。衛生保健的質量也很重要。政府建立了將近2000個社區衛生站，配備了經過培訓和領取工資的衛生工作者，并儲備了基本藥物。

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.

取消了兒童和孕婦的服務使用費后，對衛生服務的使用激增。在所有收入階層，在城鄉各地，在女童和男童二者中，兒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.

在與該研究報告同時發表的評論文章中，衛生部長表示，尼日爾政府倍感自豪的是，它推動該國從1990年在世界上兒童死亡率最高這種狀態走向目前接近實現千年發展目標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.

政府審慎地決定，不必坐等教育改善、貧窮減少或營養加強。雖然所有這些改善都很重要，但在一個積貧積弱的國家，這些目標的實現總要經歷幾代人才行。僅在2009年，估計就有5.9萬人的生命得到挽救，這就證明了起而行之的價值。

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.

這一例子顯示了建立搜集和分析數據的國家能力的重要性，政府最高層面領導的重要性，衛生成就對國家自豪感的意義，以及在一種成敗莫測的情況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，大家將會聽到更多的成功事例。如果問責框架的各個組成部分可以帶來如此規模的成功，公共衛生就確實掌握了一種面向未來的強有力的新工具。

Thank you.

謝謝大家。

更多翻譯素材，敬請關注可可英語。