Características de la Investigación-Acción

1 _{Made up mostly of Official Development Assistance, but also including Other Official Flows (loans) as described in the OECD DAC statistical} database (www.oecd.org/dac/stats).

disappointing contributions for maternal health and family planning within reproduc- tive health funding (3, 4) (see Box 7.1).

In contrast to the route chosen by the advocates of a number of other major public health priorities, such as malaria, tuberculosis or HIV/AIDS, champions of maternal, newborn and child health – including the various global partnerships (see Box 7.2) – prefer to tap into the greater funds available for overall health sector development rather than to create new, parallel funding mechanisms. Whether this is for tactical reasons or for more fundamental considerations, it fits well with the growing impor- tance of the health sector reform movement (13). The emphasis on health sector development as the platform for maternal, newborn and child health coincides with the recognition among key multilateral and bilateral donors that poverty reduction is the primary goal of development assistance (14). It comes at a moment when the wave of health care reforms in the aftermath of primary health care, rooted in a neo- liberal ideology of rolling back the presence of the state, is well under way. These re- forms were promoted in contexts of transition from socialist to market economies – in countries such as Mongolia or Tajikistan – and of rebuilding services in post-conflict areas such as Cambodia, or as part of the structural adjustment programmes of many African and Asian countries that were facing severe resource crunches. MNCH conse- quently evolves in a context dominated by discussions on the role and responsibility of the state in tackling underfunding of the health sector, accessibility of services, inequities and exclusion, inefficiencies, and lack of accountability.

The result is that maternal, newborn and child health can no longer be framed in purely technical terms. The appearance of a shared commitment to solving health sector problems that are obviously relevant to maternal, newborn and child health contributes to the assumption that MNCH policy interests are synonymous with those

cation and collaboration among organizations beginning to work in newborn health. The new Child Survival Partnership intends to galvanize global and national commitment and action for accelerated reduction of child mortality world- wide. All three put their work in a context of poverty reduction, equity, and human rights. They collaborate closely to ensure a coordi- nated approach to the continuum of care and universal coverage with cost-effective inter- ventions at the country level.

The first function of these partnerships is to stimulate and sustain the political will to keep the maternal, newborn and child health agenda as a central priority. They do so through dia- logue at the highest level of government. As many countries have to step up their efforts in combating exclusion, monitoring inequities in maternal, newborn and child health and uptake of services, as well as tracking resources flows have become matters of prime concern (8, 9). By keeping track of progress made, the partnerships can help to hold countries and their partners accountable (10).

Against the backdrop of slow progress towards the Millennium Development Goals concern- ing maternal and child health, the need for an urgent, global coordinated response has prompted several agencies and international organizations to join forces and create partner- ships for maternal, newborn and child health. Over the past few decades, it has become clear that the support required for the devel- opment of a resource-constrained country is so multifaceted and complex, that it cannot be successfully taken on by one agency alone (7). Within the field of maternal, newborn, and child health, three partnerships are currently active: the Partnership for Safe Motherhood and Newborn Health, the Healthy Newborn Partnership, and the Child Survival Partner- ship. The recently established Partnership for Safe Motherhood and Newborn Health aims to strengthen and expand maternal and newborn health efforts. The Healthy Newborn Partnership has been established to promote awareness and attention to newborn health, exchange information, and improve communi-

The partnerships can also assist in bridg- ing the gap between knowledge and action (11) by facilitating the interaction between policy-makers, researchers, funders and other stakeholders who can influence the uptake of research findings – and reorient research towards solving the operational and systemic constraints that hold back the scaling up of effective interventions.

Finally, the partnerships can help bring together the various parties involved in mater- nal, newborn and child health (ministries of health, finance and planning, national non- governmental organizations, health profes- sional groups, donor agencies, United Nations agencies, faith-based groups and others), or provide technical support to existing coordina- tion mechanisms. This creates national part- nerships through which funding, planning and implementation of national and subnational maternal, newborn and child health plans can be accelerated (12).

of reforms. In countries where external assistance plays an important role, it also gives the impression that the policy interests of maternal, newborn and child health are those of the poverty reduction strategies (PRSPs) and sector-wide approaches (SWAps) through which reforms are steered (13) (see Boxes 7.3 and 7.4). The reality, however, is not so clear-cut.