A/HRC/18/27 43. The National Human Rights Commission of Kenya shows the role that quasi judicial bodies can play in ensuring Government accountability for maternal health. The Commission initiated a public inquiry into reproductive health care, providing a forum for the discussion of reproductive health services; to identify root causes of poor quality and inadequate services; to establish causes for high rates of maternal mortality and to find practical solutions; provide victims with an opportunity to express their opinions; raise public awareness, promote public debate; and make recommendations.44 44. The Government of Malawi and its partners have a sector-wide approach funding mechanism whereby annual planning is undertaken with all stakeholders, avoiding duplications and reducing dependency on single donors, helping to achieve a 44 per cent drop in its maternal mortality rate between 1990 and 2008. 45. Community-based health surveillance assistants, employed and trained by the Ministry of Health, undertake outreach in communities, register pregnancies, carry out maternal health audits and verbal autopsies, and address young people’s sexual and reproductive health issues. Interventions at the community level focus on the monitoring of maternal deaths and promoting community participation by establishing audit committees and advocating local authorities (through meetings for community leaders and chiefs and popular theatrical performances). 46. Improved accountability has been instrumental in Rwanda. In 2008, the Government, with UNFPA support, adopted a strategy that includes maternal death reviews, using facility-based death audits, confidential enquiries into maternal deaths, and verbal autopsies. Delegations of local community leaders conduct investigations, which the Government then monitors. Reproductive health, including family planning, has been prioritized, and Government ministries are required to have women-centred plans of action and gender budgeting. The health system has been strengthened through innovative programmes to train and retain new health workers, and international assistance. Joint UNICEF/UNFPA/WHO support has increased local resource mobilization, improved family planning services at the community level, provided ambulances and piloting a rapid text message service, which has empowered community health workers in one district with a telephone that allows them to respond quickly.45 47. In Sierra Leone, the free health care service scheme, funded mainly by the British Department for International Development, aims to increase access to health care for 230,000 pregnant women by removing user fees and graduated improvement in the quality of services provided.46 Food support for pregnant women is given by WFP in some clinics, and the Ministry of Health has nutritionists in each district to advise pregnant and lactating mothers. 48. UNICEF and the Liverpool School of Tropical Medicine are implementing an innovative competency-based training programme for health personnel using mannequins to train health professionals in just four days (rather than the usual 10). This approach is ideal for countries where there is an urgent need to address a lack of skills among health workers, where the case load may not be sufficient or the overall human resources may not exist to support competency-based training. 44 Federation of Women Lawyers Kenya and Center for Reproductive Rights, Failure to Deliver: Violations of Women’s Human Rights in Kenyan Health Facilities (2007) (Center for Reproductive Rights submission). 45 UNFPA submission. 46 See http://projects.dfid.gov.uk/project.aspx?Project=201853. 13