Rajat Khosla became the Executive Director of Partnership for Maternal, Newborn & Child Health (PMNCH) in May 2024. Previously, he was the Director at the International Institute on Global Health (UNU-IIGH). With over 20 years of experience in global health, he has contributed extensively to research, policy, and practice in areas such as sexual and reproductive health, gender equality, and health equity. Khosla has also worked at the World Health Organization (WHO) and the UN Office of the High Commissioner for Human Rights.
1. What inspired you to take on the role of Executive Director at PMNCH, and what are your primary goals for the organization in the coming years?
Women’s, Children’s, and Adolescents’ Health (WCAH) stands at a critical crossroads. According to [the World Health Organization], a woman dies every two minutes in childbirth. [The United Nations Sustainable Development Goals or] SDG targets related to child survival and under-five mortality will not be met. Deep inequalities both within and between countries; wide-ranging disparities based on gender, race, and other forms of disadvantage; the ongoing [COVID-19] pandemic; old and new conflicts; and climate change demand a transformational shift in WCAH.
All of that [inequality] is taking place in a context of mounting distrust in public institutions. Democratic values are under attack, evidenced by increasing restrictions on civil society organizations. Anti-rights, anti-gender, and anti-SRHR [or Sexual and Reproductive Health and Rights] rhetoric is flourishing at global, regional, and national levels—in clinics, too, with devastating consequences for those advocating for sexual and reproductive rights and those providing for adolescent wellbeing for maternal and child health. [These individuals] are to be found in hostile political contexts attacked, abused, and even incarcerated for their work.
Women’s bodies and SRHR are facing unprecedented backlash. There is an urgent need to come together and safeguard the gains made over the last two decades. For this to happen, we need to start by understanding the intersection of external and internal challenges that continue to undermine our commitments to WCAH.
I applied for the post of Executive Director, PMNCH because I am committed to helping reshape WCAH futures. Over the last 20 years, I have worked at the intersections of research, advocacy, and practice with multilateral organizations, civil society, and [international non-governmental organizations] (INGOs) to address inequalities and injustice in global health. The partnership has a significant role to play in galvanizing political priority for women’s, children’s, and adolescents’ health. [It also impacts] global consensus on how to address those issues effectively. [Effects are, furthermore, seen] in convincing governments, international organizations, and other global actors to play their parts.
2. Can you share significant achievements through PMNCH’s initiatives?
[The year] 2025 will mark 20 years of PMNCH’s work in advancing maternal, newborn, and child health (MNCH) policy, service delivery, and financing, [along with] fostering collaborations, mobilizing resources, shaping policies, and keeping MNCH on the agenda of the highest political dialogues. As we move towards the final years of the 2030 Agenda, PMNCH holds a valuable space within the MNCH ecosystem and is entrusted with a crucial role. With a focus on evidence-based advocacy across the continuum of MNCH and the [human] life course, PMNCH is uniquely capable of bolstering the MNCH agenda through wide-ranging cross-constituency collaboration, including focus on priority issues [in] MNCH, such as preterm birth and stillbirth.
In 2023, PMNCH led the work on the updated edition of the Born Too Soon: Decade of Action on Preterm Birth report, involving more than 70 partners from over 140 countries across all PMNCH constituencies. A decade [after] the launch of the first Born Too Soon report, this report highlighted the worrying stagnation in progress on preterm birth over the last 10 years: preterm birth is the leading cause of under-five deaths, [killing] approximately one million newborns per year, and since 2000, neonatal conditions continue to be the biggest loss of human capital (DALYs) worldwide. The report calls for systemic change to ensure that every woman and baby receives high-quality, respectful care to thrive, regardless of geographic location.
Led by the government of Somalia and co-sponsored by 51 member states, the 77th World Health Assembly Resolution [(WHA77) in 2024] accelerate[d] progress towards reducing maternal, newborn, and child mortality to achieve Sustainable Development Goal targets 3.1 and 3.2. Supported by intensive and coordinated action by PMNCH, [this resolution] paves the way for increased action in the final stretch to the 2030 Sustainable Development Goals.
To support this, PMNCH convened more than 30 organizations from [civil society organizations] (CSOs), [Health-Care Professional Associations] (HCPAs), donors, private sector [groups], and [Adolescents and Youth] (AY) constituencies to develop key WCAH [requests] to member states for the negotiations around the resolution and promote strong adoption and implementation.
In 2020, PMNCH—in partnership with [the] UN H6+ Technical Working Group alongside youth-led and youth-serving organizations—developed the Definition and Conceptual Framework for Adolescent Well-Being, which proposes a new definition of adolescent well-being underpinned by five interconnected domains. Building on this framework, PMNCH and partners developed a series of 15 technical papers on Programming to Promote Adolescent Well-Being and the Adolescent Wellbeing BMJ Collection.
Through the Adolescent and Youth Constituency, PMNCH serves as the global platform for meaningful adolescent and youth engagement, mobilizing youth advocates to increase political commitment and financing for multisectoral, rights-based action for, by, and with adolescents. To advance the agenda of adolescent wellbeing, PMNCH launched the 1.8 Billion Young People for Change Campaign, a multi-year campaign to build momentum—with young people—for new policies, funds, and better services for adolescents.
The Global Forum for Adolescents, October 11-12, 2023, was a key milestone of the campaign and the [world's] largest online forum for action created by and for young people. The forum brought together over 117 partners globally and featured over 234 speakers (of which more than 50 percent were youth). The forum also spurred the organization of over 124 national events in different countries in support of the campaign and the agenda more broadly, which was a big win for the campaign.
[The 2024 report] “Adolescents in a changing world: the case for urgent investment” is the result of over two years of work by PMNCH, WHO, [the UN Population Fund] (UNFPA), [the UN Children’s Fund] (UNICEF), [and the] Victoria Institute of Strategic Economic Studies (VISES) of Victoria University, Melbourne, Australia and partners. This major report argues that substantially increased investment in programs to promote adolescent well-being [is] both urgent and fully justified, including: the human rights of this age group; the major epidemiological and demographic transitions sweeping the world; and the fact that there is a substantial repertoire of highly effective interventions and an increasing body of experience in how to deliver them successfully. Such investments also make excellent economic sense, with a large number of interventions across multiple domains of adolescent well-being yielding returns of at least US$10 for every dollar invested.
Furthermore, the costs of inaction are enormous. Over the period 2024 [to 2050], the average cost of inaction (benefits foregone) has been estimated at a staggering US$110 trillion (US$4.1 trillion per year). This equates to 7.7 percent of the GDP of the countries included in the models, which cover about 80 percent of the world’s population. The report argues that investment must be across sectors to cover all aspects of adolescent well-being, and it must meet the context-specific needs of adolescents and have opportunities for adolescents to contribute to [the] design and development of programs for them. This work is a milestone for PMNCH as well as for the development community because our arguments for immediate action are backed by concrete evidence. The investment case is also being pilot-tested in three countries (Colombia, India, and South Africa) to ensure that countries are armed/equipped with these tools as they work towards advancing adolescent well-being nationally.
3. How do you see PMNCH contributing to the achievement of the Sustainable Development Goals, particularly in the areas of sexual and reproductive health and rights?
Utilizing its strength in translating data and evidence, PMNCH can leverage its connections and expertise to develop tailored, context-specific messaging to refute dis- and misinformation on SRHR and to define and disseminate language on sensitive SRHR issues that appeals to stakeholders who are neutral or focused on other priorities. While remaining committed to the core principles of SRHR and to evidence-based interventions, PMNCH can play a critical role [in building] consensus via different constituencies on complex [topics and] appealing to those who are uncommitted or not deeply engaged in the topic.
PMNCH can [also] increase the political salience of SRHR issues through the engagement and support of high-level champions to influence domestic SRHR policy. [This strategy could include a] push for substantial and sustainable targets for domestic financing for SRHR, such as clear government commitments to the procurement of SRHR commodities—contraceptives, medication abortion, [maternal and newborn health] (MNH) products, etc.—and the provision of SRHR services.
[We also will continue to] advocate for intersectoral and public-private partnerships to explore innovative SRHR financing mechanisms and bridge funding gaps, while ensuring that governments, rather than financial institutions and actors, determine which kinds of health care are available to those in need.
4. How can PMNCH, governments, and non-governmental agencies strengthen policy and legal frameworks to alleviate the exacerbated effects of conflict on marginalized female-identifying individuals and ensure equitable health access for women and children?
Historic progress on WCAH is under threat of reversal due to the combination of conflict and climate change, with the most vulnerable feeling the biggest burden, including those in humanitarian and fragile settings (HFS). Approximately 50 percent of maternal, newborn, and under-five mortality [cases] presently occur in humanitarian settings, and children who survive often are unable to thrive, or even experience neglect and maltreatment [according to WHO]. A partner-centric approach provides the possibility to accelerate progress in this area and support stakeholders in addressing the health and well-being of vulnerable populations, including women and children.
Intensified efforts to improve access to MNCH services [are] needed in HFS where the risks of poor health are higher and where vulnerable populations face compounding challenges linked to the day-to-day realities of war, high levels of poverty, food insecurity, and displacement. PMNCH’s cross-constituency work offers the opportunity to advance the equity agenda and [invest] in pro-equity policies and interventions, thus targeting the [most] at-risk populations.
Given the significant fragmentation of WCAH in humanitarian contexts, PMNCH’s convening power also plays a critical role in the coordination of policy, service delivery, and financing for essential [sexual, reproductive, maternal, newborn, child, and adolescent health] (SRMNCAH) services. [PMNCH also bolsters] advocacy and accountability in humanitarian settings by supporting the inclusion of WCAH in emergency response plans.
5. How do you plan to engage and mobilize diverse stakeholders—including governments, civil society, and the private sector—to advance the health rights of women and children?
PMNCH is fueled by power and partnership. Partnership has been the foundation and strength of PMNCH from its inception. We are the largest multi-stakeholder partnership in the world focusing on the health and well-being of women, children, and adolescents. We harness the expertise and knowledge of partners through our 10 constituencies to advance the issues that require urgent attention. The recent WHA77 Resolution on MNCH—[to] accelerate [the] progress towards reducing maternal, newborn, and child mortality to achieve SDG targets 3.1 and 3.2—was a response to the slowing progress seen globally in tackling maternal and child mortality and called for accelerated progress on SDG targets for maternal, newborn, and child health.
In addition, through collaboration with initiatives such as Every Newborn Action Plan (ENAP), Ending Preventable Maternal Mortality (EPMM), Child Survival Action, and International Stillbirth Alliance (ISA), PMNCH [can] leverage synergies and facilitate dialogue and collaboration among diverse stakeholders to foster innovative solutions and good practices that address critical gaps in MNCH services and quality of care. Moving forward, PMNCH has identified key moments for focusing on WCAH advocacy to support policymaking and financing for issues related to WCAH. Through each moment, we engage a wide range of partners to ensure consolidated and evidence-based approaches to WCAH.
We aim to amplify the voices of women, adolescents, and youth by advocating for policies that prioritize their SRHR needs. This involves engaging with governments to influence policymaking processes and ensuring that SRHR is integrated into national health strategies. By presenting evidence-based recommendations and fostering political will, we strive to create an enabling environment where SRHR is recognized as fundamental to overall health and well-being.
Collaboration is at the heart of our approach. We actively bring together governments, civil society organizations, the private sector, academia, and international agencies to create a cohesive and unified front for SRHR. Holding stakeholders accountable is [also] crucial for progress. We support the establishment of robust monitoring and evaluation frameworks to track the implementation of SRHR commitments. By promoting transparency and accountability, we ensure that governments and other stakeholders remain committed to their promises and that progress is measured and reported.
6. How do you see PMNCH evolving to tackle ongoing and emerging global health crises, and what actions are needed for lasting equitable improvements in women’s health and health policies?
As global health challenges continue to evolve, PMNCH is positioned to adapt and respond effectively to ensure lasting equitable improvements in women’s health and health policies. While PMNCH will continue to [collaborate with] its vast network of partners, there is also scope to start/increase engagement with other partners, such as those in the private sector. This can facilitate comprehensive responses to health crises by pooling resources and expertise. [PMNCH will also develop] robust mechanisms to track progress on health commitments and hold stakeholders accountable for their promises. PMNCH will expand its engagement with political champions and allies to ensure that critical issues are not just spotlighted but also addressed to ensure tangible, lasting impact.
Dake spoke with Khosla on July 2, 2024. This interview has been lightly edited for length and clarity.