There are roughly 750 days left to achieve the Millennium Development Goals (MDGs). Among other benchmarks, this means reducing the number of child deaths worldwide by two-thirds (MDG4). The three primary killers of children under 5 years of age — pneumonia, diarrhea and malaria — are both preventable and treatable with simple and cost-effective interventions. Efforts to end these preventable child deaths will only be successful when integrated packages of interventions are available to the population most at risk.
USAID’s flagship Maternal and Child Health Program (MCHIP) supports two well-established and relatively simple strategies to address the most common causes of child deaths: Integrated Management of Child Health Illnesses (IMCI) as a means to treat children at basic health facilities and Integrated Community Case Management (iCCM), which extends case management of childhood illnesses beyond health facilities so that more children have access to life saving treatments. In addition to the simplified methodology of diagnosis at the community level, there are guidelines and criteria established to easily recognize serious conditions and when it is necessary to refer a case to clinical or more complex levels of care.
Many countries have adopted one or both of these interventions; however, their successful implementation in health facilities and communities has been challenging. In the vast majority of cases, provisions come in a disintegrated and compartmentalized manner. International support is often delivered with limited or no coordination with the countries’ national health authorities. Consequently, while parts of a country may receive massive support, other regions — and sometimes those with higher priority needs in terms of social and epidemiological severity — are completely underserved.
The past five years have shown a marked increase in global collaborations committed to ending preventable child death. The 2012 Child Survival Call to Action and A Promise Renewed, jointly led by USAID and UNICEF with the Governments of Ethiopia and India, brought together over 700 public, private and civil society sector partners. In 2013, the WHO led development of the Global Action Plan for Pneumonia and Diarrhea (GAPPD), which is an integrated effort to protect children from pneumonia and diarrhea. The Every Woman Every Child campaign was launched in 2010 and includes the Global Strategy for Women’s and Children’s Health–a roadmap to strengthened financing, policy and programming. Several coordination groups have also been formed, including the UN Commission on Lifesaving Commodities for Women and Children and the Diarrhea and Pneumonia Working Group.
Under these global advocacy initiatives, many countries have received significant support from international and nongovernmental organizations (NGOs), bilateral agencies, global funds and others. And while the intention behind this funding is commendable, the key for any global initiative is getting stakeholders to work together on evidence-based country.
It is not uncommon for institutions and agencies to be working in a country with little coordination, specifically with a country’s Ministry of Health. As a result, an agency may be capable of fully training health personnel to diagnose patients, but be hampered by a lack of basic medicinal supplies. Or supplies and medicine may be readily available, but health workers remain untrained or undertrained. Cases also arise at the logistical level where, for example, community health workers are fully trained to identify the severity of a particular case of diarrhea, or detect certain signs of respiratory ailments compatible with pneumonia, but they are incapable of effectively and timely transporting a child to a health unit for more complex care, if needed.
These challenges are well understood by national governments, donor agencies and implementing partners. And yet, as an international community, we have not established systematic ways to address or improve these situations. At the heart of these problems is coordination — we could avoid programmatic and funding overlap, and have adequate allocation of resources by improving coordination (or at least complement the available resources to support the strategic plan of the Ministry of Health). In this way, we could achieve a suitable operational plan for each country, subdivided by geographical areas, with the participation of all institutions and with proper coordination with national health authorities.
The Latin America and Caribbean Newborn Health Alliance is an excellent example of coordination at the regional level improving coordination in individual countries and ultimately reducing child mortality. The regional alliance works to support countries in efforts to adopt high-impact interventions that help to prevent maternal and neonatal death. At the regional level, countries come together to share lessons learned, identify cross-cutting success stories, attend trainings on the latest life-saving interventions, and make joint commitments to address inequity issues in each of their countries. The Newborn Alliance then acts as an umbrella resource to support these national alliances to advocate for inclusion of high-impact interventions in key health policies, develop concrete action plans, and track key indicators.
A key to the Alliance’s success — and that of its partner national alliances — has been the inclusion of all key stakeholders: national governments, donor agencies, research and advocacy organizations, and implementing partners. Ensuring that a wide variety of groups are involved and working hand-in-hand has allowed the Alliance, at both the regional and national levels, to have a tangible impact by translating political commitments into realistic programming approaches. And these approaches have brought life-saving interventions to even the hardest to reach communities.
What can be done in the remaining 750 days of the MDGs to effectively improve coordination and replicate constructive models of national alliances? There are numerous agencies supporting the health sectors of developing countries to help reach the MDGs. But without adequate coordination, missed opportunities abound to support effective and systematic national strategic plans.
In some countries, these alliances and partnerships between various organizations have shown successful streamlining of technical assistance as well as more efficient use of human and financial resources, all contributing to more effective implementation of health initiatives. The Newborn Alliance has been successful in helping different stakeholders in the region come together under one common goal — reducing maternal and neonatal death. With initiative and leadership, this structure can be replicated elsewhere. And with the current levels of attention on and funding for reducing child deaths, there is no reason why other regions and technical areas cannot adopt a similar approach.
**This article was originally published by the Huffington Post on September 25, 2013