Illnesses Don’t Discriminate: Vaccines Work

Co-authored by Carolyn Miles, President & CEO, Save the Children and William Moss, MD, MPH, Interim Executive Director, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health

Parents work hard to help their children stay healthy. Try as we might, hand washing, good nutrition, and flu shots are sometimes no match for “what’s going around.” A cough. A fever. A stomach bug. If you feel like these illnesses are everywhere – you’re right.

And families around the world are battling the same illnesses. But in some places it’s far from a fair fight. Illnesses that are easily preventable and treatable in the United States can take the life of a child in Africa. More than 1.3 million children die each year from pneumonia and diarrhea, two of the leading killers of children in poor countries.

It surprises many people to learn that pneumonia and diarrhea, not HIV, tuberculosis or malaria, are the leading cause of death in young children around the world. While diseases like HIV and malaria take a toll, pneumonia and diarrhea take more lives of children under age five than all these diseases combined.

In the U.S., routine immunization helps protect against these common sicknesses. Hib (Haemophilus influenzae type b) and pneumococcal conjugate vaccines protect against pneumonia, and the rotavirus vaccine protects against one of the most common and serious stomach bugs. These vaccines have drastically reduced the number of children who suffer from these illnesses. A 2017 study found the rotavirus vaccine cut nearly in half the number of young children hospitalized for diarrhea, saving more than $1 billion in health care costs over five years. Similar benefits have been documented with the vaccines that prevent pneumonia.

Though germs are everywhere, health care sadly is not. Parents around the world share a common goal of protecting their children, yet too many families still lack access to, or even awareness of, vaccines and medicine that could save their children’s lives. As a result, the stomach bug that means a few days off school and a trip to the pediatrician for a child in Maryland can mean severe dehydration and even death for a child in Kenya. The respiratory infection that goes around at a preschool in Atlanta causes life-threatening pneumonia for young children in Ethiopia. What separates parents around the world is not the illnesses their children face, but how the health care systems they have access to are equipped to battle them.

While some may dismiss the challenges parents in poor countries face as inevitable and unfortunate consequences of poverty, this is simply not the case. This is not only a battle worth fighting, it’s also one we can win. We know how to prevent these deaths, and in many places, we are already succeeding. India, Nicaragua, Tanzania and many other countries have increased immunization rates and have saved lives as a direct result. Since 2000 the number of children’s lives lost to pneumonia and diarrhea has been more than cut in half – from 2.9 to 1.3 million deaths annually.

Every year, fewer children lose their lives to preventable diseases. We should be encouraged—but not satisfied—with the progress we’re making. We can do better. We can increase resources to equip families and health care systems around the world with the tools they need to battle our shared infectious foes. We can find new ways to deliver lifesaving vaccines and antibiotics to make sure no child dies from a cough, the stomach bug, or a mosquito bite. And we can muster our political courage and give voice to the needs, worries, and love of parents who, like germs, are the same everywhere.

Ethiopia’s Children Deserve to Have a Childhood

Written by Carolyn Miles, President & CEO, Save the Children

As we drove into the camp area for those displaced from home, the sea of people, goats and cows on the dusty, potholed road parted and flowed around our vehicles, each intent on going somewhere fast. The entrance to the children’s area of the camp was a piece of tin in a fence of sticks and tarps and when it swung open, we could see hundreds of children running and playing and a circle of girls dancing.  This is Gedeb, Ethiopia, a few hours south of Hawassa, where more than 13,000 people have come to escape violence.  

In this rather sad place, we visited the happiest corner, full of children playing and learning in a Save the Children supported area. Small children learned their letters in a huge tent, with local teachers and volunteers coaxing them to the front of the room to practice at posters tacked to the canvas walls. There were few books, and even fewer toys, but the children were intent on learning and squealed in delight when one of us came to the front of the room to “help” with the lesson.

Outside, girls danced and sang in a tight circle and in the large field dozens of older kids were engaged in a lively game of soccer. Even in the worst of circumstances, children just wanted to play, have fun and learn like any child anywhere. 

As we walked through the camp, through crowded rows of tiny huts made of tarp, sticks and dried banana leaves, the delight of the children nearby seemed even more amazing. Inside one of the shelters, I stopped to talk with a mom named Biritu, a mom of five who is pregnant with her sixth child. This was her second time coming to the camp from her home further north, where violence and looting had caused her to flee with her children. The space they were living in was about the size of a basic bathroom here at home, with tarps on the floor of mud and two tiny spaces for sleeping and living. Even on a cool day, it was steamy inside. When I asked when she thought she might go back home, she just shook her head sadly and held up her hands – a universal sign of “who knows.”

We visited the health post in the camp, which is also run by Save the Children. Here there were doctors from a nearby hospital who work 15 day rotating shifts. Mothers lined up on wooden benches waiting to get babies checked for malnutrition and for their children to receive vaccinations or treatment for illnesses. Adults were receiving services too, but the biggest focus was on pregnant women and children, trying to keep them healthy. 

The plight of the internally displaced people (IDPs) in Ethiopia is largely unknown. Yet there are more than one million people in just these two southern regions of Ethiopia and 3.2M country-wide who have been displaced. Many of them live in camps like the one we visited and even more live in the surrounding communities, sometimes with relatives until the resources and goodwill run out and they find themselves in the streets or back at a camp.

The conditions, despite the services offered by Save the Children and other aid agencies, are harsh. There is worry that as the rainy season approaches, this camp will be flooded. The latrines and water points may not hold out and these people could be moved yet again from this place to another. For many this might be the third or fourth move in just the past year. The children can’t go to formal school and the cases of scabies, malnutrition, pneumonia, and diarrhea are growing every day. Save the Children has reached more than 470,000 of the IDPs in this region with distributions and services, but there are still hundreds of thousands of displaced around the country unreached by any aid. With a world full of crisis and disasters, the suffering of these children and their families is largely ignored. 

Ethiopia is a country of great progress – one of the only countries in the world to meet the Millennium Development Goal for two-thirds reduction in child mortality from 2000 to 2015 and a country with strong GDP growth. But that progress and the opportunities it affords children is at risk of being set back for millions of children who can’t get regular access to services, especially to health services and school.

As part of our Return to Learning initiative, Save the Children has been working for the past three years to get refugee children access to school within a few months of being displaced. We’re working to ensure the world pays more attention to the importance of education for refugee children. I came away from this trip to Ethiopia convinced that we need to do the same for IDP children here in Ethiopia and around the world. We can’t afford to let millions of children lose out on the opportunity to go to school for years on end due to displacement. Whether they are refugees in another country or displaced within their own, they deserve the chance to grow up healthy and to get an education.  

 

 

Newborn babies and their mothers receive care in a health center located in Malawi where Save the Children supports proven programs, such as Kangaroo Mother Care. Photo credit: REDD BARNA / JONAS GRATZER

Customizable Hospital Furniture for the Smallest Babies in Malawi: A Potential Disruptive Innovation

Written by Bina Valsangkar, MD, MPH, FAAP

© 2015 | Kristina Sherk Photography 

Bina Valsangkar, MD, MPH, FAAP, is a pediatrician, adviser at Save the Children and a changemaker for children. She leads a team of health experts, industrial engineers and industrial designers under a Save the Children innovation grant to re-design newborn hospital units in Malawi to deliver family-centered care. In previous roles at Save the Children, she drafted policy, conducted research and developed newborn health programs in Africa and Asia. 

While many aid agencies, academic institutions and traditional and non-profit companies work to ensure access to essential medical equipment in low-income countries, less attention has been paid to the importance of suitable medical furniture. In the newborn units of Malawi, where Save the Children has been working to improve quality of care for the last several years, a well-designed chair, neonatal crib and staff workspaces have the potential to make care more family-centered, comfortable and safer. Well-designed furniture can improve patient, family and health worker comfort, but can also improve health outcomes. A well-designed chair for the newborn unit, for example, can facilitate greater amounts of skin-to-skin time between a mother and her newborn infant—which can be life-saving for infants born prematurely in Malawi. Well-designed workspaces and neonatal cribs can improve patient flow and visibility and reduce infection risk.

Malawi currently buys and imports the majority of its hospital furniture from India and China. While these pieces offer a relatively affordable option for hospital furniture with basic function, the furniture does not fully suit the needs of patients, families and health care workers in Malawi. Hospitals there face a different patient profile, medical demands, space limitations and set of cultural beliefs and practices.

Customizable hospital furniture offers a potential solution to the problem of functional fit. Headway in this market, however, has been largely made in high-income, high-end markets, with little or no market share in low-income countries.

With seed funding from the Save the Children Innovations Council as well as Purdue University’s I2D Lab, our team of experts in health, industrial engineering and design led by Professors Yuehwern Yih and Steve Visser, is working to create a set of space-saving furniture with accompanying layout design to allow for greater family-centered care and meet the needs of patients, families, and healthcare workers at Ntcheu district hospital in Malawi. The set includes a stacked neonatal crib, lounge chair for mothers and babies to be in skin-to-skin contact together and a mobile nurse’s station. Our project was born out of research and experience from the Saving Newborn Lives (SNL) program, a now 19-year old newborn health project at Save the Children.

While getting the individual furniture pieces and layout just right and within budget for the hospital is of utmost importance, it is the process of customization in the low-income setting, and creating and using customizable blueprints to make locally-sourced pieces with learnings from prior users that we hope will be a new market foothold in Malawi, with the potential to move across markets and upmarket to other countries and regions.

To learn more about Save the Children’s changemakers, visit our website.

James, age 6, and Heshima, age 8, carry water from a dried up riverbed in Turkana County, Kenya. Photo credit: Peter Caton \ Save the Children, July 2018

When Kenya’s Rivers Ran Dry

Written by Carolyn Miles, President & CEO, Save the Children

Kenya’s people had known droughts, even severe droughts, but they’d never experienced anything like this before.

This World Water Day, I’ve been reflecting on a trip I made to northern Kenya in 2017, when the whole Horn of Africa was experiencing a devastating drought. The rivers had all run dry, crops had failed and livestock had perished. When it finally did rain, flash floods swept away anything left. Children were hungry, malnourished, sick and dying.

I met desperate mothers and little children forced to dig into dried-up riverbeds just to find some muddy water. It was a grueling process that took children many hours, twice every day. First, they walked to the dry riverbed, then dug deep holes into the dirt, sometimes 10ft down, until enough water appeared to fill their water jugs. Then they would haul themselves up and out of the hole to carry the heavy jugs back home to their families. No child should have to spend precious time away from school and their families like this, only to have water unfit to drink.

Children in Turkana County, Kenya dig for water in a dried up riverbed. Photo credit: Peter Caton | Save the Children, July 2017.

The good news is that through Save the Children’s partnership with the P&G Children’s Safe Drinking Water Program, we were able to help purify that muddy water, using P&G’s water purification technology. We met with local mothers, distributed much-needed supplies and taught them how to benefit from this easy-to-use technology. This amazing process, invented by a P&G laundry scientist, transforms dirty water into clean, drinkable water in only 30 minutes, preventing deadly, water-borne diseases – and saving lives. It also helps improve health, enable education and increase economic opportunities for entire communities.

Thanks to supporters like P&G, we were on the frontlines in Kenya, saving as many young lives as possible throughout the unprecedented drought. And we’re still there to this day, working to ensure children and families have what they need to not only survive, but grow up healthy, educated and safe. Together, we’re creating ripples of change in children’s lives, their families and communities – ultimately transforming the future for all of us.

A special thank you to P&G, in partnership with National Geographic, for the honor of being named a Water Champion – and spreading the word about our humanitarian work.

Happy World Water Day!

Civil Society Surges as a Channel for DRM Assistance Among Addis Tax Initiative Members

Photo credit: Hadil Saleh /Save the Children, Aug 2018Written by Andrew Wainer, Director Policy Research and Nada Adibah, Intern, Policy Research

The percentage of DRM assistance disbursed through civil society and NGO channels surged among Addis Tax Initiative (ATI) members in recent years. In 2015, 4% (6 million) of ATI DRM assistance was channeled through civil society, but in 2017 that increased to 10% (21 million). Furthermore, the amount of DRM disbursed through NGOs and civil society, grew 252%, the most among all channels (see Table 1).  

While seven of the 20 ATI donors contributed to this increase, it was primarily driven by three donors: Norway, the United Kingdom, and the United States which had large increases in the amount of DRM assistance channeled through civil society between 2015 and 2017.

 

 Table 1: Percent Change DRM Disbursements Channel, 2015 to 2017

Channel Change (%)
Public Sector -20
NGOs & Civil Society 252
Public-Private Partnerships (PPP) 186
Multilateral Organizations 42
Teaching Institutions, Research Institutions, Think-Tanks 61
Private Sector Institutions 77*
Other -86

 * OECD CRS values reported only for years 2016 and 2017. Percent change calculated from these two years.

 

This assistance channeled through civil society ranged from grants from the United Kingdom to research institutions to study tax policy in Ghana and Ethiopia to assistance from Norway to support media oversight of the petroleum industry in Tanzania and Uganda.

But even as ATI members increasingly use civil society to disburse DRM assistance, a review of the 2017 OECD Creditor Reporting System data reveals an increase in overall DRM assistance from ATI donors of only 14% from 2015 to 2017 (the latest year available). The total amount of DRM assistance from ATI donors increased from $168 million in 2015 to $192 million in 2017.

The increase in the use of civil society as a channel for DRM assistance is welcome, but as donors, civil society, and developing nation revenue authorities prepare to gather in Berlin in July to review progress on the ATI, the latest OECD data reveal that, while ATI DRM assistance is growing, it is not on pace to reach ATI commitment #1: A collective doubling of donor DRM assistance. Increasing donor support to civil society for engagement in tax policy can foster enhanced governance while also contributing to ATI donors’ goal of doubling DRM assistance by 2020.

US DRM Assistance
The latest OECD data also reveals that US DRM foreign assistance is increasing at a faster rate than the overall rate for ATI members. In 2017, the United States disbursed $48 million for DRM support. This is a 26% increase since 2015, when the US provided $38 million.

Also aligned with the overall ATI trend of increasing percentages of DRM aid being channeled through NGOs and civil society, US DRM foreign assistance was increasingly channeled in this way – at a rate similar to ATI donors overall. Of the $48 million in DRM disbursed by the United States in 2017, 10% (4.8 million) was funneled to civil society, larger than the overall donor rate of disbursing 7% through this channel. This amount is a major increase in using civil society and NGOs for US DRM assistance when compared with 2016 when the US recorded channeling $192,000 – a tiny percentage of its total DRM assistance – through civil society.

DRM Assistance from the Perspective of Recipient Countries
Of the $192 million in DRM assistance ATI donors provided to the developing world in 2017, Africa received the most among any region with $91 million going to DRM – 47% of all ATI DRM assistance. Asia received second largest amount of DRM assistance with $37 million – 19% of all DRM assistance in 2017. Latin America, Europe, and Oceania received much small percentages of DRM assistance (see Table 2).

Table 2: DRM Assistance Provided to the Developing World in 2017

Region Amount Received (in millions USD) Percent of Total DRM Assistance
Europe 9 5%
Africa 91 47%
America 16 8%
Asia 37 19%
Oceania 5 2%
Developing country, unspecified 35 18%

 Save the Children has supported civil society engagement in DRM in Wajir and Bungoma counties, Kenya since early 2017. In recent years Kenya has experienced a surge in DRM funding. In 2017 Kenya received $8.8 million in DRM assistance, an increase of more than 105% compared to 2015 when it received $4.3 million. The large majority of DRM assistance to Kenya is also being channeled through civil society and NGOs. In 2017 $6.5 million of DRM assistance to Kenya – 74% – was provide through this channel.

Solidifying Progress
ATI is moving slowly toward its collective goal of doubling DRM assistance by 2020, but we are encouraged by the increasing role that civil society is playing in DRM– enabling citizens to engage on tax policy and, ideally, hold policymakers accountable for good fiscal governance. Ensuring that developing country ministries of finance and revenue authorities are also meeting their commitments and opening up to citizen input on tax policy will be key to the ATI’s long term success. We also welcome the creation of the ATI database, currently under construction, which will allow for new ways of analyzing and measuring DRM foreign assistance.

In future posts, we will delve into the details and nuances of DRM assistance going through civil society channels in order to better understand where this surge of funding is going, who it’s coming from, and the reason for its rapid increase. 

 

Providing for an Entire Extended Family in Yemen – A Mother’s Story

Drawing to illustrate the blog post provided by Sukaina Sharafuddin, Save the Children’s Communications Officer based in Yemen. Photo credit: Takayo Akiyama | Save the Children, Feb 2019

Illustration by Takayo Akiyama, Save the Children

This is the third of a three-part blog series written by a mother named Sukaina who is living and raising her young son in Yemen. Sukaina works for Save the Children in her home country, which has been at war since 2015. 

The war has changed everything for me, my family and families across Yemen. So many have left.

My husband used to have a good job, but he lost it when the economy crashed. He has a degree. He speaks English well, but right now he goes out every day trying to find a job that pays. It has been more than two years since public servants, public school teachers and doctors have been paid. 

My brother is a dentist, but now he teaches Biology at a high school. We are just glad he found a job at a private school that gives salaries to teachers. My cousin used to have an excellent job as a Finance Officer. The company had to shut down when the war started. Now it has been four years and he is desperate to find any kind of job to look after his wife and two daughters. I worry about him – his face has gone pale and he is just exhausted, worrying every day about how to feed his girls.

People like me, who are lucky enough to still have a job, support their whole extended family. I support my parents, my brother’s family, my grandmother, and my cousin’s family. Although the support I provide them is very basic and is barely enough, it is better than nothing. Everything in the shops is so expensive. I used to buy diapers without thinking about it. Not now. They are a luxury item. Many families use plastic bags or cloths in children’s underwear for their newborn babies, because they cannot afford the price of diapers.

Transport, hospital, schools, nurseries – everything is breaking down.

Over past six months, I’ve taken my son to seven different nurseries. Often, it is overcrowded. He comes home dirty, because there is only one carer for every 10 children. I’m looking for a new nursery, but I want it to be close to my work, because when the airstrikes start, I need to be able to run there to get him to a safe place.

A few months ago, we had the chance to leave Yemen. My husband traveled to Malaysia and found a great job. I was planning on joining him. But in the end, I asked him to come back. I’m sure you’re wondering, ‘Why?’

Everyone keeps abandoning Yemen. I can’t. I am the provider for my entire family. I can’t abandon them. I can’t abandon my country. I figured that it will be mentally exhausting for me and I will find no joy living elsewhere, knowing that my country and my family and friends are struggling to survive.

That is why I am still here.

What hurts the most is the feeling that we have been neglected by the outside world. I am grateful to Save the Children and their supporters for not forgetting us. Seeing the work we do in Yemen is a great relief for me.

 

To learn more about the work Save the Children is doing in Yemen, visit our website.

YOUR SUPPORT CAN MAKE THE DIFFERENCE FOR CHILDREN AND FAMILIES IN YEMEN. PLEASE DONATE TO THE YEMEN CHILD’S RELIEF FUND TODAY!

Giving Birth as Bombs are Falling – A Mother’s Story

Drawing to illustrate the blog post provided by Sukaina Sharafuddin, Save the Children’s Communications Officer based in Yemen. Photo credit: Takayo Akiyama | Save the Children, Feb 2019

Illustration by Takayo Akiyama, Save the Children

This is the second of a three-part blog series written by a mother named Sukaina who is living and raising her young son in Yemen. Sukaina works for Save the Children in her home country, which has been at war since 2015. 

 

When I think about my son, I get tears in my eyes. He is three and all he has ever known is war.

This is what happened the night he was born.

It was midnight when my contractions started. We had to go to three different hospitals before we found one where they had electricity. There were airstrikes all around – it was so scary. In the end, I needed a C-section and I asked to have a general anesthetic because I didn’t want to hear the sound of bombs when my son was born.

So war has been part of his life, right from the start. I feel like it has stolen his childhood away. He is three years old! He wants to go out and explore, but we have to keep him indoors where it is safer. He can’t play with water outdoors because he could get cholera. Or play football in the street because it is too dangerous.

This isn’t what I want for him.

Before the war, we used to have big family gatherings. I loved them. Everyone would eat together. The kids would play – it was such a happy time. Now, all we talk about is the war.

We are exhausted. We are tired of crying. We are tired of war. All we want is to have a safe life where our children could live an ordinary life.

To learn more about the work Save the Children is doing in Yemen, visit our website.

YOUR SUPPORT CAN MAKE THE DIFFERENCE FOR CHILDREN AND FAMILIES IN YEMEN. PLEASE DONATE TO THE YEMEN CHILD’S RELIEF FUND TODAY!

Staying Calm for the Sake of Her Son – A Mother’s Story

Drawing to illustrate the blog post provided by Sukaina Sharafuddin, Save the Children’s Communications Officer based in Yemen. Photo credit: Takayo Akiyama | Save the Children, Feb 2019

Illustration by Takayo Akiyama, Save the Children

This is the first of a three-part blog series written by a mother named Sukaina who is living and raising her young son in Yemen. Sukaina works for Save the Children in her home country, which has been at war since 2015. 

 

It is morning, but as I write this blog post, I am already thinking about what will happen tonight. Will there be airstrikes? It was quiet for the past couple of months, but lately airstrikes have resumed.

I remember how excited we were when we moved into this apartment – me, my husband and my son. It’s on the ninth floor! Which means that we have to take the stairs every now and then because electricity is not always available. My apartment views over Sana’a (that’s the capital of Yemen) are amazing, but then the airstrikes started again on the night we moved in. There were four airstrikes that targeted the same neighborhood where my mom and my handicapped grandmother lived. I called my mom and I asked her to stay away from the windows and to be careful. I couldn’t sleep and I was worried about her, until she texted me three hours later saying everything was OK.

Now, whenever the airstrikes happen, I lie with my little boy – he is three years old – and his one-eyed cuddly sheep and we cuddle until it is over. We stay where we are because this building has no shelter. Even if we ran down the stairs – nine floors, remember – there would be nowhere to go.

Sometimes, we put on headphones and play loud music to drown out the noise.  At other times, we just listen to the sounds of the planes overhead. My little boy is so funny. He actually loves planes and carries a small orange airplane everywhere he goes. Every time an aircraft hover over, he gets all excited and jumps up and down. He says, “Whoah, let’s go see the airplane!” but I pull him away from the windows, because we don’t have any functioning airports here, so I know airplanes mean one thing: bombs. When I hear them approach, I think, “This might be the end”.

I try to stay calm for my son. On the inside, I’m completely panicking, worrying about how on earth we will get out of here if we get hit. Somehow children always feel your stress. My son tells me, “Mummy smile. Mummy, be happy don’t be sad!”

So be happy  is what I try to do. Even though my country is at war, bombs are falling, and people are going hungry, I try to smile and be happy for my son.

Think of us tonight when you go to sleep – without the sound of airstrikes or the fear a bomb will wipe you out.

 


Civilians fleeing violence face life-threatening risks the moment they embark on their journeys. The most immediate dangers are death or injury due to explosive weapons, which have been used indiscriminately by all parties to the conflict with little regard for their legal obligation to protect civilians in conflict.

If displaced families manage to survive their dangerous journeys and avoid airstrikes and shelling to reach relative safety, they face further difficulties in strained host communities or in camps lacking in adequate food supplies and basic sanitation and hygiene. This puts young children at risk of malnutrition and disease in a country where the health system has all but collapsed and some 14 million people are on the brink of starvation. Save the Children estimates 85,000 children have already died from extreme hunger and disease since 2015.

To learn more about the work Save the Children is doing in Yemen, visit our website.

YOUR SUPPORT CAN MAKE THE DIFFERENCE FOR CHILDREN AND FAMILIES IN NEED. PLEASE DONATE TO THE YEMEN CHILD’S RELIEF FUND TODAY!

A mother in Kenya holds her newborn baby. Photo credit: Allan Gichigi/ Save the Children

5 priorities for involving parents and families in the care of small and sick newborns

Written by Mary Kinney, Senior Specialist, Global Evidence and Advocacy, Saving Newborn Lives at Save the Children 

Globally, nearly 30 million babies are born too soon, too small or become sick every year and need specialized care to survive. This staggering number was published in the report, Survive and Thrive: Transforming care for every small and sick newborn, by UNICEF, the World Health Organization, Save the Children and other partners at the end of 2018. Most of these babies can survive and live without major complications with quality and nurturing care.

Evidence indicates that involving parents and families or other caregivers in the care of the small and sick newborns benefits both the infants and parents including higher breastfeeding rates, earlier discharge from the hospital, increased weight gain, improved neurodevelopment, reduced parental stress and anxiety, and improved health-related knowledge and beliefs among parents and communities.

Here are five priorities from the report for involving parents and families in the care of small and sick newborns during hospitalization:

Promote Zero Separation

Evidence shows that the well-being and survival of both mother and newborn are inextricably linked and require a coordinated, integrated approach. This not only optimizes their health but also promotes greater efficiency, lowers costs and reduces the duplication of resources. For example, mother’s presence is crucial to establish breastfeeding and to promote Kangaroo Mother Care. Promoting zero separation reduces the risk for short- and long-term health and social problems, including parental depression and anxiety.

Intentionally Engage Men

While women have a unique role as mothers, evidence also shows that men also have a key role in the care of newborns, as partners/husbands, fathers, caregivers and community members. Men often determine health care seeking as well as provide care to the newborn and mother. Health services should accommodate men to accompany their partners, including service hours, physical space and privacy for care visits.

Involve Parents in the Care During Hospitalization

Parents or other caregivers make unique contributions by being able to observe, monitor and provide care to their small and sick newborns (when appropriate, under supervision and in partnership with the health-care team). A recent randomized control trial found that parental involvement during the inpatient neonatal intensive care benefits newborn health outcomes, including infant weight gain and increased frequency of exclusive breastmilk feeding at discharge, as well as a boon to parental mental health. Interventions, such as Kangaroo Mother Care, empowers families to care for their small newborns and shortens their length of stay in the hospital.

Practice Family-Centered Care

Family-centered care for small and sick newborns has a growing evidence base with demonstrated benefits for infants (such as weight gain and neurodevelopmental progress) as well as parents (such as decreased parental stress and anxiety and increased caregiving efficacy). This approach implements four basic principles: dignity and respect; information sharing; participation; and collaboration, and is recommended by the American Academy of Pediatrics. Hospitals and communities should provide space at the facility or nearby for parents or family members, as needed.

Empower Parents

Parents are powerful agents of change for small and sick newborn care supporting other parents and influencing policy and programs. Support forums for parents, including parent-led, peer-to-peer and health professional-led groups, improve the home environment, parental mental health and parental confidence in caring for their child. Parent advocacy and support organizations raise awareness and share their experiences to help others in the same situation through events like World Prematurity Day.

 

Thank to the generous support of our donors, Save the Children has a long-standing experience promoting family engagement in newborn care, such as with Kangaroo Mother Care, demand creation for community-based newborn care, and quality improvement activities. In order to transform care for small and sick newborns, intentional efforts must be made to involve parents, and we remain committed to this effort as part of our broader approach to improve maternal and newborn health. That means that together, we have the chance to make a lifetime of change for millions of newborn babies.

To learn more about the work Save the Children has done to save newborn lives, visit our website.

Get involved by donating your birthday and help a baby live to see their first birthday – and many more. DONATE YOUR BIRTHDAY TODAY!

From Bungoma to Paris: Local Citizen Engagement Through the Addis Tax Initiative

Written by Andrew Wainer, Director, Policy Research at Save the Children

The Addis Tax Initiative (ATI) was launched in 2015 in Ethiopia with developing nations as key signatories, but – like other global agreements – it faces challenges translating global dialogue in Berlin, New York and Paris to better tax policy in Nairobi, Monrovia and Tbilisi.

This challenge to operationalize the ATI is daunting, but national-level tax policy and administration is only part of the solution for transforming tax into an engine for financing well-being in developing countries. 

Services including health and education are delivered to citizens at the local level and tax and spending at the sub-national level is where most citizens are impacted by fiscal policy that is either fair or regressive.

To ground its commitment of increased, transparent, and accountable DRM, the ATI is monitoring how developing country governments are increasing domestic revenue for inclusive development. But, so far, analysis of sub-national level domestic resource mobilization (DRM) is largely absent from this analysis. 

The role of sub-national tax authorities is certainly difficult to track, but, to be relevant to the citizens’ ground truth, the should ATI integrate local tax policy and administration.

Bungoma County, Kenya

Even at the national level in Kenya, and other signatory counties, the ATI requires further understanding and integration – it’s not yet well-understood by many fiscal policymakers and implementers. There is a need for increased ownership at the national level.

But Save the Children, working with civil society, small business groups, and county assemblies on DRM in Bungoma County, Kenya, has found that citizens are best able to educate and influence policymakers – using the Addis Tax Initiative banner – at the local level.

Revenue generation capacity at the county level in Kenya remains low, with some reports that it is actually decreasing, even after the country’s 2010 devolution law. But in Bungoma County, motivated citizen groups are filling the gap, helping shape tax policy where local government capacity is low.

Civil society can be helpful intermediaries on local level DRM to both increase tax compliance and contribute to tax policy accountability, transparency, and inclusiveness.

Specifically, Save the Children is working with the Bungoma County Child Rights Network (BCCRN), small and micro-entrepreneurs (including women-owned businesses) and the local country assembly to improve local tax collection, making it more transparent, accountable, and pro-poor. It’s already paying dividends in increased tax compliance.

In Bungoma, the main sources of local revenue include business permits and market fees. The BCCRN started with these existing tax laws, working to increase revenue activities through analysis, advocacy, and stakeholder education, including on the Addis Tax Initiative.

The result is lower market fees, creating rates that are less onerous for small-business owners with slim profit margins, and, at the same time, expanding tax compliance among these groups as taxes are reduced to rates they are better able to pay. Because taxpayers are involved in the policy discussions they are also more bought-in to the policies and apt to comply with tax regulations they played a part in shaping.

This was accompanied with increasing rates on local supermarkets, who enjoyed large profit margins and were undertaxed, according to local citizen analysis. These civil society proposals were taken up by the local county assembly.

The ATI and Progress on DRM in Kenya

Civil society in Bungoma County is just getting started with tax policy advocacy, but Kenya, at all levels, is showing signs of progress. Further training could help civil society to partner with local government to enhance property taxes – another source of local revenue that is badly underutilized in Kenya.

And while civil society can support local tax authorities “from below” there is also a need for assistance from and alignment with national tax bodies “from above” such as the Kenya Revenue Authority. County level tax officials need national guidance on revenue generation strategies and medium- and long-term tax policy plans.

To maintain progress, the Kenya government and other ATI stakeholders should make advancements in two areas:

  • Support local civil society. Civil society groups are crucial intermediaries between local government and citizens. Trusted local organizations can build trust and participation between local tax collection authorities and tax payers, improving tax compliance, fairness, and accountability.
  • Support for sub-national DRM. Most citizens encounter the impacts of taxing and spending at the local level. Increasing domestic revenues at this level can enhance budgets for local public service delivery. ATI should include sub-national domestic resource mobilization into its mandate, analysis and goals.

Civil society is already making a difference for tax policy and administration. The ATI would be wise to tap into this local source of change to ensure that its global discussions make a difference at the community level.