Working to Help the Most Vulnerable Survive and Stay Safe

Ali* (right), 14, with his sister Noura* (left), 6, outside the house their family rents in Sana’a, Yemen.

In times of crisis, when children are at their most vulnerable, Save the Children is there. Our humanitarian aid workers are willing to stay as long as it takes to ensure children and families can recover, restore their lives and build their resilience for years to come.

Today, some of the biggest challenges for children and families are those caught in the crossfire of conflict. The children of Yemen face unrelenting hunger and suffering. Every day, our dedicated humanitarian aid workers are there to help them survive, and thrive, despite the dire situation.  Jeremy Stoner, Regional Operations and Humanitarian Response Director at Save the Children Middle East and Eastern Europe Regional Office is one such humanitarian. Here is his story.

Written by Jeremy Stoner

Sana’a to Haddjah…
I left Sana’a, Yemen’s largest city, on Wednesday morning accompanied by the Director of Safety and Security. Together, we headed
for Haddjah Governorate in the north of Yemen which shares a border with Saudi Arabia. Having stopped by in Arum, where Save the Children also has a field office, to briefly the meet the staff, we climbed, seemingly incessantly, through breathtaking scenery and arrived at Haddjah City. The beauty of the area is marked by cascading terraced agriculture recently planted to catch the first of the rains rendering the mountains with a fresh green hue.

A Country at War
It is easy to be seduced by so much natural beauty but there are always reminders that Yemen is a country at war – a war which has been so devastating to 22 million people – the world’s worst humanitarian disaster. There are regular reminders of the war in Yemen at different points in the journey. While our minds are focused very much on Hodeida, where a fresh wave of violence has seen bombing escalate and deadly clashes erupt, they are also with the millions of children directly and indirectly affected by the volatile civil war, now in its fourth year.

Even a simple journey requires elaborate planning to ensure it is as safe as possible. Somewhere in Yemen and on a daily basis, we can’t actually access some of the neediest children simply because we aren’t granted permission. There are so many complications to delivering for children in Yemen but, despite that, we continue to be on the ground, working to help the most vulnerable survive and stay safe.

Arriving In Haddjah and Meeting the Team
The town of Haddjah is dispersed over a number of mountains and hillsides and has incredible views over the dramatic countryside. Save the Children opened an office here in January 2017 but had been supporting the area from other offices prior to that. The Field Manager for our  Haddjah  office  showed good leadership during our visit and clearly manages strong relationships internally with the team and externally with local authorities. His enthusiasm and passion for the work is clear. The other members of the team also demonstrated similar levels of commitment and enthusiasm which was a great foundation for our visit to see our water, sanitation and health work in Baniqais District.

Before departing, we shared breakfast with the Director General of the National Authority for Management Work. He oversees the humanitarian efforts in Haddjah and he is clear about the issues and the needs in both Haddjah and its surrounding districts. He spoke very highly, not just of the work that we are doing on the ground, but also of the excellent relationship that the authorities and Save the Children have built.

Visiting Baniqais
We left the city on Thursday morning and headed down through the mountains to Baniqais District, an area considered to be the poorest within Haddjah. From the relative cool of the mountains the contrast in the valleys way below couldn’t be stronger. A searing heat greeted us as we stepped out of the vehicle to have a look at the central water tank that Save the Children has put in to serve the Health Centre and nearby houses in the local community (funded by UN OCHA). It is a serious-looking tank fed by a network of eleven wells, also supported by Save the Children. The quality of construction of these wells and the central tank itself looks good with each having a solar pump attached to feed water to the central tank near the Health Centre.

Later we visited the Health Centre itself to see more of the rehabilitation work that we have been supporting there (also UN OCHA funded). We have added a small laboratory and clinic on site for malaria which might be unusual for a Health Centre. However, the plans are to convert this Health Centre into a District Hospital to serve this desperately poor and under-resourced district. We will be able to achieve this dream with a second round of funding from OCHA which we expect shortly. Under this phase of funding, we also intend to extend our water, sanitation and health (WASH) work to cover more of the District’s water needs. This will hugely relieve the burden on women and especially girls who can be seen carrying water for 5 or 6 KMs from the nearest well to their homes. Water carrying can be the single most important contributing factor to girls dropping out of school early which is barely thinkable.

Children’s Health
The water system was working perfectly during my visit with plenty of fresh water available throughout the clinic! We visited on a Thursday, which is the weekend in Yemen, and so the Health Centre was technically closed. However, they do operate a 24-hour service for health emergencies.

Thank goodness for this, as I saw a boy who must have been about 4 years old brought to the clinic with severe diarrhea by his brother who himself was only 10 or 11 years old. The staff examined the boy for acute diarrhea as well as cholera. They would have to send a sample to Sana’a to confirm the boy’s condition, as they don’t currently have the equipment to diagnose cholera. They do, however, have the basic equipment to test for malaria.

One of the doctors showed me the log of cases that he keeps explaining that the peak months for malaria in this region are January thru March. In March of this year alone, 1,200 malaria cases were dealt with by the Health Centre. Now, the number of cases is down to around 150 or so.

I met the pharmacist of the Health Centre who, for the time being, had a good supply of basic drugs including antibiotics and ant-malarial drugs. Just these two types of drugs save children’s lives and it feels good to know that Save the Children is supporting health centers like this across Yemen. The Centre also has a dedicated nutrition section where mothers get advice on the best food for their children, based on what is available locally, and malnourished children can get support. In this district alone, food baskets are given to 1,200 families every month with special food for children to build them back to their ideal weight.

The Health Centre management team were present and provided us with a thorough tour of the facilities. Again, people were delighted with the support that the team have been providing and enthusiastic that the Centre can become a District Hospital to serve the most deprived people in the Governorate.

Samir* suffers from Severe Acute Malnutrition and was brought to a Save the Children-support health center for care.

Haddjahh Hospital and Pediatric Unit
We returned from the district to Haddjah City where our first stop was the hospital. It is the Authority of Al-Gamhori Hospital or the main hospital in Haddjahh. Here, Save the Children has installed an impressive solar power system on the hospital’s roof. A truly huge array of panels that provide electricity to the hospital – light and fans so that they can deliver essential tertiary services to the Governorate population (about 2.2 million). Close by to the hospital, we have renovated a large building which will become the pediatric unit for children at Governorate level. This will provide children’s health care at the Governorate level from nutrition, to curing childhood killer diseases and nutrition support to mothers and their children – can’t wait to hear about its progress once it is up and running! 

Delivering in Conflict
Reflecting on Save the Children’s amazing 614 staff and numerous volunteers in the Yemen Program, it is clear that they are working under incredibly difficult circumstances but able to serve some of the neediest children in the world. Many staff remain in Haddjah during the week, only returning to their families on the weekends.  

As the situation in and around Hodeidah remains tense, it is worth remembering that some of our staff and their families have come to the relative safety of Sana’a and are working from the country office as their temporary base. Our expatriate staff also do an incredible job with severe restrictions on their movement every day but still maintaining the drive and commitment to make a success of Save the Children’s Yemen Humanitarian Program.

As the Program gears up to our highest level of humanitarian response, I was left with a strong sense of hope. This is built on the excellent staff that I met both national and international combined with some really powerful work on the ground for vulnerable children and communities – excellent! The incredible thing is that, despite the war and the suffering in such a massive and complex crisis, we are absolutely delivering what is needed and are looking to do even more! 

 

Improved breastfeeding practices have the potential to save the lives of 823,000 children, like Sakariye

No one understands how breastfeeding can increase a child’s chance of survival the way a mother of a malnourished child does.

Did you know that undernutrition is estimated to be associated with 2.7 million child deaths annually or 45% of all child deaths.1 However, research estimates that breastfeeding saves the lives of over 820,000 children under 5 years old each year.

In fact, around one in eight of the young lives lost each year could be saved through breastfeeding,3 making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths.4 Here’s why.

Breast Milk Is a Superfood
In the first hours and days of her baby’s life the mother produces milk called colostrum, the most potent natural immune system booster known to science.5 A baby who is breastfed colostrum receives significant protection against pneumonia and diarrhea, which are two major causes of deaths of children in poor countries. A child who is not breastfed is 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhea. 2

If we can ensure that every infant is given breast milk immediately after birth, is fed only breast milk for the first six months and continues being breastfed through two years of age and beyond, we can greatly increase the chance that they will survive and go on to fulfill their potential.

Mothers Face Barriers to Breastfeeding
Additionally, because of the chronic shortage of health workers, many women in developing countries give birth at home without skilled help, or in a health facility where the health workers are over-stretched and under-trained. One third of babies are born without a skilled birth attendant present. As a result the opportunity for new mothers to be supported to breastfeed in the first few hours is lost.7

The Importance of Breastfeeding Support
A mother’s access to skilled breastfeeding support can have direct impacts on her ability and confidence to breastfeed.  Breastfeeding isn’t easy for everyone, particularly in emergencies.  In these times of difficulty, mothers need access to support.  Skilled support as well as basic interventions that support mothers and their youngest children have a direct impact on her child’s survival. Here is the story of one such mother.

Amran* holds her six month-old son Sakariye*, the youngest of her 3 children.

Sakariye*’s mum, Amran*, remembers the first time her son was seriously ill. “He was 15 days old. First, he had problems breathing, then he got measles,” she explained. Amran* did her best to care for Sakariye*. She tried to get him medicine. She tried to breastfeed him, but he continued to struggle.

A baby’s health is closely linked to its mother’s and so it was for Sakariye* and Amran*. When drought caused food shortages in Somalia where the family lives, Amran* did what any parent would do. She put her young children first.

“I wasn’t able to breastfeed Sakariye* because I was sick and malnourished,” says Amran*. She faced real challenges in feeding her child and lost her confidence in being able to feed Sakariye*.  Amran* didn’t have access to skilled breastfeeding support that could have immediately referred her for health services and supported her with information and counselling on breastfeeding.

With limited available options, Amran* began introducing water and food to supplement her breastmilk. At six-months old, Sakariye* fell ill, getting frequent diarrhea. He started vomiting and having fevers. He grew so weak he couldn’t turn over any more. Amran* knew her baby was in danger. She brought him to Save the Children’s treatment center, where he was diagnosed with malnutrition and admitted.

Today, Amran* is sitting by her son’s cot on the ward. She’s smiling because she has seen big changes in him during the last few days.

“It is good we are here,” she says. “Sakariye* has started recovering. He takes injections and other medicines. They give him some nice therapeutic milk.” Sakariye* is getting stronger and so is his mum.

Amran* is able to breastfeed again and she is looking forward to taking her son home.

Mabior*, who has pneumonia, is breastfed by his mother Ayen* at a hospital in South Sudan.

All across East Africa, babies and young children are at risk of malnutrition. Every day, more than 15,000 children around the world die before reaching their fifth birthday, mostly from preventable or treatable causes.9 A large, and growing, share of them are newborn babies in the first month of life.

Save the Children works with partners at global, national, regional, and community levels to prevent malnutrition by bringing a wide-range of multi-sectoral interventions and programs to disadvantaged families.

While our main target population is mothers and children, Save the Children’s strategies also include support for fathers and other caregivers.

Save the Children’s Emergency Health and Nutrition programs focus on  lifesaving maternal, newborn and child healthcare, including breastfeeding promotion, protection and skilled support.

To learn more about the work Save the Children has done to celebrate breastfeeding awareness, visit our website.

YOUR SUPPORT CAN MAKE THE DIFFERENCE FOR CHILDREN AND FAMILIES IN NEED. MAKE A DONATION TODAY!

 

1. Nourishing the Youngest

2.Edmond, K M, Zandoh, C, Quigley, M A, Amenga-Etego, S, Owusu-Agyei, S and Kirkwood, B R, ‘Delayed breastfeeding initiation increases risk of neonatal mortality’, Pediatrics, March 2006, 117(3):e380-6

3. Mullany, L, Katz, J, Yue M Li, Subarna, K, Khatry, S, LeClerq, C, Darmstadt, G L,and Tielsch, J M, ‘Breast-feeding patterns, time to initiation, and mortality riskamong newborns in southern Nepal’, Journal of Nutrition, March 2008, 138(3):599–603

4.Source: UNICEF, World Breastfeeding Conference, December 2012

5. Uruakpa, F, ‘Colostrum and its benefits: a review’, Nutrition Research, 2002, 22, 755–767, Department of Food Science, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada.

6. State of the World’s Mothers Report 2015

7. Superfood for Babies: How Overcoming Barriers to Breastfeeding Will Save Children’s Lives

8. Nourishing the Youngest

8.WHO

9.End og Childhood Report 2017

Cholera Epidemic in Yemen Threatens Puts Children at Risk

Children at Risk in Yemen Need Urgent Support as Cholera Outbreak Threatens Hodeidah

Undernourished children in Yemen’s district of Hodeidah are far more likely to contract cholera should the disease spread quickly in the hot summer months. A new alert from Save the Children reports conditions are ideal for cholera to spread rapidly, with almost 3,000 suspected cases reported in the first week of July across the country – the highest number seen since the start of the year.

“There is no time to waste,” Carolyn Miles, President & CEO of Save the Children said in a recent statement. “Aid agencies need unimpeded humanitarian access to save lives. The international community must also step up its support so that we can prevent another outbreak of cholera.”

In Yemen, the poorest country in the Arab world, an estimated 2.9 million children and pregnant and lactating woman are acutely malnourished.1  Undernourished children are far more likely to contract cholera, as the disease causes violent vomiting and diarrhea. The disease is especially deadly for children under five years and those whose immune systems have been badly compromised by malnutrition.

Families in Yemen have already been through so much as war wages on for a fourth year. Children like Lina* are especially susceptible to the deadly effects of cholera.

Cholera Epidemic in Yemen Threatens Puts Children at Risk
Lina* (8 months) visits a Save the Children supported health facility in Amran to receive treatment for malnutrition. Two of her siblings have already died due to illness.

At 8-months old, Lina* is already receiving treatment for malnutrition. Her parents brought Lina* to a Save the Children-supported health facility in Amran so a health worker could administer emergency treatment, including therapeutic food and medicine. “We are from a remote village,” Lina’s* mother explained. “We barely have anything. Lina* is in a weak state. We buy food as much as we can afford. I give them bread to manage their hunger. What can I do?”

Lina’s* family has been displaced for at least six years. Her parents have already lost two children to illness.

Cholera Epidemic in Yemen Puts Children at Risk
Families like Lina’s* are struggling to withstand continued conflict, food reduction and danger in Yemen.

Since early May, the frontline of Yemen’s civil war has edged closer to Hodeidah, the main port city on Yemen’s west coast and the country’s primary entry point for goods and humanitarian aid. Save the Children is increasingly concerned that Hodeidah city could be besieged as the Saudi- and Emirati-led coalition makes advances in northern Yemen and continues to consolidate gains around the south of the city. This could potentially cut off Hodeidah city, its port and its people from the rest of the country. 2

Save the Children is on the ground, working to provide children caught in the crossfire with access to food, health care, education and protection. We need your generous gift to support our efforts. Our relief in Hodeidah now includes treating children for life threatening conditions such as malaria and diarrhea. We’ve rehabilitated health centers and hospitals and provided equipment, medicines, and support to help keep the health system functioning.

To learn more about the work Save the Children has done in Yemen, visit our website.

YOUR SUPPORT CAN MAKE THE DIFFERENCE. MAKE A DONATION TODAY TO SUPPORT OUR YEMEN CHILDREN’S RELIEF FUND.

 

1. Conflict in Yemen Fact Sheet 

2. A Siege of Hodeidah Could Have Devastating Consequences, Warns Save the Children 

Redefining Gender Roles Through Kangaroo Care in Africa

A Kenyan Father Participates in Kangaroo Mother Care…and Likes It

Written by Nicolle Keogh  | Photography by Peter Caton

Fathers play an important role by assisting mothers with Kangaroo Mother Care, a technique where skin-to-skin contact and breastfeeding offer newborn babies warmth and nutrition during the most critical stage – the first 24 hours. However, in many cultures, fathers are reluctant to participate in perceived maternal techniques. Here is the story of one such father and how he is working to redefine gender roles for Kenyan fathers.

In Nairobi, Kenya, William works as an assistant tutor to provide for his young family. Every morning, he prioritizes spending time with his twin babies in their one-room home before beginning his day.

“I always wake up around 5 a.m. so I can hold each of them before I start preparing myself for work,” he says of 7- month-old Audrey and Amber. He proudly adds that now that his girls are healthy 7-month olds, they squeeze in some playtime before he leaves home.

Holding both girls in his lap, he recalls his first weeks as a father, when he spent hours of each day praying for their health after they were born three months premature. Weighing about 3.5 pounds each at birth, Audrey and Amber spent over two months in the hospital while their health and weight improved. William visited every day after work, anxiously wondering during each taxi ride whether his newborns had lived to see another day.

redefine gender roles for Kenyan fathers
Save the Children is strengthening the skills and capacity of health providers in seven hospitals located in the Langata area of Nairobi, Kenya, so that they can deliver higher quality care to preterm and low-birth-weight babies. The project is targeting to reach 2,200 new born babies each year, including William’s twins Amber and Audrey.

In Nairobi, most hospitals face the challenge of not having enough incubators to meet demand, so it’s not uncommon to see four tiny newborns sharing one machine. When William arrived to visit his family at the hospital, he’d often learn of newborns in the same unit who hadn’t survived.

“I never held them when they were in the hospital because I was afraid and thinking, ‘What if I hold this baby, then the next moment she’s not there?”

But with help from a Kangaroo Mother Care (KMC) program supported by Save the Children and Red Nose Day, both girls grew to become healthy babies.

KMC is the practice of providing skin-to-skin contact between a caregiver and newborn. The technique decreases mortality by regulating the baby’s temperature, breathing and heartrate; promotes breastfeeding and provides an opportunity for parent-baby bonding.

Audrey and Amber responded immediately to KMC and began gaining weight at a rate of about 4 ounces per week. William was impressed by the progress but a common social stigma regarding traditional gender roles kept him from expressing his interest in KMC. “In the African culture, there is this thing that kids are supposed to be taken care of by the mom,” he explained.

After two and a half months of practicing KMC in the facility, Audrey and Amber were finally healthy enough to be discharged.

Once at home, William began assisting his wife with KMC. They’d spend their nights sitting side-by-side, each with a baby on their chest in Kangaroo position.

When they returned to the hospital for their first follow-up a week later, the twins’ weight had
increased by over a pound. William was convinced that he should continue as a key player in the twins’ KMC journey.

“One important thing that I’ve learned from practicing KMC is that even me, as a dad, I have a very big role to play with my kids,” William says. “Other than providing for them, I can also be part of bringing them up.”

William recognizes that his family is fortunate to live in Nairobi where KMC is practiced, and able to afford the public transportation fare to attend follow-up visits at the hospital. “If this program could reach people in the rural areas, it will make life a bit easier [for those people] and it will even make the world happy,” William said. “Because the joy of each and every family is to see the child come home from the hospital healthy.”

“Thank you very much for bringing this program to us,” William said. “It has taught us a lot, it has brought joy to my family. KMC is the reason why I can hold my babies, I can play with them, I can laugh with them. So all I can say is thank you very much.”

YOUR SUPPORT CAN MAKE THE DIFFERENCE. MAKE A DONATION TO SUPPORT OUR WORK IN KENYA AND AROUND THE WORLD.

Save the Children’s Saving Newborn Lives program is a project that aims to reduce newborn deaths and improve newborn survival in high-mortality countries in Asia, Africa and Latin America.

Health workers present when the baby is born can help the mother establish exclusive breastfeeding, and can support the mother to keep the baby warm through skin-to-skin contact – a technique known as Kangaroo Mother Care. Fathers play an important role by assisting mothers with KMC.

5 HARMFUL LONG-TERM EFFECTS OF FAMILY DETENTION ON CHILDREN

5 Harmful Long-Term Effects of Family Detention on Children

This post originally posted by Save the Children Action Network.

Written by Mira Tignor

It is difficult to imagine hearing the panicked cries of children being separated from their families, but this is the reality happening at the U.S.-Mexico border.

The separation of migrant families at the border has been the subject of intense media scrutiny and outrage. Even if the issue of family separation were to be resolved, children are still negatively impacted by indefinite family detention, with their well-being at risk.

Below are 5 harmful long-term effects of family detention on children:

  1. Harms family relationships and stability – Family separation can permanently damage familial relationships, even after reunification. Many children don’t understand why the separation is happening, and feel that their parent has abandoned them. The American Academy of Pediatrics explains that “detention itself undermines parental authority and capacity to respond to their children’s needs,” and results in fraught parent-child relationships.
  2. Damages psycho-social development and well-being – Detention involves experiencing a loss of control, isolation from the outside world and detachment from community and culture. These experiences are harmful for people of all ages, but have a higher impact on children because their brains are still developing. The president of the American Academy of Pediatrics said that detention affects children’s brain chemistry in a way that is comparable to child abuse. Research has shown much higher rates of depression, anxiety, PTSD and suicidal thoughts in children who have been detained.
  3. Worsened school performance – Detained children often experience impaired or delayed cognitive development, which affects concentration and other abilities that are crucial to academic success. This makes keeping up with the age-appropriate reading and math level especially difficult for detained children. Even once their period of detention is over, their learning capabilities are already behind those of their peers.
  4. Poor sleep quality – The lack of bedding for children sleeping on concrete floors, coupled with the mental stress they are under, often results in sleeping problems such as insomnia, sleepwalking, bedwetting and night terrors. Poor sleep quality, in turn, can have detrimental effects on physical and mental health.
  5. Risk of exploitation and abuse – Children are at higher risk of being exploited or abused while in detention centers. There have been reports of privately run detention centers paying extremely low wages to detainees for their labor, as well as experiences of physical and sexual abuse from guards and other officers. Some detention centers have been reported to use severe disciplinary measures to control children’s behavior, including drugging children without consent.

In order to help children address these consequences and prevent more children from having to experience them, we must contact our members of Congress and urge them to put the best interests of children first.

YOUR SUPPORT CAN MAKE THE DIFFERENCE.

ABC News “This Week with George Stephanopoulos” Interviews Carolyn Miles on the U.S. Border Crisis

On Sunday, June 24, CEO and Save the Children President & CEO Carolyn Miles and International Rescue Committee President David Miliband were guests on ABC News “This Week with George Stephanopoulos.” On the heels of World Refugee Day, their discussion focused on the treatment of immigrant families at the southern border and the worldwide refugee crisis.

Carolyn Miles spoke to the trauma that separating a child from his or her family inflicts. Her words supported the grave concern Save the Children has for the treatment and well-being of children from Mexico and Central American nations who are in the custody of the United States government after crossing the U.S.-Mexico border.

Top of mind is also the Presidential Executive Order which Save the Children believes simply replaces family separation with indefinite family detention. ‘The trauma that happens to children is very real,” Carolyn Miles explained. “It’s psychological. It’s physical. It’s lasting. You see that what happens to kids when they’re separating from their families in these kind of crisis is something that stays with them.”

Carolyn Miles also shared a personal story of a boy she met while travelling in El Salvador. Working closely with local communities and organizations in El Salvador, Save the Children designs Sponsorship programs to help vulnerable children from early childhood to early adulthood — giving them a healthy start in life, the opportunity to learn and protection from harm along the way.

Watch the full segment, visit ABC News “This Week with George Stephanopoulos” and sign Save the Children’s petition telling President Trump that we have ZERO TOLERANCE for policies that do not put children’s interests first.

U.S. Government Investments That Give Everyone a Fair Chance

By Carolyn Miles, President & CEO, Save the Children

Tax season is over this year in the United States, but efforts on taxes are only gaining speed and attention in many developing nations.

USAID Administrator Mark Green has highlighted this as key to helping countries on their “Journey to Self-Reliance.” USAID aims to invest more aid to help developing countries reform their tax policy and administration – referred to as domestic resource mobilization (DRM) – as a way to finance the Sustainable Development Goals (SDGs) and to gradually transition countries so that they no longer need our development assistance, and they remain strong partners to our country.

But the success of US investments in DRM ultimately depend upon trust – specifically, the trust that people in a country have in their government. Will governments fairly collect taxes and will they spend tax revenues in ways that are equitable and help reduce poverty? In this regard, paying taxes is at the heart of the citizen-state compact. When citizens pay taxes they expect to receive quality health and education services, security, and basic infrastructure from their government in return. Citizens want their governments to be accountable for how their tax money is spent.

To guide USAID in assisting partner governments to foster this citizen-state compact and mobilize domestic public revenues for equitable and sustainable development, the Modernizing Foreign Assistance Network (MFAN) created “Principles of Public Sector Domestic Resource Mobilization in Developing Countries.” The principles are as follows:

• Ensure DRM investments are pro-poor, sensitive to gender, and support inclusive economic growth. More tax funding will not magically reduce poverty;

• Align with country priorities. Support an overall country plan to strengthen its DRM systems, and to invest funds in the development priorities of partner countries. For all international assistance – country ownership is key;

• Take a holistic approach to DRM, including by building a transparent and inclusive process for setting national DRM policies, strengthening judicial and audit institutions, and reducing tax evasion and avoidance;

• Engage citizens and other development stakeholders in DRM activities. DRM programs should be highly participatory and democratic by helping to finance broader engagement of citizens and other development stakeholders in DRM activities; and

• Transparently assess progress. The US government should support accountability of tax systems to their own citizens working with partner governments to develop benchmarks for monitoring and evaluating equitable DRM and sharing them publically in their countries.

Save the Children knows firsthand from our work in communities in places like Kenya how difficult it can be for civil society and citizens to engage in dialogue with their governments around tax policy. Such discussions are often technical and not transparent; civil society organizations often lack the resources and capacity to engage. But tax reform will not lead to more accountable governance without civil society and citizens at the table; so it’s vital that aid for DRM support not only the government’s activities, but also support civil society’s ability to engage in the process.

MFAN has created these principles not only to ensure that the US government’s DRM strategy is a catalyst for inclusive economic growth and poverty reduction, but to ensure that it also includes the voices of vulnerable and marginalized populations so that reform reduces inequality and improves governance.

As experts have noted, DRM that produces meaningful improvements for marginalized and vulnerable populations is unlikely to occur without their voices being included. Donor nations like the United States can play an important role to ensure that these voices are integrated into national DRM dialogue and that equity and fairness become the centerpiece of tax policy and administration reforms.

Citizen Voices in Tax Reform: The Need for Evidence from the Developing World

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

Global momentum on tax and development is escalating this year with the February Global Conference of the Platform for Collaboration on Tax, discussions on tax policy to reduce inequality at the World Bank Spring Meetings in April, and the upcoming tax capacity building conference hosted by Sweden.

These dialogues often emphasize the role of governments and multilateral institutions in harnessing tax systems to finance the Sustainable Development Goals (SDGs). While governments play a central role in taxation, Save the Children is focusing on the role of citizens in shaping their own tax systems in the developing world, specifically through our work with civil society at the sub-national level in Kenya.

Traditionally, donor countries haven’t prioritized investments in civil society. As we’ve revealed in a previous postonly 3% ($6 million) of the total $191 million in DRM support provided by all donors in 2015 was channeled directly to civil society or citizen groups.

This is much less than the 12% ($21 billion) of the total $174 billion in foreign assistance that was disbursed to local civil society or NGOs across all sectors. And it is even lower compared to the percentage of foreign assistance channeled to citizens and civil society in other large development sectors including:

  • Basic education (16%)
  • Basic health (21%)
  • Government and Civil Society (23%)

Expert Consensus on Citizen Engagement

At the conceptual level, there is broad expert agreement on the importance of mobilizing political will to make domestic resource mobilization (DRM) inclusive and accountable. Privileged interests are unlikely to change through a purely technocratic approach to DRM.

As Maya Forstater of the Center for Global Development states in the Tax and Development: New Frontiers of Research and Action brief, “The main enabler [to increasing DRM] is political commitment strong enough to overcome vested interests among taxpayers, politicians, and tax administrators themselves.”

That’s where citizen engagement can play a key role – supported by donors when and where it’s appropriate.

In the journal Public Administration and Development, economist Odd-Helge Fjeldstad states, “Donors should complement the traditional ‘technical’ approach to tax reform with measures that encourage constructive engagement between governments and citizens over tax issues.”

This isn’t always reflected in DRM technical assistance.

As Fjeldstad states, “Although donors and tax practitioners seem to acknowledge the importance of these issues, they have yet to be translated into a clear-cut governance-focused tax reform agenda in practice.”

This is partly due to the lack of empirical research on the impact of civil society on DRM. But while this research base is nascent, there are examples of citizen engagement being a driving force behind effective DRM.

School books and crayons are given to children at the start of the school year, Oct. 3, 2017 in Assuit, Egypt
School books and crayons are given to children at the start of the school year, Oct. 3, 2017 in Assuit, Egypt

Cases from the field

Chile has one of the most effective tax systems in Latin America, due in part to the broad societal engagement that occurred during its transition from dictatorship to democracy during the 1990s.

In the report, Taxation and State Building: Towards a Governance Focused Tax Reform Agenda, Wilson Prichard states that while this in part due to technocratic reform, “Many dramatic improvements in the Chilean tax system can be traced to…when representatives from across the political spectrum came together [to establish]…an inclusive fiscal pact.”

There are also examples in Africa of how citizen engagement played a decisive role in tax policy.

In Ghana during the mid-1990s, a government proposal to introduce a value added tax (VAT) without public consultation was met by massive public protest and, “The government was forced to quickly repeal the tax…The protests were sufficiently large and unexpected to fundamentally shake government confidence, leading it to significantly expand the inclusiveness of its governing style.” Prichard states that the protests, “Succeeded in bringing together political elites, businesses and small taxpayers in making shared demands on government.”

Citizens and civil society can also enhance tax administration in smaller, less dramatic ways, for example by collaborating with revenue authorities to collect taxes. In Guinea, market traders’ associations’ helped to monitor and enforce payment of market taxes in return for government investments in improved market facilities. This community monitoring approach, “contributed to dramatic improvements in both revenue yields and public service delivery.”

In spite of these examples that societal engagement enhances DRM efforts, more evidence is needed.
Fortunately, the role of civil society in DRM is generating increasing dialogue among analysts and advocates. In Stockholm, tax for development discussions will include a focus on the role that civil society plays in tax capacity building.

For our part, as Save the Children launches its tax policy citizen engagement project in Kenya, we aim to be both a consumer and producer of evidence on how citizens can shape DRM in the developing world to better serve the needs of societies’ most vulnerable citizens.

Gender Equality Data Gaps

A Leap in Gender Equality Begins with Better Data

By George Ingram and Nora O’Connell | Photo credit: Victoria Zegler

While the movement for global gender equality is growing – including prominent placement at the recent World Bank and IMF Spring Meetings – major gaps remain that, if addressed, could unleash significant progress. One of the first gaps that United States foreign assistance agencies should tackle is the lack of uniformity on the gender equality data they collect and use.

Our institutions – the Brookings Institution and Save the Children – recently teamed up to host a roundtable with current and former U.S. government (USG) officials, private sector, academic, and non-profit experts to examine the data gaps in gender programming and investments.

We agreed more rigor is needed in calculating U.S. government investments in gender equality globally, and more importantly, determining what these investments are achieving and teaching us about what works. This will help to shift U.S. aid from outputs and earmarks to impact and move us closer to genuine equality.

According to the most comprehensive data on foreign assistance for gender equality – the OECD’s gender equality policy marker – during 2014/2015 about 21 percent of all USG foreign assistance included some focus on gender equality. This puts it behind the average of most donors from highly developed nations who dedicated an average of 35 percent of their foreign assistance to gender equality.

The OECD’s gender equality policy marker is the only comprehensive measure of the extent to which the USG dedicates its foreign assistance to gender equality. And while this marker was a major step forward in measuring how much foreign assistance goes to gender equality programming by donor and sector, major gaps remain — including information about what these investments are achieving.

Various USG agencies have made strong commitments to improving gender data and are making progress on collecting and reporting their impacts and challenges – a continued focus on advancing gender data is vital.

Perhaps one of the greatest challenges to USG collection of high-quality gender data is the lack of uniformity of approach among USG foreign assistance agencies. USAID, the State Department, the Millennium Challenge Corporation and others are all collecting gender data on their programs and financing, but there is little consistency across the data. This makes it impossible to ascertain the full extent to which the United States is supporting gender equality around the world and whether those programs are truly making a difference at eliminating the disparities between women and men, girls and boys.

If we invested in the collection of more detailed data, USG could also improve its programming on gender equality. When the USG agreed to the Sustainable Development Goals, we committed to collecting more sex-and age-disaggregated data on project outcomes. As an example, this will not only allow us to compare the under-5 nutritional outcomes of boys versus girls and the employment rates in fisheries of men versus women; it will also enable us to see if women’s employment is translating into greater decision-making power at the household level or in the public sphere.

From the roundtable discussion, we identified three actions we must undertake to address gender data gaps:

1) Leverage New Momentum for Aid Reform

The gender data gap is ultimately an aid effectiveness issue. With reform momentum gaining at USAID and the State Department, we can demonstrate the benefits of quality gender data in terms of boosting development outcomes. Ultimately, there is a cost associated with improving data collection and we need to foster political will in order to back this up and garner the support we need to make better gender data a reality.

2) Listen to Voices on the Ground

The USG should finance more citizen-generated data as well as engage diverse local stakeholders in monitoring, evaluation, and learning related to USG gender equality programs. Data drives so much of what people working on the ground do and it’s important to incorporate their voices into this conversation. Fully engaging with actors on the ground will ensure that the USG is strategically targeting data collection and bringing all the efforts together to maximize impact. Additionally, by connecting with people at the local level, we can learn how quality gender data contributes to women’s empowerment and better development outcomes, enhancing the case for further data investment.

3) Establish a Cohesive Gender Data Reform Agenda

As noted above, gender experts are saying we need fewer data silos. Currently gender data is fragmented across USG agencies and sectors. We need a comprehensive data approach so data can be efficiently collected and compared across USG agencies. Furthermore, we need an agreed-upon set of program and funding targets that are measurable so we can know whether or not we are accomplishing what we set out to do.

By working to improve and standardize data collection, analysis, and use across all sectors, the U.S. government can be a leader in catalyzing a quantum leap towards gender equality and the empowerment of women and girls around the world.

Learn more about Save the Children’s Global Advocacy at https://www.savethechildren.org/us/what-we-do/global-programs/global-advocacy.

 

This post was originally published on the Brookings Institution’s Future Development blog.

Malnutrition in Children

4 Causes of Malnutrition in Children and What You Can Do About It

As a concerned parent, you are sensitive to the nutritional needs of your child, and that includes avoiding risk factors that could lead to malnutrition. Understanding the major causes of malnutrition can help you form good habits when it comes to your own health as a parent, as well as the health of your child.  Here, we breakdown four major factors that contribute to malnutrition in children.

Poor Quality of Diet 

Malnutrition, at its core, is a dietary deficiency that results in poor health conditions. We typically think of malnutrition as it relates to children not eating enough of the right foods. It can also occur when children eat too much of the wrong foods. Either way, more than 170 million children fail to reach their full potential due to poor nutrition.

At a Save the Children-supported school in Bolivia, young children enjoy healthy snacks.
At a Save the Children-supported school in Bolivia, young children enjoy healthy snacks.

Malnutrition can occur in children of all ages, but young children are the most vulnerable. The World Health Organization has stated that malnutrition is the single most dangerous threat to global public health [1]. It contributes to 45 percent of deaths of children under the age of 5 [2].  This is due, in part, to the critical importance of the first two years of a child’s life.

Maternal Health

The largest window of opportunity for a child’s health occurs in the first 1,000 days-from the start of a woman’s pregnancy to her child’s second birthday. Mothers who are malnourished during their pregnancy can experience complications giving birth. Many children are born small because their mothers are undernourished[3].  Severely malnourished mothers can also have trouble breastfeeding their infants.

We know that breastfeeding for the first six months of a child’s life has health benefits that extend into adulthood. However, if a mother is too malnourished to breastfeed, these health benefits may not be passed on and a child can be at risk for malnutrition. This is especially true in developing countries.

At a Save the Children-supported health center in Tanzania, Zinak*, 24 and 7-months pregnant, receives a prenatal check up.
At a Save the Children-supported health center in Tanzania, Zinak*, 24 and 7-months pregnant, receives a prenatal check up.

Mothers like Zinak*, pictured above, who live in developing countries can be unaware of nutritional benefits of breastfeeding. In Tanzania, for example, the average duration of breastfeeding is only 2.4 months[4].  Tanzania is one of the 10 worst affected countries in the world by chronic malnutrition and is the third worst in Africa.

Global health programs like the ones Save the Children supports works to help maternal, newborn and child health, which ultimately helps end child malnutrition. We work in many of the world’s poorest places, in the United States and abroad, to alleviate child hunger and prevent malnutrition. However, children living developed countries are still at risk for malnutrition if they are born into poverty.

 

Socioeconomic Status

Poverty is the number one cause of malnutrition in developing countries. Often times, families living in poverty lack access to fresh fruits and vegetables. Many communities do not have full-service grocery stores that regularly stock fresh produce.

Even if they do, fresh fruits and vegetables can be expensive. When fresh fruits and vegetables are out of reach for children, they can fill up on less expensive, less healthy foods.

Rebecca, 25, holds her daughter Rachael*, 11 months while she eats high nutrient peanut paste after being treated for severe acute malnutrition at a Save the Children stabilization center in South Sudan.
Rebecca, 25, holds her daughter Rachael*, 11 months while she eats high nutrient peanut paste after being treated for severe acute malnutrition at a Save the Children stabilization center in South Sudan.

War and Conflict

Sadly, the violence of war and political unrest can also lead to severe malnutrition. In South Sudan, for example, conflict and drought has led to devastating conditions for children. Save the Children in South Sudan is the lead health and nutrition provider in much of the region. We run 58 feeding program sites for infants and young children, all powered by the support of our donors.

The crisis in Syria has also shed light on the number of refugee children who are at risk of malnutrition. Children, who make up more than half of the world’s 22.5 million refugees[5], often go without healthy food, health care and an education.

Access to food and water has become a heartbreaking challenge— leaving thousands of Syrian children at risk for malnutrition. There are many ways to help Syrian refugee children. Your knowledge and support can make a world of difference for children around the world.

 

*Name changed for protection

[1] [2] http://www.who.int/mediacentre/factsheets/fs178/en/

[3] https://www.savethechildren.org/content/dam/usa/reports/advocacy/sowm/sowm-2014.pdf

[4] https://www.savethechildren.org/us/what-we-do/events/breastfeeding

[5] https://www.savethechildren.org/us/what-we-do/emergency-response/refugee-children-crisis