Progress for Children in the Fight against HIV/AIDS

kechiKechi Achebe, MD, MPH

Senior Director, HIV/AIDS, International Programs

Save the Children US

June 27, 2016

UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) released their “AIDS-Free Generation” report at the UN General Assembly High Level Meeting on Ending AIDS June 8-10th in New York, which indicated a 60% decline in HIV incidence among children since 2009 in the 21 sub-Saharan Africa nations most affected by the HIV epidemic. As a distinctive partner of UNAIDS, Save the Children contributed to these achievements through implementation of HIV/AIDS prevention, care, and treatment programs throughout Africa and Asia, helping 11.7 million children in 2015.

UN General Assembly, June 8-10, 2016
UN General Assembly, June 8-10, 2016

The On the Fast-Track to an AIDS-Free Generation report highlights the many recent accomplishments made towards achieving an AIDS-free generation:

  • New HIV infections among children in the 21 sub-Saharan Africa countries dropped from 270,000 in 2009 to 110,000 in 2015.
  • New HIV infections among children have declined globally by 50% since 2010—down from 290,000 in 2010 to 150,000 in 2015.
  • 49% of children living with HIV around the world now have access to life-saving treatment, compared to 32% who received treatment in 2014.
  • Seven countries have reduced new HIV infections among children by more than 70% since 2009 (the baseline for the Global Plan).
  • In India, the only Global Plan country outside of sub-Saharan Africa, new HIV infections in children dropped by 44% and coverage of services to pregnant women increased from less than 4% in 2010 to 31% in 2015.
  • More than 80% of pregnant women living with HIV in the 21 countries in sub-Saharan Africa had access to medicines to prevent transmission of the virus to their child—up from just 36% in 2009.
  • Six countries—Botswana, Mozambique, Namibia, South Africa, Swaziland and Uganda—met the Global Plan goal of ensuring that 90% or more of pregnant women living with HIV had access to life-saving ARVs. Six additional countries provided antiretroviral medicines to more than 80% of pregnant women living with HIV.
  • Access to treatment for children living with HIV has increased more than threefold since 2009—from 15% in 2009 to 51% in 2015.

Despite this groundbreaking progress, the report also highlights prospective areas of improvement:

  • Nigeria reduced new HIV infections among children by only 21%.
  • Still only half of all children in need of treatment have access to ART.
  • Early infant diagnosis coverage remains low. In the majority of the 21 countries in sub-Saharan Africa, less than half of childrenborn to women living with HIV received HIV testing within the first two months of age in 2015.
  • New HIV infections among women of reproductive age declined by 5% below the target of 50%. Between 2009 and 2015, around 5 million women became newly infected with HIV in the 21 priority countries in sub-Saharan Africa, and AIDS-related illnesses remain the leading cause of death among adolescents on the continent.

To continue to address these areas, at the meeting, UNAIDS and PEPFAR—in collaboration with other partners—

Vice President of SC US Global Health, Robert Clay, meets with Myanmar's Minister of Health, Dr. Myint Htwe on June 10, 2016 during the High Level Meeting on Ending AIDS.
Vice President of SC US Global Health,
Robert Clay, meets with Myanmar’s Minister of Health, Dr. Myint Htwe on June 10, 2016 during the High Level Meeting on Ending AIDS.

launched their Super Fast-Track framework for ending AIDS among children, adolescents, and young women. Titled “Start Free, Stay Free, AIDS-Free,” the initiative will build upon current progress made towards the previous Fast-Track framework to end the global AIDS epidemic. The new Super Fast-Track framework sets ambitious targets to:

  • eliminate new HIV infections among children;
  • find and ensure access to treatment for all children living with HIV; and
  • prevent new HIV infections among adolescents and young women.

The link to several press releases at the event can be found here.

Providing a Future for Millions of Syrian Children

It takes only a few hours on a beach on the Greek island of Lesbos to understand the enormity of the current refugee crisis sweeping Europe and the many dangers that refugees face, including so many mothers and children.

 

On one typically busy day, our Save the Children staff counted 22 small rubber dinghies arriving in just five hours — filled with babies as young as three months old and adults as old as 76. While no Greek official was on shore to meet the refugees, volunteer aid workers, including Save the Children staff, were there to assist and guide them toward registration. The numbers of people arriving in Greece this year is staggering — up from 40,000 last year to 580,000 so far this year. During one five-day period last month, 48,000 new arrivals — or nearly 5,000 a day — came to shore.

 

I recently visited the north shore of Lesbos and talked with a number of refugee families arriving by boat. One woman I met from Syria was traveling with her little girl, little boy, and two brothers. Her husband was left behind in Syria and was hoping to meet them later. We helped guide their boat to the shore and pulled them out of the water, and she said she couldn’t believe they were alive. She was so cold and overcome by emotion, she shook violently. We wrapped her in a space blanket and one of our workers offered her his scarf. Slowly, as we gathered warm clothes for her children, she stopped shaking and even smiled weakly as her daughter showed off her warm jacket.

 

I also visited the two informal camps outside the island’s capital city of Mytilene, where refugees must register to continue their journey to Europe. One camp was originally for Syrians and the second camp for other nationalities, the majority of whom are from Afghanistan. Our staff met several teenagers making the trip by themselves. One boy from Afghanistan was traveling with a small group including four other teenage boys. They were trying to get to Germany, where one of the boys had a brother. No one knows precisely how many children are making this journey alone, but recent estimates put the number in the tens of thousands and is growing rapidly. Recent figures from the Serbian government, for example, show that nearly one in four refugee children arriving in Serbia in recent months have been unaccompanied.

 

While the international community continues to struggle to find a solution to the conflict in Syria, now approaching its fifth year with no end in sight, the sheer numbers of desperate Syrian citizens are staggering. Four million have fled the country and over 7 million have been forced from their homes but remain inside Syria.

 

Almost 3 million Syrian children are not in school, including half of those who have fled to neighboring countries. As Secretary of State John Kerry noted last week, “Imagine what it would mean for America’s future if the entire public school systems of our largest cities — New York, Chicago and Los Angeles — were suddenly to close and stay closed.” Schools, in fact, are among many public institutions that are in shambles. More than 4,000 attacks on schools have taken place in Syria since 2011, according to the U.N. Meanwhile, two of Syria’s neighbors, Lebanon and Jordan, are reaching their breaking point in assisting Syrian refugees.

 

What can we do? Save the Children has joined other major aid agencies in calling on national governments to adopt a bold new deal for refugees. In the short term, we need to provide much more support in the region in terms of food aid, employment, medical care and education so more refugees will not feel compelled to leave the region and reduce the current huge migration to Europe. In addition, we need to eliminate many restrictions that leave refugees living in limbo — in constant fear of arrest, detention and deportation.

 

We also need a special focus on children. Donors need to take additional steps to ensure that children are protected and educated. Otherwise, we face the prospect of helping create a lost generation of Syrian children. Investments now in education and protection for these children can pay enormous dividends once the war ends and rebuilding begins.

syrian children

In recent months, we have seen growing support from individuals and corporations to assist refugees. In early September, the worldwide dissemination of a photo of a little refugee boy drowned on a beach in Turkey helped people see this crisis as a human tragedy that is affecting tens of thousands of innocent children and their families. Our long-time corporate partners, such as Johnson & Johnson, stepped up their support for our humanitarian response for refugee children.

 

With the recent attacks in Paris, we are presented with very hard choices. Our sympathies, of course, are with the hundreds of families around the world who lost a loved one in the barbaric events of November 13.

 

But we can’t turn our backs on the Syrians who are also fleeing death and destruction in their country. By continuing to increase humanitarian support in Syria, in surrounding countries, and for the hundreds of thousands of Syrian refugee families, we are not only doing the right thing but are also providing a future for millions of Syrian children.

 

This post originally appeared on the Global Motherhood section of The Huffington Post

The Time is Now: Delivering on the SDG Agenda

 

TheGlobalGoals_Logo_and_Icons

There’s no way around feelings of euphoria today.

 

World Leaders at the United Nations are ringing in a new set of Sustainable Development Goals (SDGs) that promise to end extreme poverty and the scourge of hunger and preventable deaths of infants and children around the world.

 

At the same time, the Pope is calling for solidarity with the most deprived and those displaced by conflict and climate change.

 

Over the coming days, millions of people globally – from youth in Ghana to Shakira — are taking part in the “world’s largest” prayers, lessons, and ceremonies to light the way for the SDGs. It’s one of those rare moments in which governments, faith institutions, everyday citizens and popular idols unite around a common cause to forge a historic moment.

 

Three years of debate among UN diplomats and millions of citizens voicing their priorities has culminated in the approval today by 193 nations of new Sustainable Development Goals, to replace the Millennium Development Goals established in 2000. Negotiations on the SDG agenda have been among the most collaborative in UN history. It is truly a global vision for a better world.

 

Furthermore, the SDGs comprise a holistic agenda – 17 goals rather than 8 – with ending extreme poverty at its core supported by a healthy planet in a peaceful world.

 

The goals are bold and ambitious. The trick will be maintaining the momentum once the speeches end, the crowds disperse, and the cameras turn their focus elsewhere.

 

It will take a collective effort to achieve this, but the most defining players will be governments who will bring political will and resources to deliver a better future for their people.

 

Here are six actions that all governments can take to make the SDGs real for their countries:

 

1) Create national action plans to implement the SDGs. Each government should take the SDGs back home, consult widely with local actors, and make policy and programmatic decisions to put the goals into practice in their country. The entire SDG agenda of 17 goals and 169 targets may not be applicable to every country but there are a core set – namely, the “unfinished business of the MDGs”– like health, education and poverty, which do apply to every country and can be acted upon starting today.

 

2) Commit financing to the SDGs. Countries should align their budgets to achieve these outcomes. For the United States, this may mean more investments to reduce deaths caused by obesity, heart disease, or automobile accidents, while for poor countries global health dollars could be invested in community health workers to reduce deaths associated with childbirth and malnutrition.

 

3) Assign a high-level government lead on the SDGs. To ensure rigorous monitoring and accountability, it is important to put in place a focal point on the SDGs who can reach across ministries and carry political weight to ensure action and coordination.

 

4) Communicate a clear commitment to the SDGs. Heads of state can take these goals home and share them with Parliament or Congress and speak to citizens, private companies, and others to contribute financing, technical know-how, and new ideas and innovations to deliver on the SDGs. Citizens should also play a role holding governments’ “feet to the fire” to be accountable for achieving this agenda over the next 15 years.

 

5) Prioritize action to “leave no one behind.” Many times on large agendas such as this one, people try to attain the easy solutions and quick wins. This time, however, the world pledged to achieve progress for the poorest and most vulnerable groups first. This requires investments in gathering and disaggregating data to ensure that all groups benefit from progress and no one is being “left behind,” such as girls living in poverty.

 

6) Publish an annual whole of government report on the SDGs and participate fully in the global follow up and review process. Every country should create progress reports on the SDGs and encourage citizen participation to leverage all resources and people-power in fulfilling the 2030 agenda. This will demand that we work together to strengthen our systems for evaluation and learning in order to scale projects that work and end those that don’t.

 

With the new SDGs, we can build a world in which no child lives in poverty, and where each child has a fair start and is healthy, educated, and safe. But progress toward meeting these goals in each country will depend on more government investment, open and transparent country institutions, participation by a diverse cross-section of civil society, and effective partnerships between government, civil society, private sector, and donors.

 

In 2030 we will judge success by what has been delivered, rather than by our declarations today. Let’s use this historic moment to pave the way for concrete action for children around the world.

Stories of Motherhood from Central Africa to South East Asia

The following blog first appeared on The Huffington Post

 

Every year Save the Children’s State of the World’s Mothers report ranks the best and worst places in the world to be a mom, giving us a window into the shared strengths and burdens that mothers face.

 

All mothers carry the brightest hopes for their children’s health and wellbeing, whether their homeland is at the top, middle or bottom of the ranking. To show you how motherhood unites women from all corners of the world and walks of life, we have invited two moms from two different continents to talk about the trials and tribulations of motherhood in their countries.

 

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Metro Manila, Philippines: Rizelle, 17, pictured holding her three-week-old baby, lives in a makeshift home under a bridge in the slums of Metro Manila. But she was fortunate to receive post-natal check-ups and immunizations for her newborn.

 

Maria Christina H. Oñate is from Metro Manila, Philippines. Holding the 105th spot out of 179 nations, the Philippines is a middle-of-the-road country for moms that has made great progress in recent years, especially in reducing the child mortality rate for the poorest children in cities. Rosalie Djouma is from the Central African Republic, which at the 177th spot is the third worst place in the world to be a mom.

 

Together, these two women represent two countries with very different realities for mothers and babies. Both women have dedicated their lives to helping some of the most vulnerable moms and children in their communities as part of their work with the international organization Save the Children. Here, they share their stories of motherhood, as well as their hopes and aspirations for all moms around the world — whether they live in bustling Metro Manila or the rural countryside of the Central African Republic.

 

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Kaga-Bandoro, Central African Republic: Giselle and her son Ronny fled their home because of violence. “I am a woman,” said Gilselle, “and during war, it is always the innocent, it is women and children like us, those who do not fight, who suffer most.”

 

Oñate: The Central African Republic is third from the bottom in the annual ranking of the best and worst places for moms. What was it like for you to raise children in a country that ranks so low for moms?

 

Djouma: As a nursing medical supervisor with Save the Children working in the Central African Republic, my experience as a mother is rather unique compared to many women in the country. My job allows me to provide for the health and education of my children and support my family. The sad reality for many mothers in the Central African Republic is that the social safety nets and reliable health services are not available, leaving them and their children vulnerable to extreme poverty.

 

Djouma: You’re fortunate to live in a country that does much better in the ranking than my homeland. What’s it like to be a mom in the Philippines?

 

Oñate: My son Diego is now a healthy, bright and curious three-year-old. I remember the wonderful time I was pregnant. As a working professional in Manila with health insurance, I had access to quality health services, which allowed me to take advantage of family planning counseling and newborn care. My son benefits from preventive care, immunizations and the luxury of doctors’ visits whenever he feels unwell, which is a far cry from the situation for many mothers.

 

Oñate: What are some specific challenges moms in the Central African Republic face?

 

Djouma: The current situation for mothers and children in the Central African Republic is critical. During the political and military crisis there are some mothers who have lost their husbands, their property and who do not have a source of income. Some children who have lost their fathers and mothers become easily exploited by certain groups of people. Many children are unable to continue their studies.

 

Rural mothers have similar struggles to those living in slums. The differences are that rural mothers have farm work, while those from slums have small businesses.

 

Djouma: What’s some of the progress the Philippines has made for moms and children?

 

Oñate: The Philippines is making strides towards progress in the care of moms and children with the introduction of programs through a new national social protection initiative, the implementation of health care innovations and by increasing the number of health professionals serving urban and rural communities.

 

In my work I get to listen to the people behind inspiring stories who unceasingly help vulnerable mothers and children access basic health care. They are committed community health workers who do home visits and counseling to pregnant and lactating women to ensure healthy pregnancy and safe delivery and care for newborns, including the importance of exclusive breastfeeding.

 

Djouma: The new report commends the Philippines for the progress it has made in reducing child mortality and narrowing the survival gap between the richest and poorest children in urban areas. What challenges still remain for the poorest moms and children in cities?

 

Oñate: My work on maternal and child health in marginalized communities in Manila brings me up close and personal to the everyday struggle of poor, unemployed mothers with usually four or more young children. The struggle to find ways of putting a meal on their table is constant and, more often than not, their health and that of their children takes the back seat.

 

These poor urban mothers are at risk of dying due to pregnancy and childbirth because of a lack of access to health services. These are mothers, including teenagers as young as thirteen, who experience unplanned pregnancies, lack adequate prenatal care, give birth at home with no skilled birth professional, have no access to emergency obstetric and neonatal care, and receive no postpartum care.

 

Oñate: What would it take to improve the conditions for mothers and their children in the Central African Republic?

 

Djouma: Many women are responsible for financially providing for their families and need additional support to generate incomes — whether through entrepreneurship or agricultural opportunities.

 

Families also need expanded access to education and health care facilities to help ensure the safety and wellbeing of children, in both rural and urban areas.

 

Save the Children’s annual State of the World’s Mothers report, which was released this month with support from Johnson & Johnson, has become a reliable international tool to show where mothers and children fare best, and where they face the greatest hardships. It is based on the latest data on health, education, economics and female political participation. The full report is available at:www.savethechildren.org/mothers.

 

Editor’s Note: Save The Children is a partner of Johnson & Johnson, which is a sponsor of The Huffington Post’s Global Motherhood section.

For Babies In Big Cities, It’s Survival Of The Richest

The following blog first appeared on The Huffington Post

I will never forget the moment when I looked out the car window at a bustling, steamy intersection in the heart of Manila, and locked eyes with a young woman. She was holding a tiny baby while begging in the street.

 

I glanced down at my six-month-old son, sleeping contentedly in my arms inside our air-conditioned car. The enormous inequalities between my world and hers struck me as never before. The child in my arms was about the same age and no smarter, cuter, or better than hers. Yet due to mere circumstance of birth, I knew my son would have many more opportunities in life, while this mother and her child would struggle to survive each day to the next.

 

It’s been 20 years since that fleeting moment, but the vision of the mother and her child has stuck with me. It drove me to change careers and join Save the Children, where we work tirelessly to ensure that every mother and child has a fair chance in life.

 

These days, more and more mothers in urban areas are seeking better opportunities for their children. That’s why Save the Children’s new report, State of the World’s Mothers 2015: The Urban Disadvantage — released with support from Johnson & Johnson — focuses on the health and survival of moms and babies in cities. The findings reveal a harrowing reality: for babies in the big city, their survival comes down to their family’s wealth.

 

I have been back to Manila many times. I am happy to report that, along with other urban centers in the Philippines, it is an example of how cities can narrow survival gaps between the rich and the poor by increasing access to basic maternal, newborn and child services, and making care more affordable and accessible to the poorest urban families.

 

A child’s chance of dying before his fifth birthday has been steadily declining over the years among the poorest 20 percent of urban families in the Philippines. From when I first visited that country in the mid ‘90s until today, child mortality rates among the urban poor have been cut by more than half and the urban child survival gap has narrowed by 50 percent between wealthy and poor kids.

 

Sadly, the Philippines is one of just a few countries with such dramatic improvements for poor urban children. In too many countries, urban child survival inequality is worsening, even as those nations have been successful in reducing overall child mortality rates.

 

In my travels throughout the developing world, I’ve never had to look very far to see evidence of these differences. For example, in New Delhi, India – a city with one of the largest health care coverage gaps between rich and poor – it is not unusual to see a gleaming hospital steps away from a sprawling slum, and to have babies literally dying on the doorstep.

 

But it’s not just in the developing world where our report found stark disparities between the haves and have nots. In our nation’s capital, Washington, D.C., a baby born in the lowest-income district, where half of all children live in poverty, is at least10 times as likely as a baby born in the richest part of the city to die before his first birthday. And while Washington, D.C. has cut its infant mortality rate by more than half over the past 15 years, the rate at which babies are dying in the District of Columbia is the highest among the 25 wealthiest capital cities surveyed around the world.

 

We all have a lot more work to do to ensure that every mother has the same opportunities for her baby, whether she lives in Manila, Washington, D.C. or anywhere else in the world.

 

Find out more about Save the Children’s new report atwww.savethechildren.org/mothers.

Notes from the UN and the Clinton Global Initiative: Speaking Out for Children in New York

This was a busy week for global development, as leaders from government, business and civil society came together in New York for the Clinton Global Initiative meetings and the UN General Assembly. As usual, Save the Children was there to take the opportunity to make children a central part of the agenda—and urge action on their behalf.

 

It’s no surprise that Ebola was a major part of the conversation, as the outbreak continues to dominate the headlines. I spoke with Reuters about how critical it is for the international community to step up our efforts to treat Ebola victims and halt the spread of the virus. We have increased our ongoing response to the outbreak in West African countries and we are moving forward with a stronger, community-based response through local Ebola Care Centers in rural areas. Easier access to local medical help and supplies, plus ongoing education about how to contain the spread of the virus, is urgently needed to save lives and protect children. As the death toll from Ebola nears 3,000 one thing is certain: the world must act quickly.  

 

Another big issue this week was the ongoing crisis in Syria—and we are working to ensure that children are not forgotten in discussions about geopolitics and conflict. Our new report, Futures under Threat: The Impact of the Education Crisis on Syria’s Children, shows the effects of conflict on millions of school-aged children. Before the conflict began, almost all Syrian children were enrolled in school but now Syria has the second-worst enrollment rate in the world. I talked about the report on Al Jazeera America and we used our influence this week to demand that Syrian children, both inside the country and those living as refugees, are protected and educated—their best chance at building a better future.

 

Of course, one of the greatest areas of focus for Save the Children is newborn and child survival as we work to accelerate progress toward achieving Millennium Development Goal #4, to reduce the under-five mortality rate by two-thirds by 2015. The world has made significant progress, but we have more to do in the 500-day sprint to the end of 2015 and in the post-2015 agenda to get to zero and finish the job. At Mashable’s Social Good Summit on Sunday, I introduced a “Simple Ways to Change Lives” panel featuring Liya Kebede, Ethiopian model and maternal health advocate, UNFPA’s Dr. Babatunde Osotimehin and our own Victoria Shaba, a midwife from Malawi, to talk about how trained and equipped health workers can save the lives of mothers and children using low-cost, proven interventions.

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Finally, I joined with others at the Clinton Global Initiative to announce a new partnership to support literacy across the globe. Together with the Bezos Family Foundation and their Students Rebuild program, we are engaging school children everywhere in The Literacy Challenge to design and create bookmarks. The Bezos Family Foundation will give $1 for each bookmark they receive through the challenge to help power our Literacy Boost program in Asia, Africa and Latin America.

 

We take advantage of major meetings like those held this week to advocate for a better world for children—but we know that one week in New York won’t address every issue and answer every question. That’s why we match our global advocacy work with everyday efforts in communities around the world, fighting for progress in large ways and small, to give kids a chance at a better life.