Why I Don’t Want Another Mother to Experience My Health Care Scare

Written by Soha Ellaithy
Senior Director, Strategic Foundation Partnerships and Senior Partnership Director, BASICS

I was born and raised in Egypt, a middle-income country that has a functioning healthcare system and universal healthcare coverage – albeit of often dubious quality.

In 2008, one in 10 Egyptians had chronic Hepatitis C, the highest rate of infection in the world. The direct cause of this catastrophic situation is a mass-treatment campaign conducted by the Egyptian government in the 1970’s and 80’s to eradicate schistosomiasis infection. The repeated use of needles resulted in Hepatitis C, a virus not yet known, being inadvertently spread to millions of people.

When, in 2011, my oldest son went on a school trip to Nepal, he contracted a diarrheal infection and had to be rushed to a local hospital to receive intravenous fluids. He called me and, to my horror, described stepping over pools of blood on the floor to get to a bed with no covering. My heart dropped – and to this day it still does when I think about that moment.

I knew exactly what the implications could be.

I’ve witnessed firsthand the terrible devastation of a healthcare-acquired infection on families and could not bear the thought of my son contracting Hepatitis C or HIV. It took a full three agonizing months of tests to clear my son of any possible infections that he might have picked up from a needle prick in an unclean hospital.

Photo courtesy of: FACEBOOK PAGE/ SO THAT HE'S NOT SURPRISED
Egypt’s doctors have been anonymously sharing pictures of the conditions they work in – with stray animals and overflowing sewage on display – after the country’s Prime Minister said he was “surprised” at the state of the country’s run-down hospitals. Photo courtesy of FACEBOOK PAGE/ SO THAT HE’S NOT SURPRISED via BBC

Despite a fairly strong medical education system and a tireless and dedicated medical staff, public health care systems in many countries like Egypt, continue to be plagued by poor adherence to proper hygiene standards and the devastating consequences that result.

As the Senior Partnership Director leading the submission to 100 & Change, when my colleagues first discussed with me the idea of eliminating this risk globally, I was immediately engaged. As we fine-tuned our idea in meeting after meeting, I became very excited that in BASICS (Bold Action to Stop Infections in Clinical Settings) we truly have a solution that will change the way healthcare is delivered across the world.

I feel very passionate about this project because it is inconceivable that in this day and age, we are still grappling with a problem whose solution is so simple: wash your hands, clean your working surfaces and be diligent in using sterilized equipment.

BASICS tackles the root causes of the problem and builds a solution that is self-sustaining. Using behavioral science to modify individual behavior so that simple hygiene routines can become “second nature,” we will build the supporting infrastructure and design a national system that ensures this new normal is part of a fully functioning and supportive national health system.

I dream of the day when no mother would ever take her child for a simple procedure only to go home with a child who has a life-threatening disease for absolutely no good reason!

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

Photo credit: Allan Gichigi/ Save the Children, March 2016

A Clean Maternity Ward Is Every Woman’s Right

Written by Janti Soeripto
Chief Operating Officer and President, Save the Children 

Two things never fail to strike me when visiting health facilities as part of my work. First, without exception, is the absolute dedication of healthcare professionals to want to help mothers and children survive and thrive.

Secondly, it’s the incredible frustration of seeing basic gaps in delivery that interrupt that service. From access to clean water, the availability of consistent power sources to affordable referral options and a reliable cold chain to keep drugs safe for use, it must seem a constant game of solving one problem even as another arises for those running health clinics to consistently achieve the outcomes we all want.

Getting to one huge outcome – a sustainable, significant global reduction in healthcare-acquired infections that cause tragic deaths of newborns and mothers and needless pain and suffering – is at the heart of the BASICS partnership. Each partner – Save the Children, WaterAid, the London School of Hygiene & Tropical Medicine and Kinnos – brings a proven approach for tackling one of the factors that contribute to millions of newly acquired infections every year.

Integrating them into one strategy is an elegant solution.

And if we know why infections get passed to mothers and newborns in maternity wards (and to anyone in a health facility, for that matter); if we know what to teach health workers and cleaners to change their behavior and which tools they need; and if we know how to work with governments to set and institutionalize cleanliness standards for facilities; then why wouldn’t we make BASICS one of every partners’ highest health priorities?

The short answer is, we have.

BASICS’ objective of improving health outcomes couldn’t be a more natural fit for each partner’s aspirations, especially for Save the Children, which has been at the fore of maternal and child health programming for decades. Our 2030 ambitions for children include the global breakthrough that no child under age 5 anywhere will die from a preventable cause.

The teams of staff who’ve designed BASICS (Bold Action to Stop Infections in Clinical Settings) are deeply committed to transforming health care to make it safer for everyone … starting with women and newborns but then benefiting anyone who seeks care at a facility.

Each year, 17 million women give birth in facilities where cleanliness is questionable. BASICS will catalyze a simple, low-cost change in practices that can save many of them and their infants from death or illness by infection.

Who is to say these women and babies don’t deserve the same right to a clean maternity ward that I had when my own children were born?

As I step into the role of leading Save the Children, I’m putting the weight of the agency behind BASICS. We’re all eager to begin transforming health care as the recipient of this next 100&Change award.

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

Accidental Super Heroes: When the Work of Humanitarians Means the Difference Between Life and Death

Written by Dr Unni Krishnan is Director Emergency Health Unit (EHU), Save the Children 

Humanitarians are ordinary people. Sometimes people become humanitarians by accident when they find themselves in the midst of a disaster.

What makes them true heroes is the selfless and extraordinary work they do in some of the most difficult places in the world.

In wars and disaster zones, the work of humanitarians serves one key purpose – a catalyst to advance the idea of humanity and life, with dignity. This is something one can’t learn through an academic crash-course alone.

World Humanitarian Day, observed on 19 August every year, is a day to remember our accidental superheroes like Khadiza Rimjhim, who I met in Cox’s Bazar in early 2018.

Rim Jim Nurse working in the Emergency Health Unit in Cox’s Bazar; Photo credit: Unni Krishnan/Save The Children

Rimjhim was a young Bangladeshi nurse working in a health center run by Save the Children’s Emergency Health Unit. She was busy providing healthcare for dozens of Rohingya refugee children. It was a challenging task and she was doing her best to find a balance between taking care of sick children and addressing the anxieties of parents who had a hundred questions.

Cox’s Bazar in Bangladesh is home to nearly a million Rohingya refugees who arrived from Myanmar in mid-2017, fleeing violence and a terror campaign launched by the Burmese armed forces, which UN officials said was orchestrated with “genocidal intent”.

Humanitarians become so not always by design. An unexpected turn of events in life and witnessing the suffering of refugee children was the turning point for Rimjhim. “I never imagined working in a refugee camp,” Rimjhim told me. She graduated as a nurse in early 2018 and the work at the health center was her first job. “I have seen enough suffering here. My work here means a lot to the children here and to me.” The work of humanitarians such as Rimjhim often makes the difference between life and death for children in refugee camps. 

Photo credit: Sacha Myers/Save the Children
Kambale Kivasigha , Emergency Health Unit, Save the Children; Photo Credit Sacha Myers/Save The Children

What is the humanitarian spirit?

In mid-2018, when the worst flood in a hundred years hit the South Indian state of Kerala, I met several fishermen who acted instantly – they rolled up their sleeves, loaded their fishing boats into trucks and rushed to the flood-affected areas. Armed with nothing more than unflinching courage and grit, they rescued thousands of people long before helicopters reached the scene.

These fishermen were not humanitarians in the official sense. But they showed humanity and selflessness. They saved lives and embodied the humanitarian spirit.

Another person who became an accidental humanitarian is my colleague Kambale Kivasigha.

In 2002, several hundred people fleeing violence took refuge in the nursing college where Kambale was working as the principal.  They were sick and terrified. Amongst them were several children. Kambale didn’t know anything about humanitarian work at the time, but that didn’t stop him. He gave up teaching and started providing emergency healthcare for children and their families.

Ever since, Kambale has been on the frontlines of conflicts, disasters and disease outbreaks, providing life-saving humanitarian help.

He is now a nurse with Save the Children’s Emergency Health Unit and for the past year, has been working in Democratic Republic of Congo’s (DRC) Ebola-affected areas.

“Fighting the Ebola virus is only one of the challenges,” Kambale told me. Health workers and aid workers in DRC are fighting the battle against Ebola on several fronts. Firstly, they are fighting a deadly virus. Secondly, various armed groups have been attacking health workers and health centers and disrupting health services. Thirdly, misinformation and fake news have triggered mistrust amongst communities resulting in attacks on health and humanitarian workers.

Local volunteers such as the health workers in the Ebola affected areas of DRC or Kerala’s fishermen are often the first responders, and sometimes the only responders, in many disasters.

What makes a good humanitarian?

In early August this year, I was asked this question by a group of young students, many of them millennials, during a conference in Kuala Lumpur organized by MERCY Malaysia, a humanitarian organization.

The students wanted to know what humanitarian agencies look for when they recruit staff. Not an easy question and there is no perfect formula!

Firstly, humanitarian workers are compassionate and courageous. Secondly, they have clarity of purpose and believe in the magic that it is always possible to make a difference. Finally, they are collaborative, optimistic and bring energy. These are just some starting points.

Humanitarian work is not just a profession, but often a state of mind.

If you are a nurse, teacher, doctor, engineer, shelter or communications expert, it is an added advantage but not a replacement for the universal humanitarian values and principles that inspire humanitarian workers.

Foundations for a better, safe and just world are; an unflinching commitment (to a higher cause); unfailing optimism; a compassionate approach (to people who have lost almost everything); and professionalism.

These building blocks make ordinary people like Rimjhim, Kambale and fishermen of Kerala into extraordinary humanitarians – into superheros.

 

*Dr Unni Krishnan is Director Emergency Health Unit (EHU). EHU is Save The Children’s global capability to provide life saving medical assistance and health care in humanitarian settings.

 

Save the Children in Nepal

The First Letter

11-year-old Sabrin lives in the Mahottari district of Nepal, which serves as the district capital. Save the Children introduced its Sponsorship programs to the south-east of Nepal in 2018 in theMahottari and Sarlahi districts to address children’s poor access to education and basic health facilities. Sabrin is the first child in her area to receive letter from her sponsor. Here is an excerpt from our conversation with her at her home that she shares with her extended family, including her lovely eight cousins.

 

Save the Children in Nepal
Sabrin and Sushmita pose for a photograph while in school

Madam Sushmita (field staff) had come to our school many times before but that day she had come to meet me. She had a big smile on her face when she handed me an envelope. She told me that it was a letter for me from my friend who lives in another country. This was the first time she brought a letter; other times she would talk to us and take our photos. I had never received a letter before, neither had anyone in my community. Confused yet excited, I read the letter aloud while she listened intently. My friend lives in America and works at Save the Children. Madam Sushmita told me that Save the Children works for children like us so we can have good education in schools.

All of my friends were curious too. They asked Sushmita madam if she had letters for them as well. My new friend’s name is Sue. She likes to cook and play games…so do I! I was very excited to read her letter but I was sad to know that she broke her leg and needs some time to recover in the hospital. She already knew that I want to become a doctor when I grow up. When I heard about her broken leg, I imagined that if she had been here and I were already a doctor, I would have treated her with care.

Just like me, Sue enjoys reading. I wrote her that Nepali is my favorite subject. I like to read stories and there are many stories in my Nepali book. I wish I had more information about my friend in her letter…what her favorite foods are and the foods people eat in her country. I wanted to know about her family too and what kinds of clothes she wears. I also want to know if she is feeling better now.

Save the Children in Nepal
Sabrin showing us her neighborhood while her school is off for monsoon vacation

Everything I could remember, I told Sue in my letter. Eid is the festival I enjoy the most- I told her that too. I also prayed for her speedy recovery. I wanted to tell her so many things but I did not have enough space. I could not write more even though I wanted to! I will write more once she feels better and writes me back.  

 

Photo credit: LJ Pasion/Save the Children

Expanding Education in the Philippines

“My mom lets me go to school only if there is extra money,” says Cristina, age 9. “I was able to attend before, but not anymore. Now I wash dishes for a small canteen where my mother works.”

Eight-year-old Ashly (pictured above) tells a similar story: “I used to go to school. I’m supposed to be in Grade 3. But I have to help Mama and Papa sell vegetables. I sell them in the street every day from noon until late at night. I have many cousins who also don’t go to school.”

There are 1.3 million children like Cristina and Ashly in the Philippines today who are not enrolled in school. But this is far fewer than the 2.9 million children who were out of school 20 years ago. In 1999, 1 child in 6 was out of school. Today, that figure has dropped to 1 in 16. After almost two decades of no progress, the Philippines cut the share of children out of school by about 60% in just the last 10 years.

Girls in particular have benefited from this progress. The out-of-school rate for school-aged girls has fallen by 69% since 1999, compared to 55% for boys. This means, however, that boys are now much more likely to be out of school than girls, especially older boys.

Progress in the Philippines is reducing inequalities. The poorest children have made by far the greatest gains at every level of education.

Photo credit: LJ Pasion/Save the Children
Aldrin, 7, poses for a portrait at the spot where reading camp sessions are held in their community in Barangay 176, Caloocan City. In this small space, he and at least a dozen more children take part in activities such as reading, writing, and drawing facilitated by Save the Children partners. (Photo by LJ Pasion/Save the Children)

The Philippines Department of Education (DepEd) has implemented an intense and continuous campaign to reduce the number of children quitting school. It has incentivized school attendance with feeding programs and cash transfers based on school attendance.1  DepEd has also piloted a wide range of alternative schooling models to offer flexibility for students’ differing circumstances and address the specific needs of learners.2 

For children who still are not in school, Save the Children has adapted its successful Literacy Boost approach to provide learning opportunities outside the classroom. Christina and Ashly both participate in Reading Camps where they engage in fun, play-based activities to develop their literacy skills and habits.

“I learned how to read, write and draw,” said Ashly. “They teach me and tell stories and then we all read together.”

Since it was launched in the Philippines in 2012, the Literacy Boost program has been implemented in seven cities and provinces throughout the country. In 2018 alone, it reached 31,560 girls and 33,080 boys.

To learn more about the work Save the Children has done to support child literacy and help set children up for success, visit our website.

1. and 2. Changing Lives in our Lifetime: Global Childhood Report 2019 

Save the Children in Ethiopia

It’s More than Luck

By Zewge Abate

Internal Communications Manager, Save the Children in Ethiopia

Mebrit, 32, has four children and lives in a small village in Central Tigray, in northern Ethiopia. Being a mother is tough in her community, where families are largely dependent on subsistence farming. In addition to the daily care of the house chores – including but not limited to cooking, cleaning, looking after the children and washing clothes – mothers also help their husbands with farming activities such as sowing and weeding. 

 

Save the Children in Ethiopia
Mebrit learning about parenting with Community Health Worker, Medhin

There is a saying in Ethiopia that “luck is what determines a child’s development” and most community members perceive this as the truth towards child development. Mebrit always thought she was doing her very best to help her children grow well. Like all mothers in her community, she carried them on her back while doing the house chores and running errands, fed them as well as she could and love them so much. But since March 2018, when she started taking part in Save the Children‘s trainings for mothers with young children, she realized, “There is much more to what I was doing as a mother.”

Mebrit said her one-year-old baby, Helen, “is the luckiest because I apply my knowledge from those sessions to support her to grow physically and mentally.”

Something that Mebrit learned from the early learning trainings for parents was how to use the items she has available, such as corks, to make learning into a game for little Helen, and help her make sense of the world.

Now, she also talks to Helen more than she used to. “Even if she does not understand what I say, talking to Helen and telling her stories contributes to her future linguistic skills.”

Save the Children in Ethiopia
Mebrit teaching her youngest daughter Helen with household items

Mebrit teaching her youngest daughter Helen with household itemsLittle Helen was able to walk on her own a little before she turned one in August, and Mebrit told me, “Neither her sister nor her two brothers were able to walk until after they turned one because I didn’t help them the way I helped Helen, holding her hands and always encouraging her to move.”

Early learning and parenting program, provided through Save the Children’s child sponsorship program, has changes children and parents’ lives in over 50 villages or kebeles, in the local Amharic language.

“[Before, I] sometimes shouted at them when they messed up,” Mebrit said, remembering how her relationship with her children has changed since the trainings. Having attended seven early learning sessions so far, she now makes sure that all the time she spends with Helen is spent playing and helping her thrive. 

Medhin, a local health worker that supports sponsorship’s programs in Mebrit’s community, shared “I am very happy to see mothers actively engage in playing with and helping in their children’s physical and cognitive development.” Specifically for Mebrit, Medhin said, “I can definitely say little Helen has grown super active because of her mother’s regular early learning activities.”

Thanks to sponsors, Save the Children in Ethiopia is improving the growth and development of children in Central Tigray during their first 1000 days of life, by enhancing their connections and bonding with their caregivers through developmentally appropriate play and communication boosters.

Photo credit: Ellery Lamm/Save the Children

Logging Reading Minutes with Save the Children’s 100 Days of Reading Campaign

Written by Sara Neumann, Director, Media & Communications, U.S. Programs 

 

Summer is my favorite season – more sunshine, time with family and friends, trips to the beach and of course, summer reading! I’ve always loved to read for pleasure – books can take you anywhere. I’m so excited that this summer, I can log my summer reading minutes as part of Save the Children’s 100 Days of Reading campaign and help children across rural America through September 8, World Literacy Day.

Literacy has always been a cornerstone of the programs we provide in the United States and around the world, and in celebration of our 100th anniversary, Save the Children has launched our inaugural summer reading campaign. Called Read A Story, Change Their Story, the campaign encourages all children, parents, teachers, librarians, caregivers, adults, and more to log their summer reading minutes at SavetheChildren.org/READ. Participants can positively impact the lives of children growing up in rural America who do not have adequate access to early learning or children’s books, while also promoting literacy in all communities.

The summer slide can affect any child, not just those growing up in poverty. Children’s summer learning experiences during their elementary school years can impact their success in higher grades, including whether they graduate from high school and even move onto college. Reading just 20 minutes a day can have tremendous impact on children – and adults – of all ages.

As a young girl, I loved the library and my elementary school librarian, Mrs. Pezzullo, in particular. She would always have a stack of recommendations waiting for my nearly daily trips. In fact, when I was little, a school librarian was my dream job. And last week, I was transported back to my elementary school days when my 6-year-old niece Lily pulled The Phantom Tollbooth off of my bookshelf. It was one of my most favorite books from childhood, but to re-read the classic alongside Lily has brought me such joy – and perspective – to talk about how we’re both imagining Milo and Tock’s trip to Dictionopolis and beyond. There were so many new words that we were inspired to buy Lily’s first children’s dictionary – my collegiate version was just a little complicated. She’s home now, but we’re continuing our adventure via FaceTime – we’re just arriving at Digitopolis with the Humbug in tow!

Reading is powerful. It changes lives. It grows minds. It informs you of the world around you, and helps you think differently, too. Since the campaign began, I’ve logged 4,400 minutes to help children in need. Will you join me?

Check out the incredible resources provided by our awesome partners – like coloring pages and reading lists and activities – to keep the fun going!

Photo credit: Charlie Forgham-Bailey / Save the Children, Oct 2018

Getting to 2030 Vision to End Preventable Child and Maternal Deaths: Building on the global progress for women and children

Written by Smita Baruah, Senior Director, Global Health and Development Policy, Save the Children

Children today have a better chance than any time in history to grow healthy, be educated and be protected, as noted in Save the Children’s latest report, Changing Lives in our Lifetime: Global Childhood Report. Today there are 49 million fewer children stunted, a form of malnutrition that impacts a child’s ability to survive and thrive than two decades ago. There are 4.4 million fewer child deaths than they were in the year 2000.

These successes are not by accident.  Strong and increased political leadership at both global and national level have greatly contributed to changing the lives of women and children around the world in addition to scaling up of proven interventions and innovation.

The United States is one donor government who deserves much credit for accelerating progress on women and children’s health, beginning with its leadership at the first child survival resolution in 1982 through hosting the Child Survival Call to Action meeting in 2012 that set the stage for the vision to end preventable child and maternal deaths by 2030.

Critical Role of US Leadership in Reducing Maternal and Child Deaths
Last month, USAID launched its 5th annual progress report, Acting on the Call: A Focus on the Journey to Self-Reliance for Preventing Child and Maternal Deaths.  The report notes that in 2018 alone, USAID helped reach 81 million women and children access essential — and often life-saving — health services. USAID’s contributions have led to significant reductions in child mortality in many countries such as in Bangladesh where child deaths were reduced by 63% since 2000 and in Uganda, which experienced a 66% in reduction of child deaths during the same time period.

The report demonstrates the ways in which USAID has also helped increase national political will. Since the Child Survival Call to Action forum in 2012, governments in more than half of USAID’s priority countries for maternal and child survival have increased their domestic budgets for health.  In Uganda, for example, USAID worked with the Ministry of Health to increase the percentage of the allocated budget for health from 79% to 97%. 

Bangladesh, a USAID maternal and child health priority country, is an example of how donor assistance coupled with national political will, creates change for women and children. According to the Global Childhood Report, Bangladesh has had a sustained commitment to improving child health despite changing leadership. With donor and their own investments, Bangladesh has focused to strengthen health systems and scale up proven solutions for mothers, children and newborns with a focus on equity. However, focusing on health interventions alone did not contribute to Bangladesh’s success.  Women and girls’ education and empowerment are also key factors driving progress as well as the engagement of civil society, including children and young people.

Getting to 2030
In 2015, the United States and other world leaders and stakeholders committed to a set of global goals which includes the ambitious goal of ending preventable and child and maternal deaths by 2030. There is indeed much to celebrate.  To continue on the path to achieve the global goal of ending preventable child and maternal deaths, U.S. and other stakeholders must continue to focus on continuing to invest in maternal and child survival programs and designing and implementing highest-impact evidence based interventions. 

This also includes investing more resources in areas that are becoming the greatest contributions to child deaths: newborn health, pneumonia and addressing malnutrition.  Without increased focus on malnutrition, Save the Children’s report notes that in 2030, 119 million children will still find their physical and cognitive development stunted by malnutrition, with the poorest children at highest risk. Addressing pneumonia must also be prioritized. According to the Global Childhood Report, childhood pneumonia is the leading infectious cause of deaths in children under age 5 and it kills more children than diarrhea, malaria and HIV combined.

While much progress has been made in increasing national governments’ political will to reduce child and maternal deaths, resources must follow this commitment. The U.S. should work with national and local governments to continue to increase its own domestic investments in health, particularly for maternal and child survival interventions. This also includes working with national and local governments in ensuring that these resources are reaching the hardest to reach populations. Women and children who are furthest behind must be identified and prioritized in terms of investments, service provision and decision making. US should also work with governments to ensure that all women and children, especially excluded women and children, are counted to measure progress towards reducing child and maternal deaths. 

Going beyond just working with the Ministries of Health is critical.  U.S. and other stakeholders must continue to engage local civil society in the efforts to change the lives of women and children. In Ethiopia, for example, Kes Melakeselam Hailemnase, a 64 year old Orthodox Priest and head of Embaalaje Woreda Orthodox Churches Forum, reached more than 8.000 individuals with maternal, child, newborn health messages during regular sermons and other religious festivities after receiving training on Community Based Newborn Care, organized for faith-based leaders.  Kes’ efforts helped Abeba Mesele, a 21 year old mother of two, learn the importance of going to a health facility for antenatal check up and early post natal check ups.  

Change often happens at the local, community level. As USAID works with countries in their journey to self-reliance, development plans must be made in consultation with recipient country governments and civil society.  To ensure sustainability and self-reliance, development must be owned by the people of the countries receiving foreign assistance.

As the 2019 report shows, USAID has greatly contributed to building in country capacity by training health professionals including community health workers. This may not be enough. With increased natural disasters and the resurgence of pandemic threats such as Ebola, U.S. should work with governments and other stakeholders in helping to build resilient health systems. 

Finally, continued U.S. partnership and assistance is critical to a country’s success in improving the lives of women and children around the world. USAID should maintain evidence-based, highest-impact interventions and a comprehensive approach to addressing maternal and child survival and continue to provide robust resources.

Photo credit: Susan Warner / Save the Children

Taxation with Representation: Citizens as Drivers of Accountable Tax Policy

Written by Andrew Wainer, Director, Policy Research  and Sadie Marsman, Research Assistant
Photography credit: Susan Warner / Save the Children

Protests by citizens against their government’s tax systems have not just occurred across cultures and centuries, but have led to revolutions.

In 18th century America, for example, the British crown’s assertion of its right to tax colonists without consent led to the Boston Tea Party and, eventually, the American Revolution. “No taxation without representation” is perhaps that revolution’s most famous slogan. Since then, it’s been played out in countless other parts of the globe.

Throughout history, taxation has been controversial and often dramatically contested. Yet today it is accepted as one of the primary ways for governments to increase domestic revenue in order to better meet the basic needs of citizens.

Save the Children’s new report, Taxation with Representation: Citizens as Drivers of Accountable Tax Policy, analyzes the evidence on citizen tax advocacy in developing countries in order to garner insights, and identify trends, on how civil society organizations (CSOs) contribute to accountable and progressive tax policies within the framework of equitably financing the Sustainable Development Goals (SDGs).

The report, being launched this week in Berlin at a meeting of the Addis Tax Initiative, is intended to:

  • Provide additional guidance to policymakers seeking to support pro-development and accountable DRM in developing countries, and
  • Contribute to the growing evidence base on the role of CSOs in tax policy

A Tax and Governance Virtuous Circle?
Tax policy isn’t just about tallying revenue collection numbers and tax-to-GDP ratios. It’s also about ensuring revenue collection is pro-development, and contributes to enhanced governance. A broad representation of citizens’ voices must be included in that tax policy’s development and execution including marginalized and vulnerable groups.   

To create a tax system that is representative of broad societal goals, factors such as gender, ethnicity, geography and language must all be considered. While technical experts should, and will, continue to play a central role in tax policymaking, domestic resource mobilization (DRM) will fail to achieve its potential as a key source of finance to achieve development goals if it’s pursued without citizen input, and without prioritizing equity.

With this in mind, the report analyzes a series of cases in the research and policy literature on civil society engagement in tax policy at the national and subnational levels. The goals of our analysis are to illustrate what has worked and what is needed to support citizen engagement for more accountable tax policies.

 Citizen Engagement at the Subnational Level: Burundi
A 2014 World Bank study in Rutegama, Burundi, found that fostering partnerships between civil society and local administrators was necessary for successful citizen engagement, given the low levels of civil society capacity and state administrative capacity in fragile contexts.

Capacity building had to happen with citizens and the state, together.

World Bank researchers found that, “Within the Burundi context [it]…must be done in tandem with encouraging state developmental responsiveness.” In Burundi, as in other instances analyzed in the report, international donors–in this case primarily the Swiss Agency for Development and Cooperation (SDC) and the German Agency for International Cooperation (GIZ) – facilitated the decentralization process, encouraging engagement between CSOs and local fiscal officials.

In Rutegama, the municipal administrator created a partnership with local civil society, in which they were involved in discussions on budget and tax collection. Burundian law facilitated more equitable participation of women because gender balance is enshrined in law at both the local and national levels.

For example, communes in Burundi are governed by a council of 15 members that must also reflect a degree of gender balance (by law, at least 30% must be women).

For its part, matching the local government commitment, civil society raised awareness among taxpayers on the links of taxation to public expenditure. At the time, the public already had access to budget expenditures, but many citizens were unable to read the documents in French or make sense of the budget’s complicated format, so additional taxpayer education was conducted.

Due to the government’s commitment to transparency and social accountability, and gender equality, citizens placed more trust in their government and were more willing to pay taxes. After the program was implemented in 2010, Rutegama experienced increasingly larger revenue collections each year for the next three years.

Recommendations
Based on the analysis of the country cases, the report presents recommendations on how to support citizen engagement in DRM including:

  • Support subnational-to-national links through donor DRM programming. Donors can build national-level civil society tax advocacy through supporting more developed subnational work. Local level civil society advocacy can be foundational for building broader national campaigns and serve as the training ground for tax policy advocacy.
  • Support government and civil society co-design of tax policy. Engaging civil society and governments together – particularly at the local level – has a track record of success. The citizen-state compact can be strengthened when capacity needs are addressed together, rather than only building the capacity of government.  Confrontations between citizens and government tend to occur when there is no platform to engage on tax issues.
  • Engage in the full budget cycle. Over the last decade, civil society organizations across the world have advocated for effective and equitable provisions of services through the budgeting process. In so doing, they have gained expertise as well as become agents of change able to influence budget allocations at all levels of government. Combining tax advocacy, with budget advocacy, civil society can be more effective in advocating for accountable and equitable revenue collection and spending on public services

To ensure that a tax policy is pro-development, and contributes to enhanced governance and social inclusion, a broad representation of citizens’ voices must be included.  Otherwise, DRM will fail to achieve its potential as a key source of finance for development around the world. We look forward to presenting that case to our ATI partners this week in Berlin.

 

 

Photo credit: Caroline Trutmann Marconi / Save the Children, Nov 2018

Mexico’s Progress in Ending Child Labor Is a Father’s Story of Progress As Well

The latest child labor estimates tell a story of real progress and of a job unfinished, as outlined in Save the Children’s Global Childhood Report: Changing Lives in our Lifetime. Child labor rates and the global number of child laborers have declined dramatically in recent years. Globally, rates are down 40%, and 94 million fewer children are working now than in 2000. But progress has slowed and the world remains far from the 2025 target to end child labor in all its forms. 1

Much of the decline in child labor in recent years has been credited to active policy efforts to extend and improve schooling, extend social protection, expand basic services and establish legal frameworks against child labor.2

Mexico has made impressive progress against child labor, cutting its rate by 80%. This progress deeply personal for many families with young children who hope for a better future for their sons and daughters, free from child labor. 

Amador is one such parent.

The father of five school-age boys himself, Amador dropped out of school to work and make money when he was about 10. “My dad was disabled and I was the last child,” he said. “I did not have an education. I still don’t read very well.”

Amador’s story was much more common in 2000 than it is now. Just a generation ago, 1 of every 4 Mexican children aged 5 to 14 was engaged in child labor.5  Today, Mexico has cut its child labor rate from 24% to 5% – a remarkable decline. This progress saves an estimated 4 million children a year from child labor.6

Data suggest Mexico’s progress has been broad-based, benefiting both male and female children, children from urban and rural areas, and children from all regions. Progress has been strong among the poorest households, and equity gaps are shrinking.7

The Mexican government regularly collects and disseminates information on child labor.8 It has also invested in education and provided incentives for children to attend school rather than work. Education reforms in the 1970s and 1980s helped create a new generation of more educated parents less inclined to send their children to work.9 The Prospera program, launched in 1997, offers small cash payments to impoverished parents to keep children in school and attend workshops on nutrition, hygiene and family planning.10 Improvements in living standards and an overall reduction in poverty also contributed to the decline in child labor, as did the movement of jobs away from the agricultural sector.11

Save the Children Mexico has partnered with the sugar industry to better comply with Mexico’s child labor laws and make changes in the way business is done. This alliance, established in 2012, identifies child labor risks throughout the sugar supply chain, finds alternatives for at-risk children and supports community work to prevent child labor in the fields. The partnership also advocates for better child labor regulations and has working groups to promote best practices.

There are still an estimated 3.2 million child laborers in Mexico, 134 so increased attention on this problem is needed, especially in rural areas. Amador is determined that his five boys will not be among that statistic. “I’m giving my children an education… so they can study and be someone in life.”

1. El Instituto Nacional de Estadística y Geografía. “3.2 Milliones de Niños y Niñas y Adolescentes de 5 a 17 Años Trabajan en México: Módulo de Trabajo Infantil (MTI) 2017”

2. Understanding Children’s Work Programme. Understanding Trends in Child Labour: A Joint ILO-UNICEF-The World Bank Report. (Rome: 2017)

3. ILO. Global Estimates of Child Labour: Results and Trends, 2012-2016. and ILO. Global Child Labour Trends 2000 to 2004. (Geneva: 2006)

4. ILO. Marking Progress Against Child Labour: Global Estimates and Trends 2000-2012. (Geneva: 2013)

5. Includes household chores for at least 21 hours. 

6. National estimates for 2017 suggest child labor rates have declined further, to 3.6% of children aged 5-14. Source: El Instituto Nacional de Estadística y Geografía. “3.2 Milliones de Niños y Niñas y Adolescentes de 5 a 17 Años Trabajan en México: Módulo de Trabajo Infantil (MTI) 2017” (2018) 

7. Understanding Children’s Work Program. The Mexican Experience in Reducing Child Labour: Empirical Evidence and Policy Lessons. (2012) 

8. UNICEF. Child Rights in Mexico.

9. Understanding Children’s Work Program. The Mexican Experience in Reducing Child Labour: Empirical Evidence and Policy Lessons.

10. Dávila Lárraga, Laura. How Does Prospera Work? Best Practices in the Implementation of Conditional Cash Transfer Programs in Latin America and the Caribbean. (Inter-American Development Bank: April 2016)

11. El Instituto Nacional de Estadística y Geografía. “3.2 Milliones de Niños y Niñas y Adolescentes de 5 a 17 Años Trabajan en México: Módulo de Trabajo Infantil (MTI) 2017”