Celebrating 10 Years of Literacy Boost – What Have We Learned So Far?

Written by Pamela Mendoza and Sonja Horne

Childhood is unique experience across the world, but all children deserve the chance to access high quality education, especially around literacy. But how best to create a suite of tools that can be adapted to the experience of children across the world? In 2009, Save the Children set out to answer this questions by developing our evidence-based non-profit Literacy Boost approach to address cumulative evidence of gaps in basic reading instruction,  and its flexible design in the components allows for adaptation to better guide schools, teachers, parents, and communities on literacy practices. Now, a decade on we want to take the opportunity to reflect on the lessons learned from implementing Literacy Boost over the last 10 years and investigate Literacy Boost’s contributions to the children in more than 27 countries currently using and adapting Literacy Boost. This blog post is just an introduction, the full report of the first decade of Literacy Boost is available for download at our Resource Centre.

What is Literacy Boost?
Literacy Boost is an adaptive approach designed using evidence gathered from across countries Save the Children works. It aims to improve literacy learning outcomes, and increase reading skills of children, especially those who may struggle to learn to read, in a growing number of program sites across the globe.[i]

Literacy Boost focuses on four areas:

  1. Reading Assessment: Identify gaps and measure learning improvements in the core reading skills
  2. Training teachers: Teachers are trained on core reading skills and writing to incorporate skill-building into their regularly scheduled curriculum
  3. Community action: Quality teaching and learning environments inside and outside of schools to help children improve their reading skills
  4. Enhancing the literacy environment: Provide appropriate reading materials to practice and enjoy reading

What have we learned?
Literacy Boost improves student’s learning skills, especially for girls and children from weaker home learning environments.

Literacy Boost focuses on life-wide learning that is, children’s engagement in enjoyable, cognitively demanding literacy-related activities both inside and outside the home (Friedlander, Dowd, Borisova, & Guajardo, 2012). Literacy Boost significantly improved learning outcomes in 13 out of 17 sites included in this analysis. Literacy Boost students learned more on average than students that did not receive the intervention. Overall, there has been a positive shift from non-readers to readers with comprehension, particularly for children within Literacy Boost schools (Figure 1).

Figure 1. Reading Comprehension Tiers Aggregating Data from 17 Samples

Notes: Non-Reader: Students who cannot read 5 words correctly in 30 seconds. Beginning Reader: Students who can read 5 or more words correctly in 30 seconds but can only answer 75% or less of comprehension questions correctly. Reader with Comprehension: Students who can read 5 or more words correctly in 30 seconds and who can answer more than 75% of comprehension questions correctly.

Notes: Non-Reader: Students who cannot read 5 words correctly in 30 seconds. Beginning Reader: Students who can read 5 or more words correctly in 30 seconds but can only answer 75% or less of comprehension questions correctly. Reader with Comprehension: Students who can read 5 or more words correctly in 30 seconds and who can answer more than 75% of comprehension questions correctly

In terms of equity, Literacy Boost is helping girls learn more letters, read more passages and understand their meaning. In 12 country samples, Literacy Boost girls gained significantly more in foundational and advanced literacy skills than the girls that did not receive the program. For home learning environment (HLE), in 12 studies we found that Literacy Boost students that had low interactions at home gained significantly more in at least one literacy skill compared to their peers that did not receive the program. 

Adaptability and focus on educators and families helps children improve their reading in a variety of contexts

On Literacy Boost successes, reflections from the different country office (CO) sites are dominated by improved teaching in classrooms and improved learning by students. CO colleagues report that teachers now know reading skills and create materials to promote them. At the student level, CO colleagues note the increase in pass rates, in the percentage of children who can identify letters and words, their improvement in fluency and reading with comprehension, greater participation in class, and enthusiasm for reading engagement in learning both inside and outside schools among others. Finally, a core set of respondents note successes in both garnering ministry support and using different mechanisms to achieve greater scale with Literacy Boost within their communities.

On gender and disability, only nine Literacy Boost sites responding to the survey have elements that are specifically addressed to the learning needs of boys and girls. For instance, in Cote d’Ivoire, Niger, and the Philippines have prioritized developing or selecting gender-sensitive books. Twelve of the country teams report having design aspects of their Literacy Boost programming that are specifically targeted to ensure inclusion for children with disabilities. For example, in Malawi, Guatemala, Niger, and Papua New Guinea the team implements the SNAP (Student Needs Action Pack) alongside Literacy Boost to equip teachers with skills to identify and support learners with diverse learning needs.

Half of the respondents report that in their site the children speak the language of instruction (LoI) at home, while the other half offer evidence of a complicated linguistic setting for learning. Overall, the respondents are supporting children who speak 114 different languages at home across these 27 sites. While in some cases the use of a variety of local languages to promote learning is formally promoted, in many more it is used—likely as it is feasible when teachers speak the children’s home languages.

Literacy Boost influenced the development of a National Reading Strategy which has resulted into the implementation of National Reading Program through the Ministry of Education,” Malawi staff

Within the last decade that Save the Children has been implementing Literacy Boost, many successes have been captured, including the overall positive impact of the program, as well as equity improvements for participant children and a significant uptick in the number of implementing sites. Given its overall success, it is not a surprise that the program was one of the first programs endorsed by Save the Children as a common approach in 2016. As the program moves forward and is implemented in more sites, it is important to take into account the lessons learned and to set a focus on sustainability for all of Literacy Boost’s core goals, so that the improvements made towards children’s literacy will benefit not only the children currently partaking in the program but all children who come after them.

Despite the substantial progress that has been made towards increasing education access over the last decades, 670 million of children and youth lack basic mathematics and literacy skills[ii]. The COVID-19 pandemic is exacerbating the learning crisis and negatively impacting more than 1.6 billion of children and youth. While the majority of countries are making huge efforts at putting in place remote learning strategies, a recent survey from Save the Children shows that students are having access to fewer distant options and lacking the necessary support given that caregivers are facing challenges accessing essential services and goods.[iii] Furthermore, recent evidence suggests that school closures across contexts have led to significant learning losses in the past months.[iv] The dire effects on learning due to the current COVID-19 pandemic further highlight the need for evidence-based, context-appropriate learning approaches that develop and support quality learning for children in schools and communities. Literacy Boost has been one approach that has been proven to improve learning outcomes for some of the most marginalized children across the globe.

[i] https://resourcecentre.savethechildren.net/library/literacy-boost-common-approaches

[ii] https://www.un.org/sustainabledevelopment/education/

[iii] https://www.savethechildren.org/content/dam/usa/reports/advocacy/global-childhood-report-2020.pdf

[iv] https://www.cgdev.org/sites/default/files/practical-lessons-phone-based-assessments-learning-revised-jul2020.pdf

Realizing the Global Ceasefire on Violence Against Girls – A first look at the new UN Global Gender Response Tracker

Written by Gabrielle Szabo, Senior Policy and Advocacy Adviser on Gender Equality

On April 6, 2020, the UN Secretary General called for a global ceasefire on all forms of violence in response to what he called a “horrifying surge in violence against women and girls in the home”. More than 140 governments responded to the call. Yesterday, just short of the six-month anniversary of the Secretary-General’s announcement, the UN answered civil society calls for accountability by launching its COVID-19 Global Gender Response Tracker. This is a critical step forward, providing precious new data at a time when policy-makers, advocates and researchers are struggling to keep up with rapidly changing circumstances.

What can the tracker tell us?
The tracker currently looks at 2,500 policy measures enacted by governments in 206 countries and territories and will be continually updated. It is a remarkable example of the value of collaboration between governments and UN agencies, and an important step in support of accountability to women and girls. The tracker examines the introduction of ‘gender-sensitive’ policy measures and responses to violence against women and girls, efforts to promote their economic security and address unpaid care burdens (like childcare and chores).

Global analysis shows us that low and high-income countries all over the world are implementing gender-related measures in response to COVID-19:

  • Almost 80% (164) of countries and territories surveyed had introduced measures considered gender-sensitive in response to COVID-19 – a total of 992 measures.
  • More than 70% (704) of those measures were intended to address violence compared to just 17% (177) aimed at economic and social security and 11% (111) aimed at addressing unpaid care work.
  • Two-thirds (63%) of measures to address violence concerned services, including helplines and shelters, and the next most common measure was awareness-raising (18%).
  • Poor and fragile countries and territories are the least likely to have introduced both measures to address violence and gender-sensitive measures in general.

And what about girls?
We know that girls face high-levels of gender-based violence, including age-specific violence like child marriage. But adolescent girls in particular, too often fall through the gaps between child protection and gender-based violence services. Girls are also more likely to shoulder excessive burdens of unpaid work, particularly in times of crisis. So, what does the tracker tell us about how governments are addressing girls’ needs?

The tracker is not age-disaggregated but back-of-the-envelope analysis by Save the Children shows that girls are specifically referenced or addressed by just 16% (33) of the 206 countries/territories analyzed – on quick inspection, many of these measures have girl-specific elements and cannot simply be accounted for by the tendency to refer to “women and girls” collectively.[1]Just three of these 50 measures (in Chile, Mexico and Uganda) relate to social protection, all of the others address violence.

What sorts of measures are governments taking?
Measures range from helplines and shelters to women only police emergency response teams (Jordan), awareness-raising activities, panic buttons on smart phones (Guatemala), virtual court hearings (Barbados) and safe spaces (Afghanistan, Bolivia), to additional leave for working mothers (Mexico), bicycles for gender-based violence service providers (Malawi), issuing of alerts for missing women, girls and boys (Guatemala), support to access menstrual hygiene products (South Africa), and inclusion of women’s organizations in government briefings (Uruguay).

Do any countries stand out?
Any number of countries could be identified as standouts, but some exciting examples include:

  • Egypt, which has the highest number of girl-specific measures (4) of any country/territory including new remote referral hotlines, continuation of family court hearings despite suspension of other court hearings and measures to continue and adapt efforts to end harmful practices, specifically female genital mutilation (FGM) through the pandemic.
  • Uganda, one of just three countries to include girls’ empowerment programming for economic and social protection through ‘Girls Empowering Girls’, an urban cash transfer and mentoring programme for adolescent girls that has adapted to allow remote enrolment, delivery and mentoring.
  • Bangladesh, Cambodia and Kenya, all of which have introduced measures to reduce harmful practices including child marriage and FGM that exclusively or primarily affect girls and are projected to increase as a result of the COVID-19 crisis.
  • Democratic Republic of Congo (DRC) – despite being a fragile state, DRC is one of just 8% (48) of countries analysed to make violence against women and girls an integral part of their national and local COVID-19 response plans.

What’s next?
With this growing wealth of information at our fingertips, governments must take the opportunity to learn from each other and adapt and improve responses to COVID-19. And advocates must make use of this new accountability tool. Closer examination will be required to understand the extent to which girls’ age-specific needs are being responded to, including in relation to their rights to education and sexual and reproductive health.

The next iteration of the tracker will include a women’s leadership measure. This is an exciting development and will be a real test of governments’ commitment to girls’ right to participate. A global ceasefire on violence against girls is still far from a reality. As we celebrate International Day of the Girl and work toward #GenerationEquality, we must use this new tool to ensure that girls voices are at the centre of decision-making processes, through COVID-19 and as we work together to build back safer.

Save the Children will continue to monitor content from the Global Gender Response Tracker as part of our own live-tracker looking at the impact of COVID-19 on children.

[1] These percentages are based on searches for the term ‘girls’, ‘child marriage’ and ‘FGM’ and ‘female genital mutilation’. Inclusion of the search term ‘child’ would have significantly increased the number of countries and measures considered to be specifically addressing girls and a closer analysis would be needed to determine whether these measures specifically addressed the needs of girl children.

COVID-19: Bringing the “Shadow Pandemic” to Light

Written by Janti Soeripto, President and CEO, Save the Children

While the world is paying rapt attention to the daily rise and fall of the numbers of cases of COVID-19 around the world, there’s another part of this crisis that is not getting the action that it needs: gender-based violence.

UN Women is calling it a shadow pandemic, with the risk of gender-based violence to girls and women surging higher as COVID-19 has forced them to stay in their homes – some trapped with their abusers and isolated from support – and put both economic and psychological stress on families. Girls around the world are living in grave risk of violence. And they need our support right now, especially girls living in humanitarian settings.

Reports just last week by humanitarian responders confirmed that even with the limited quantitative data available, there is cause for extreme concern in humanitarian settings. The Global Protection Cluster, which coordinates the UN’s humanitarian response on gender-based violence and child protection, reported increased rates of gender-based violence related to COVID-19 in 90% of humanitarian field sites where they are responding; over 60% report it having a severe impact on affected populations. 

We know that adolescent girls are particularly vulnerable because of the intersection of their age and gender. For example, during the Ebola outbreak in Sierra Leone, school closures led to increases in sexual violence experienced by girls. This contributed to a 65% increase in adolescent pregnancy in some districts in the country; and because they were pregnant, those girls were banned from returning to schools when the outbreak ended due to a policy that has since been changed, compounding the impact this violence had on their lives.

Guidance from the UN and gender-based violence practitioners have long called for humanitarian actors to assume that gender-based violence is happening, regardless of whether data on incidence or prevalence is available. That’s both because collecting the data can further endanger women and girls who are experiencing violence, and because even in the best of circumstances, violence is under-reported due to the enduring stigma.

It’s therefore vital that we learn from past experiences – such as the Ebola outbreak — and apply that learning to our current crisis.  We are long past the time where we can pretend we are unaware of the risks of gender-based violence. We have the knowledge and the tools to respond.  We urge the humanitarian community to harness the will to act now to protect a generation of girls from gender-based violence:

  1. Create a specific objective on gender-based violence prevention and response in the final update of the global humanitarian response plan for COVID-19 and mandate the collection, analysis and use of sex, age, and diversity-disaggregated data across all assessments and interventions.

We’re extremely concerned that despite experience and the evidence we do have, gender-based violence is still glossed over in a litany of risks in the global COVID-19 humanitarian response plan. But it’s not too late.

The UN Office of Coordination of Humanitarian Affairs (UN OCHA) holds the pen on the global plan to address the impacts of COVID-19 in humanitarian settings. They are releasing a final update to the plan next week and have the opportunity to act quickly and make a life-saving difference for girls at risk.

There is broad based support across the global community to do just this, demonstrated by this letter[LA1] endorsed by 576 international and local NGOs, governments, partnerships, institutions and UN agencies.

  • Increase funding for gender-based violence prevention and response in humanitarian contexts proportionate with the extreme need.

Gender-based violence remains grossly underfunded within humanitarian crises, despite evidence that indicates it’s a widespread occurrence. In fact, it only accounts for 0.58% of the current budget for the global response plan for addressing COVID-19 in humanitarian settings — and even that paltry sum has yet to be funded. Donors must back up their rhetoric with funding commitments and programs tailored to address the needs of adolescent girls at risk in humanitarian settings.  This includes not only targeted programs to address gender-based violence, but also integrating it into other programs, such as training frontline health workers so that they can identify and respond to gender-based violence.

  • Prioritize the safe and meaningful participation and leadership of girls and women on the frontline of this crisis in humanitarian decision-making and COVID-19 response efforts.

Recent research from CARE International has shown that despite commitments by the UN and government actors – women’s rights organizations at the local level are still not being meaningfully included in humanitarian decision-making during the COVID-19 response. In addition, local women’s rights actors, essential to the COVID-19 response are not receiving the funding support they need.  Women and girls must be included in decision-making at all levels and receive the funding they need to provide critical gender-based violence prevention and response services. 

Beyond the direct health impacts, COVID-19 is risking decades of progress on gender equality and girls’ rights with devastating consequences for years to come. This is a “shadow pandemic,” that must be brought into the spotlight. Enough is enough.

Promoting Brain Building Moments™ Within Community Traditions and Cultural Practices

Written by Amee Barlet, Save the Children Washington Deputy Director
and Rochel White, Early Steps to School Success Early Childhood Coordinator

Early Childhood Coordinator Rochel White sings a traditional Twulshootseed butterfly song during a home visit while a mother engages her child in back-and-forth interactions through drumming.

Save the Children’s Early Steps to School Success (Early Steps) program and Vroom® celebrate parents and caregivers as their child’s first and most important teachers. Vroom, an early learning initiative from the Bezos Family Foundation, empowers parents and caregivers to play a proactive role in their child’s brain development by turning everyday moments into Brain Building Moments®.  

Save the Children has integrated Vroom’s science-based tools and tips into our early learning programs to advance educational outcomes in some of America’s most isolated and low-resourced communities. By celebrating a community’s strengths, cultural traditions and values – Save the Children is able to foster community-wide commitment to early learning while bringing Vroom’s Brain Building Moments™ to cultural celebrations and traditional practices.

In Washington State, we partner with the Quinault Indian Nation to promote healthy childhood development. Rochel White has served as an Early Steps Early Childhood Coordinator since 2017 and has two decades of experience in early learning. She speaks English and Twulshootseed (the language of the Puyallup Tribe and Southern dialect of the greater Lushootseed language) and takes Quinault language classes.

Taholah, where the Quinault people have lived for time immemorial, is the main village of the Quinault Indian Nation. It is an isolated community – with one road in and out – set on the coast at the mouth of the Quinault River. Services are difficult to access, the nearest library is over an hour away, and while there is a Tribal Health Clinic on the reservation, many families must travel for at least an hour for primary care and speciality and support services. There is also a dearth of pediatricians and reproductive health practitioners in the county.

Fish runs through the Quinault River have been low lately due to climate change, hurting families that rely on them for income and subsistence. To make early learning more accessible to more families, Rochel implements Early Steps around the working hours of those involved in the hunting fishing, and shellfish industries, which follow schedules set by the tides. This has led to an increase in enrollment and engagement with the program and the visits. 

Over the past year, Rochel has hosted a series of Vroom events for families with young children throughout the community. At each event, she has shared brain development information and has used the five Brain Building Basics™ to support culturally centred parent child interactions.

At one event, Rochel hosted a button blanket activity. Button blankets are traditionally worn by northwest coastal tribes. The blankets typically feature a family crest and abalone buttons. “The buttons signify your wealth – how much you have to give away and how large your family is, as those were traditional Native American determinants of prosperity,” Rochel explained. Rochel handed out felt squares, traditional shapes and buttons. Parents were encouraged to talk about their families, count buttons in English and Quinault, make patterns and talk about shapes, textures and colors.

Rochel shared, “The buttons had Velcro on the back so families could rearrange their designs. We used felt pieces for the little ones and buttons for children ages 3-5. I showed how it was an opportunity to count with little ones and how families have always used cultural practices to teach their children. I posted the 5 Brain Building Basics and discussed with families how they were able to include these when they are counting, asking their little ones where they want to place their buttons or what crest they wanted, and talking about what button blankets are. Each family took home their button blanket and a copy of the Brain Building Basics sheet. I suggested families hang their blankets up or use them with a baby doll.”

Rochel noted, “One grandparent sat down and counted in Quinault with her grandchildren while they chose their buttons. I was so happy to hear this and told her how much brain building she is supporting by doing that with them. She remarked ‘I don’t often read to them anymore, on account of my bad eyes, but I tell them stories every day.’  We chatted about how much eye contact and facial expressions are utilized in storytelling.”

After the activity, Rochel posted information about the event on Facebook and a parent commented, “I loved the craft! I can’t wait until it’s all dry and the kids can redecorate it over and over.”

The vast majority of the 100 students at Taholah School struggle to meet grade level standards in Math and English Language Arts. The school superintendent reached out to Rochel to plan and implement early childhood activities to build family/school connections and help children feel more comfortable the day they start kindergarten.

During a recent family math night, Rochel planned a shape sorting and pattern activity that incorporated formline – a feature of the indigenous art of the region. One participating family included Leo[1], who was almost 3, his parents and his older sister, a kindergartener. Both parents had consistently read to their son, but now talk to him more and make a point of keeping eye contact, as Rochel had encouraged them to do. “Leo’s mom was one of the first parents to really get involved in the Vroom activities. She consistently asks for more ideas each week and lets me know how Leo liked them, and if he needed more support,” said Rochel. “I see that dad, as well as mom, is engaged in asking questions about growth and development as well as wanting to learn more activities to help support Leo,” says Rochel.

Rochel uses the Early Steps Plan and Play curriculum, elements from the Positive Indian Parenting curriculum and her own creative ideas to enrich her home visits and parent child groups with a cultural focus. Rochel has taught parents to use heirloom cradleboards (traditional padded frames for swaddling babies) to soothe their infants. She has shown parents how drumming and singing songs can be a way to bond and develop language, math and listening skills.

“Rochel has helped us learn how to teach our children in so many ways. When we started the program my husband and I had disagreed on a lot of parenting and learning stuff, but I have become more confident teaching them now,” shared an Early Steps mom.

During the current pandemic, Rochel continues to engage and support the Taholah community in fostering healthy childhood development. Rochel integrated early learning resources and critical hygiene materials into the school’s distribution efforts. She held a book fair while families were picking up laptops for their school-age children. Families arrived at staggered times to collect their laptops and choose from a large selection of recently donated children’s books. The event reached over 50 families, and about 170 children received books. Additionally, Rochel created early learning Boredom Buster resource kits and brought them to families who were staying safe at home.

The connections that Rochel has forged are proof of the impact she has made in the community and her dedication to raising the quality of all programs serving Quinault children. She has developed strong relationships with families as well as other agencies serving them. Rochel is frequently asked to plan an activity, drum, sing or be a storyteller for events at the school and at Early Head Start and Head Start programs.

The Director of Taholah’s Head Start program asked Rochel to join their policy council, providing her with another opportunity to share her expertise on early childhood and her deep knowledge of incorporating culture into routines, curriculum and interactions. Through the Early Steps Book Bag Exchange program, community read-alouds among other endeavors, she is able to mentor other professionals and model best practice. Amee Barlet, Save the Children’s Deputy Director for Washington shares, “I am inspired by Rochel’s approach to relationships, culture and mentoring. I believe Rochel is an early childhood leader creating high quality culturally appropriate learning opportunities for children in the Taholah community. She is an advocate for all children.”

[1] Child’s name has been changed.

Monitoring and Evaluation Plan Key to Basics Uptake and Scaling

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by the BASICS team

BASICS will implement a robust monitoring and evaluation, learning and data use plan designed to be institutionalized and sustained within national and local government health systems.

Data from healthcare facilities in our four demonstration countries (Bangladesh, Cambodia, Nigeria and Tanzania) will be reported to district-level governments through established quality improvement or infection prevention systems, depending on the country context. Information related to infection prevention readiness, staff and patient behavior compliance, cleanliness, supply and antibiotic burn rates and health outcomes will be reported.

The BASICS team will validate the quality of this data through our monitoring systems at representative sentinel facilities.

This data will be aggregated and analyzed to assess infection preparedness, behavior compliance and health improvements.

During the first three years of BASICS’ implementation, we will use this rigorous data to demonstrate significant cost savings, improvements to quality healthcare and improvements in health outcomes for health systems. With this data in hand, we will also advocate for national scale in our demonstration countries and globally.

We will also develop an M&E toolkit that can be leveraged to contextualize and scale-up beyond the initial four countries.

How BASICS Will Adapt to Respond to Unique Cultural Barriers

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

BASICS (Bold Action to Stop Infections in Clinical Settings) will launch in four countries where governments have shown commitment to reducing infection risk. Yet, local cultural, economic and social barriers can pose unique challenges. We have received a number of questions on how we see BASICS adapt and flex to meet unique cultural contexts.

In this video, our staff on the ground share their perspective and experience on how they worked with behavior change interventions to achieve significant promising results in their countries.

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings), visit savethechildren.org.

How Behavior Change Interventions Can Be a Key to Improving Hygiene in Healthcare

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by the BASICS Team

 The 100&Change competition has challenged us to think critically and creatively about developing a solution that tackles one of the world’s most forgotten problems: healthcare-acquired infections (HAIs). BASICS was designed to catalyze and support transformative changes in how healthcare staff practice good hygiene in order to reach dramatic reductions in HAIs across national heath systems, saving lives, reducing antibiotic use and freeing up much-needed resources.

There are many reasons why following effective hygiene protocols can be difficult for healthcare staff in low-resource settings, such as lack of sanitation infrastructure and clean water and broken supply chains that fail to deliver needed materials. These physical barriers present one set of challenges – changing health workers’ longstanding habits and practices are another.  Overcoming these challenges requires work at all levels, from influencing very personal behaviors to national health policies.

How do we realize such a bold ambition – reducing HAIs by half in four demonstration countries to start, and then scaling to other high-burden countries – when our solution relies on individual and group behavior change in a diversity of settings?

One of our key strategies is to ensure that healthcare staff feel truly invested in the BASICS approach, and are actively engaged in a process that works for their social, cultural and socio-economic reality, and other important factors related to behavioral change.

The BASICS’ framework is grounded in the proven Behavior Centered Design approach. Developed and refined over a decade by scientists at the London School of Hygiene and Tropical Medicine, it combines evolutionary and environmental psychology with the best marketing practices to create imaginative and provocative behavior change interventions.

Once BASICS launches, we will begin with in-depth formative research, which consists of participatory methods inspired by anthropology, psychology and other behavioral and social sciences. This will help us understand the individual, social, and cultural drivers of the infection prevention control behaviors that BASICS is designed to change.

These insights will then be used to tailor BASICS to the local context. This will maximize both individual and institutional acceptability and adoption of changes.

BASICS partners Save the Children, London School and WaterAid have already used the approach in one of BASICS’ four demonstration countries –Cambodia. This experience will help to give BASICS a firm fooothold there, and inform work in the three other demonstration countries of  Bangladesh, Nigeria and Tanzania.

In Cambodia, we found that many people believe that if their hands don’t look soiled, that means they’re clean. Open defecation is also socially accepted, especially when there’s abundant open space.

Save the Children has, over the past six years, run the NOURISH program, which targeted behaviors in health, water, sanitation and hygiene and agriculture. The impact of the changed behaviors is very significant, including a 75 percent drop in open defecation in the program areas.

WaterAid and the London School, in partnership with the National Institutes of Public Health and 17 Triggers, recently used Behavior-Centered Design to develop a novel intervention to improve hand hygiene compliance among Cambodian midwives.

They identified the personal, institutional and cultural drivers of hygiene practices and are now testing a model that combines traditional infection prevention control training, emotional messaging that reinforces midwives’ desire to provide quality care to mothers and newborns and environmental cues to trigger hand hygiene at key moments.

Midwives’ compliance with good hand hygiene practices during childbirth will be measured later this year. These learnings will be very useful once we implement BASICS in the country.

In Bangladesh, we’re very excited about the impact of our programs addressing HAIs. When we started, there were quality standards for infection prevention in place, but they were simply not complied with. Staff were not adequately trained, supplies were limited at best, and there were no systems in place to ensure that healthcare facilities practiced effective hygiene.

We had to also address the widespread use of traditional, but harmful, practices like applying cow dung or corrosive mustard oil to a newborn’s umbilical cord. We were successful in helping staff to transition to the use of chlorhexidine through guidelines, training and the development of effective supply chains.

It was a long process, but it worked. Some 85,000 healthcare staff in 64 districts were trained. Independent monitors found that 86 percent of healthcare staff were proficient in the use of chlorhexidine. They also found great improvements in the sanitizing of medical equipment such as bag masks and suction devices.

As we’ve seen in Cambodia, Bangladesh and in many other countries, sustainable behavior change is possible at both the individual and institutional levels. BASICS will draw upon hard evidence and our collective eperiences to advance this bold solution in health facilities and across national health systems.

Breaking Barriers and Stirring Dreams

Fred, a 13-year-old pupil in Uganda, was born with a cleft lip and defective voice box that affected his speech development. He underwent corrective surgery while he was still a toddler, but his speech did not fully recover.  Because of these speech challenges, Fred found it hard to attend school and associate with other children. He recalls how they used to laugh at him, ridiculing him with different names because he was not able to clearly express himself.

“My classmates avoided playing with me because I wasn’t able to talk to them,” he explains. “They only wanted me to be part of the games in which they would make fun of me and laugh, and I disliked coming to school because of that.”

Fred reading with classmates

To reach children that carry such burdens and keep them from leaving school, Save the Children has implemented an “inclusive education” program that provides real learning opportunities for children with disabilities. The program strengthens teacher capacity to support children with different learning challenges – whether they be physical, behavioural, speech, hearing or attention retention. Teachers are provided with specific training on how to deal with cases like Fred’s, including how to incorporate positive discipline in the classroom and provide a safer learning environment.

Fred outside his school

Additionally, the program has also increased community awareness about inclusive education, which has led parents to understand the importance of sending their children to school — even those who face such challenges — and Enrollment  at school as increased.

“Fred’s parents are supportive and willing to help when issues arise,” explains Rebecca, Fred’s English teacher. “Communication is much better now with his parents and we’re able to work together to support his learning.” Fred is now thriving at school and has dreams to become a lawyer one day so that he can help children who suffer stigmas that prevent them for reaching their full potential.  “I now love going to school and I have friends to play with,” he says. “Mybest game is football where I am a midfielder.”

The Power of Clean Water

Hannah lives in a small village in Zambia near an emerald mine with her parents, brother and sister in a house made of concreate blocks and iron roofing sheets.  Her father is a teacher and volunteer with Save the Children and her mother raises and sells chickens.  As a fourth grader, Hannah’s jovial personality and easy smile make her stand out.  She wants to be a nurse when she grows up.

Five years ago, Save the Children introduced the sponsorship programs in her community and built new underwater piping that provided clean water. Hannah vividly recalls the old rusted borehole at the school that had contaminated water and would run out in the hot season. That is where her family got their drinking water.

“The borehole was so old that the water used to be very muddy. I think rats used to die in there because the water had some rat fur,” she explains.

According to the Head Teacher at Hannah’s school, “the water would dry out and the month of October, during the hot season, was our worst. Children were made to stay home during these times and lessons were disrupted,” she explains.  “Children were slow to catch up on lessons; they would repeat a grade due to poor performance or not return to school at all.”

Today, with the new well, children in the village are eager to learn all the time and they now know how to practice healthy habits, including handwashing. Many households in Hanna’s village have also benefited from the clean water source, and personal hygiene has improved for everyone.

“Now that Save the Children has made us a better borehole, children are being kept in school throughout and our surroundings look beautiful because we have excess water to even water the grass and flowers,” boasts the head teacher proudly.

Hannah helping a friend write a letter to their sponsor

“The water is so nice, clean and cold like it has been refrigerated. I know it is safe because I have not heard of any of my friends that have gotten sick from drinking it. I even carry some of it at home in my water bottle” says Hannah.

Simply providing clean, quality water to a community makes an enormous difference in the lives of children.  It not only has the obvious benefits for health and hygiene, but it also allows children to learn and lead productive and happy lives. Thank you to our sponsors for making this life changing impact possible!

Hopes of a Young Leader

By: Maria Rosario Garcia, Sponsorship Communication Coordinator

At a time where most children are hooked on gadgets, 13 year-old Justin loves to spend time in his  neighborhood to read along with other children. He wants to encourage more children to read so they can help build a better community even at a young age.

Justin has lived with his grandparents since he was nine years-old after the death of his mother and his father’s absence from the family. Yet, despite this heartbreak, he remains positive about life. During our conversation, Justin’s eyes show a deep sense of sadness and longing for his parents. But I was surprised at the sudden change of his emotions. His eyes suddenly brightened up, as he said: “I use these hurtful experiences as my motivation to study and work hard for my dreams.”

Justin posing with his neighborhood reading audience

Fortunately, in 2016 he found support and opportunity through various Save the Children educational programs designed to improve the learning environment at school and in the wider community. He soon joined a reading camp that encouraged his passion for reading and story telling. Seeing some of his classmates struggle to read even simple words made him realize that if he could do it, others could, too. This in turn created a desire to share his knowledge and love of reading to his peers, and he soon became a reliable “Reading Buddy” at his school and in his community.

He believes reading is one of the most important things that children can do to educate themselves, fuel their imagination, and help their community to grow. During his free time, Justin walks around narrow alleys in his village to invite children to read along and listen to his stories. “I do this because I want to be an inspiration to young people and I want to help end poverty,” he explains.” He finds joy seeing the dazzling faces of other children who imagine that they are part of the stories. Weekends and holidays are not wasted for our little champion. Justin never gets tired of moving around and giving his time and effort to make a difference in his own way. Through his leadership, he continues to serve, encourage, and inspire children to dream and strive to become achievers.

Justin telling his story of how Save the Children has benefited him at a Sponsorship conference