Diary of a Girl Champion: Bringing the Stories of Malawi’s Girls to the U.S.

Written by Cecelia, age 16

This blog was originally published on Save the Children’s UK blog, Voices for Change

Introduction
I am Cecelia, 16, from Malawi and a champion for girls rights on health and education. I believe that girls deserve opportunities to reach their fullest potential. I talk to leaders in my community and my peers about girls needs and rights. I want girls to stay in school and complete their education and to see harmful cultural practices that lead to early marriage and teenage pregnancy to end. I desire to become a doctor to serve and inspire young girls.

I was selected by Save the Children to represent girls from Malawi and the region in New York and Washington DC to talk about our lives and advocate for them.

October 8, 2019
The long-awaited trip to the United States finally arrived. I was so excited and looked forward to my first experience on the plane and to explain to them [immigration officers] about my mission in New York.

After landing in New York, we checked in and went on a small tour around New York City. I saw Times Square and Central Park and they are really beautiful! Back at the hotel, I met Anxhela, another girl champion from Albania.

October 10, 2019
That night I kept waking up not believing I was actually here. I prepared for the day and went to the Save the Children offices to meet Anxhela and others.

We got a briefing on the Child Safeguarding Policy and the UN and then we went to UNICEF offices for a panel discussion on Preventing Families from Separation and Protecting the Rights of Children Without Parental Care. A young girl panelist impressed me for ably expressing herself. I rehearsed more to do the same the next day.

October 11, 2019 
Today I have my first big task here in New York, I was going to speak at the annual Girls Speak Out at the UN headquarters. We walked to the UN building and went through security checks. We each got a t-shirt for the event and we rushed to the washroom to change.

As guests arrive I felt a little nervous. I scan the crowd trying to locate my chaperone, Alinafe, who I spot smiling at me and I happily wave my hand to her.

The program starts and girls narrate their country stories that affect them such as trafficking, teenage pregnancies, early marriages among others. My turn came to tell the Malawi story: Everyone is listening attentively as I tell them what to be a girl in my country means, issues affecting my fellow girls and I ask for support from government, policy makers and my peers to work together in order to bring change in the lives of many girls. I also spoke about the work I do in my community to promote girls’ health, particularly girls’ sexual and reproductive health needs, so that they are able to stay in school.

October 12, 2019
Today’s event is “Bridge the Gap for Girls” and we are at Brooklyn Bridge. Everything is colorful here. Cameras are everywhere and it seems everyone wants to take pictures of me, Anxhela and Karen-another girl champion from Peru.

Save the Children US CEO, Carolyn Miles officially opens the meeting and she invites us to the stage. Karen goes first to give her remarks and I am next then Anxhela. I talk about girl’s health, and emphasize that if girls are given opportunities they can reach their full potential. Next, we cut the ribbon to mark the beginning of the bridge walk. We all walk across the Brooklyn Bridge which is very long and beautiful.

October 14, 2019
Monday morning we reach Washington DC and more activities are lined up. I am excited and I look forward to going to Capitol Hill and meet many important people.

October 15, 2019

Today I am part of an all-girl panel discussion at the Senate House with Anxhela, as well as Fatima and Vishwa, two other girl champions supported by Plan International. Somehow, I am nervous yet confident that I will deliver. I spoke about the importance of girls’ voices and the meaningful participation of girls in policy spaces. I got good feedback after my speech.

I met some members of the Congress and my message to them was that most girls don’t get to finish school due to teenage pregnancies and child marriage and this is a situation that needs to change.

 

My advocacy journey here is almost reaching the finale but not until Anxhela and I have participated in a breakfast round table discussion with the women caucus at the Capitol Hill office. What a rare chance to meet and interact with women leaders. I was excited to receive any pieces of advice they would give to a young girl like me. I feel very happy after the meeting as I have learnt a lot from this encounter.

Finally, we meet Congresswoman, Lois Frankel in her office. Talking to her directly about my work and then asking for support for my fellow girls back home and across the region makes me feel like I am doing real advocacy. Mission well accomplished.

 

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

Frustration and Optimism: My Mixed Emotions for Reducing Healthcare-associated Infections at Birth

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 Wendy J. Graham
Professor of Obstetric Epidemiology, Department of Infectious Disease Epidemiology

Today, advances in healthcare routinely enable miracles of survival and recovery. But some discoveries have been forgotten or demoted in the race to implement the latest. The importance of hygiene at the time of birth goes back centuries.* Yet here in the 21st century, so-called “places of care” bring increased risks of infection to patients and health workers when basic preventive principles are not followed. Safe water to drink, a clean surface to deliver upon, and good hand hygiene by those attending you – how more basic can it be?

After nearly 40 years in public health, I am re-invigorated by the chance to be part of what the BASICS partnership proposes: integrating four agencies’ best practices and learning in infection prevention in healthcare settings into one systematic approach in partnership with countries to dramatically reduce infection rates at the point of care.

Health facilities – and especially maternity wards – are the natural environment of my interest and passion for change. Initial work in Botswana in the late 1970s and early 1980s – at the time when HIV/AIDS was just emerging, gave me a firm grounding in the tough realities of healthcare in under-resourced settings, together with a lifelong admiration for health workers who provide care 24/7 in such circumstances.

It’s in these maternity wards where many mothers and newborns acquire infections. They’re often busy and overcrowded places, with invasive procedures, instruments that may not be sterilized between use, and major infrastructural and supply challenges to maintaining cleanliness and hygiene. The photo here of a ward in West Africa captures this situation – indeed, with women being asked to bring their own bottle of bleach when they came to deliver as there had been no cleaning fluids in the maternity for months.

This is a striking reminder of the hidden costs of care families endure and the weakness in the health system, which means women deliver where “safe care” cannot be guaranteed and where health workers cannot protect themselves from infection risks either. Both “cannot’s” are violations of basic human rights.

This is why I’m so excited about the potential of BASICS to empower all health workers about proper hygiene and infection prevention practices and enable health systems to provide safe care equitably and routinely. And we mean “all” – acknowledging the crucial role in facilities played by workers who are not care practitioners – such as cleaners, orderlies and maintenance staff –  in creating a clean environment. These often-forgotten “workers for health” also have great potential to be agents for change.

But, of course, it’s not just the four BASICS collaborators and the crucial country partners who want better health outcomes for mothers and their newborns, and for them to leave a facility without a life-threatening infection.

Access to health facilities providing clean care was the second-highest demand of the 1.2 million women and girls in 114 countries who took part in the White Ribbon Alliance’s 2018 global What Women Want campaign on reproductive and maternal health needs. Women and girls overwhelmingly demanded clean facilities, clean toilets in maternity wards, a clean bed, and skilled health providers with sterile supplies and clean hands. 

None of these demands are impossible to achieve. The crucial innovation proposed by BASICS is to take the best evidence-based practices of each partner and create one comprehensive package of training, access to clean water in facilities, an innovative cleaning product and systems change in order to institutionalize and sustain clean care in the partner countries.

I am optimistic that BASICS can result in better quality healthcare that will save tens of thousands of lives and millions of dollars by averting healthcare-acquired infections.

In the time it has taken to read this, many more health workers’ could have washed their hands, many more women could have delivered on clean beds and with sterile instruments, and many more babies could have been discharged home without an infection from the facility. This advance does not require a new discovery – we know what to do now.

BASICS will be a catalyst for the miracle of survival and good health for mothers and newborns. 

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.

 

*Graham WJ, Dancer SJ, Gould IM, Stones W. (2015) Childbed fever: history repeats itself? BJOG, 122:156–159.

The Blue Dye Innovation that Makes Disinfecting Health Facilities More Effective and More Visible

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 Jason Kang, Co-founder and CEO, Kinnos

In 2014, I co-founded Kinnos in response to the West Africa Ebola crisis. At the time, one of the biggest problems contributing to high rates of infection was ineffective surface decontamination caused by human error and gaps in training.

Disinfectants like bleach are transparent, making it easy to miss spots; hydrophobic, making it bead up and roll off the surfaces it’s meant to disinfect; and only effective if used for a specific contact time, meaning healthcare workers must ideally wait for a certain period for pathogens to be inactivated. These problems are universal to disinfection in facilities outside the scope of epidemic outbreaks.

Highlight, our patented additive, colorizes the disinfectant so that users can easily see where it has been applied. Highlight modifies the liquid properties to eliminate droplet formation and improve adherence to surfaces. The color fades as the contact time needed for the disinfectant to work passes, indicating when decontamination is done.

To put this into context, our time at the Ebola Treatment Unit in Ganta, Liberia, was particularly memorable – I remember the intense heat and how incredible it was that staff were wearing layers of stuffy, personal protective equipment for 4 to 6 hours at a time. However, this also meant that they were only too eager to remove their protective gowns and coveralls, often not waiting the requisite contact time for the disinfectant sprayed on their protective garments to work.

Combined with the inherent difficulties of achieving full coverage with bleach, we quickly understood why health staff were up to 32 times more likely to be infected with Ebola than the average person.

When healthcare workers started telling us that Highlight was making them feel more confident in their own safety and easing their stress in such high-risk situations, we realized that our technology was tapping into an invaluable resource: peace of mind. Interacting with the healthcare workers who had volunteered to put themselves directly in danger to help others was humbling and inspiring, and doing our part to make their lives even a little bit better was incredibly motivating.

The breakthrough that Highlight represents – the ability to overcome training and language barriers to empower health workers and those who clean facilities with a feeling of confidence through disinfection they can see – can have a profound impact in reducing healthcare-associated infections globally as part of the BASICS solution. In our mission to prevent infections and improve patient safety, we have not forgotten about the people who are tasked with the important step of disinfection.

In addition to our humanitarian focus in low- and middle-income countries, Kinnos is working to radically reduce healthcare-associated infections and the prevalence of antimicrobial resistance within the U.S. healthcare system.

We’ve partnered with leading medical organizations to pilot our technology in hospitals, ambulatory surgical centers and other facilities. It’s a sober reminder that infections affect society at large and are an urgent global problem that require a concerted effort to solve.

The fact that someone today can receive a life-threatening infection from a place where they expect medical care and treatment is unacceptable, and we are motivated to make this a problem of the past.

Historically, so many resources have been devoted to diagnosis and treatment, even though it’s recognized that prevention is key to sustainable healthcare. We always knew that surface disinfection was only one key part of the larger infection prevention ecosystem, so having the opportunity to enact a system-wide program with the rest of the BASICS team is extremely exciting to me.

The world has been waiting too long for an initiative like BASICS to set the standard of infection prevention.

Why I’m Passionate About Reducing Infections in Health Care Facilities

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 Alison Macintyre, Health Technical Lead – WaterAid

Having spent a lot of my childhood in and out of hospitals, I believed that hospitals were a place where you go to get better, get well; where you leave feeling more positive and healthier than when you arrived. And, I still do.

As I embarked on my career in the field of water, sanitation and hygiene (WASH), I realized for most of the world, that isn’t true. We, the global health community, are currently failing to achieve the absolute basics. Right now, we can’t ensure we are, at an absolute minimum, doing no harm to the millions of people who use health care systems every day. Too many health care facilities operate without water, without toilets that everyone can use, and without water and soap to stop the spread of infection.

This failure is what motivates me. We will only see dramatic, sustained changes in health if we get the basics right. 

Early in my WASH career I was in Papua New Guinea, undertaking a study on the role of WASH during childbirth for women. Most of the women I interviewed were unable to reach a facility to give birth and had to deliver their babies, often alone, on coffee plantations, in pig pens or on the side of the road.

As part of the study, we also visited health facilities. I had hoped that they would provide a potential solution for improving maternal and newborn mortality in these remote communities. One facility has always stuck in my mind.

Despite the newness of the facility (it was only five-years old), water, sanitation and hygiene were not available. A refrigerated, fully stocked drug cabinet was present, but gloves and soap were not. There was a sophisticated rainwater collection system, but the pump to distribute the water to the facility was broken and they weren’t able to fix it. There were two modern toilets, but they were locked and reserved for staff – patients had to go out to a hole dug in the back of the facility, passing an open waste pit on the way, to relieve themselves.

The lack of water also meant women were turned away if they arrived in labour. The next hospital was 2 hours away on a treacherous road.

How did a hospital have sophistical equipment, but couldn’t fix a water supply and women weren’t able to deliver their babies? How were antibiotics kept cold-chain with a reliable supply, yet soap and gloves were not available?

I left the facility angry, wondering how health systems neglected WASH in so many ways.

This visit made me realize that when statistics show us that health care facilities do not have basic WASH services, it doesn’t always mean the infrastructure is completely absent. Often, it may not suitable (for instance in the case of toilets not being accessible to people of limited mobility) or it is not functioning, or basic commodities like soap are not part of general supply lists.

I also realized that it is the system that’s broken, not just the infrastructure. Health systems that have monitoring and budgets for WASH, trained operation and maintenance staff, in-service and pre-service training on hygiene and cleaning, WASH standards and accountability mechanisms, are uncommon. This should be the norm.

That’s why I’m excited about the prospect of leading the WASH element of BASICS (Bold Action to Stop Infections in Clinical Settings), on behalf of WaterAid. Through the work I’ve done, I have learned the importance of integrating basic WASH into broader patient safety and infection prevention control programes. Without such integration, a system-wide approach is not possible and WASH will never become part of the day-to-day routine of health center operations.

BASICS brings together NGOs, researchers and the private sector to support health systems to sustainably address WASH and patient safety. The BASICS team has a wealth of expertise on health, WASH and evidence-based behavior change. This combination is essential for improving patient safety, health and the quality of health care facilities for all.

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.

Data Snapshot: How Do Donors Support Citizen Engagement in Tax Policy?

Written by Andrew Wainer, Director, Policy Research

This summer’s Addis Tax Initiative (ATI) conference in Berlin demonstrated that the ATI is increasingly open to civil society participation. It was a forum where donors and revenue authorities discussed how to better harness tax for development, but local and global NGOs also asserted the importance of accountability and equity in tax policy and administration.

The elevated voice of civil society on tax follows an increase in donor domestic resource mobilization (DRM) assistance to civil society, according to our analysis of OECD data[i].  For example, among ATI donors, the percentage of DRM assistance to civil society rose from 4% ($6 million) in 2015 to 10% ($21 million) in 2017 – an increase of 252%, the largest increase of any category of assistance (see Table 1).

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

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

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

Nevertheless, donor investment in civil society on tax issues remains small within the bigger picture of DRM funding.  And even as the role of civil society in tax policy and administration increases, much more needs to be learned about the impacts of civil society participation

Norway Provides Half Its DRM Assistance to Civil Society
Analysis of the OECD’s Creditor Reporting System data reveals that, for 2017, the top five ATI DRM donors to civil society (by amount of US dollars) provided 95% of total DRM assistance to civil society among all ATI donors (see Table 2 below).

The UK provided the largest amount of funding for civil society – $9 million, or about a quarter of its total $37 million DRM budget for 2017. And the US – while providing the largest total amount of DRM assistance – provided the second largest amount to civil society – $5 million. But Norway is particularly notable for providing fully half of its total DRM budget to civil society – a far larger percentage than any of the other top 5 donors.

Table 2: Top 5 ATI Donors Providing DRM Assistance Channeled Through Civil Society, 2017

ATI Donor Country DRM Assistance to Civil Society (millions of USD)* Total DRM Assistance (millions of USD)* % of Total DRM Assistance Channeled through Civil Society
United Kingdom 9 37 24
United States 5 49 10
Norway 4 8 50
Denmark 1 5 20
EU Institutions 1 14 4

*USD Figures are rounded to the nearest million

 

Assistance Split Between Local and International NGOs
ATI assistance to civil society is clustered among five major donors, but what type of civil society organizations receive this assistance?

As Table 3 demonstrates, it’s split: In 2017, 40% of all ATI DRM assistance to civil society went to developing country-based NGOs, defined as: “An NGO organized at the national level, based and operated in a developing [country].”

While developing country NGOs received a substantial minority of the assistance, the same amount was disbursed to NGOs based in donor countries. These are defined as national-level NGOs based and operated in donor counties. Such organizations would include, for example, Oxfam America and Save the Children USA.

 Finally, almost 20% of this assistance to civil society was delivered to international NGOs, defined as, “an NGO organized on the international level. Some INGOs may act as umbrella organisations with affiliations in several donor and/or recipient countries.” Examples in this category include Doctors Without Borders and the Society for International Development.

Table 3: DRM Civil Society Assistance Delivery Channel, 2017

Delivery Channel Amount (millions of USD)* % of Civil Society DRM Assistance Received Through this Channel
International NGOs 4 19
Donor-county based NGOs 9 40
Developing-country based NGOs 9 40

*USD figures are rounded to the nearest million

 

Africa Receives More Than Half of All DRM Assistance to Civil Society
What part of the world is this donor assistance going to? In 2017, more than half ($11 million) went to Africa (See Table 4). Western Hemisphere nations were the second largest recipients – receiving almost a quarter ($5 million) of all ATI DRM civil society assistance. Asia, Europe, and  Oceana received very small percentages of this type of assistance totaling a combined 6% of all assistance to civil for tax work.

Table 4: DRM Civil Society Assistance to Recipient Regions, 2017

Recipient Region Amount (millions of USD)* % of Civil Society DRM Assistance Received by Region
Africa 11 53
Americas 5 23
Developing Countries, Unspecified 4 18
Europe 1 4
Asia <1 2
Oceania <1 0

 

How is DRM Assistance to Civil Society Used?
As Table 5 demonstrates, almost half of all assistance is directed toward capacity building. Tax advocacy is a complex and contested space, so civil society organizations often need help building the capacity to credibly engage on fiscal issues – particularly at the national level – so this large allocation makes sense. 

Table 5: Civil Society Uses for DRM Assistance, 2017

Function Amount (millions of USD)* % of Total Civil Society ATI DRM Assistance Spent on Function
Transparency 3 14
Technical Assistance and Support 2 10
Research 1 5
Capacity Building 9 43
Other 1 5
Unspecified 5 24

*USD Figures are rounded to the nearest million

 

Taxation and Gender Equity
Ensuring that tax policy and administration is gender-responsive is also an important component of ensuring tax equity. The OECD “tags” foreign assistance for gender equality by assigning activities as ones where gender equality is a “principal objective”, a “significant objective”, or where gender equality is not an objective. As illustrated in Table 6, according to the OECD data, only 13% of civil society DRM assistance in 2017 contained a gender equality component – activities where gender equality were either a principal or significant objective.

Table 6: Support for Gender Equality and Women’s Empowerment for Tax, 2017

DAC Gender Marker Score Amount (millions of USD)* % of Total Civil Society ATI DRM Assistance Dedicated to Gender Equality
(Gender is the principal objective) 0.6 3%
(Gender is a significant objective) 2 10%
Total:   13%

*USD Figures are rounded to the nearest million

 

Based on this analysis of the OECD data, we have a clearer – but still incomplete – picture of how ATI’s increasing DRM assistance to civil society is being used. We have little understanding of the impact of these funds.   

We need to continue to assess the impact of civil society in making tax policy and administration more accountable, participatory, and transparent. Data is key – donors and the OECD must ensure that data on donor assistance to civil society for DRM is reported and labeled accurately and that data is disaggregated, especially by age and sex. The analysis in this blog is a first step to outline the trends and contours of donor assistance for civil society engaging in DRM.  

As the Addis Tax Initiative develops its vision for 2020 and beyond, Save the Children continues to emphasize the role of local citizens in shaping tax policy and administration.  

In coming years, we hope that donor agencies will improve investments in country-based NGOs to strengthen local self-reliance, promote fairer tax allocations, and finance pro-development public expenditure. 

[i] Because the OECD continually updates the historical data in the CRS and these analysis were carried out over a period of months, calculations may vary. Like all large datasets, the CRS may also contain labeling and reporting errors that impact accuracy. Our analysis is based on an analysis of the OECD data as presented.

 

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: 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 

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”