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.


Including Children with Disabilities During COVID-19

Written by Alexander Mentkowski

During global pandemics, the role of government is vital in protecting its citizens. Unfortunately, not all citizens are always included in government responses to emergencies, and the COVID-19 crisis is another example of this. One group of citizens that is often excluded are people/children with disabilities (P/CWDs).

In China, a teenager named Yan Cheng, with cerebral palsy, a neurological disorder which makes it difficult for a person to move and maintain their balance, suffered from neglect due in part to his disability. Yan Cheng stayed behind in his village of Wuhan while his father and brother left for Lunar New Year’s celebrations. His father contracted COVID-19 shortly after.

The father informed a Wuhan charity for disabled people about his son and told them that Yan needs to be fed and assisted with changing his clothes daily. Unfortunately, Yan was only fed twice between January 24th to January 28th and died on January 29th.  The exact cause of Yan Cheng’s death has not been determined, but this is just one example of the barriers that P/CWDs face during a global health crisis.

The Disability Community

The World Bank and World Health Organization (WHO) state that P/CWDs account for 15% of the world’s population and 80% of them live in developing countries.  World Health Survey data from 51 countries revealed that people with disabilities were more than twice as likely to report finding health care provider skills inadequate to meet their needs, four times more likely to be treated badly and nearly three times more likely to be denied needed health care.

This research also finds that 100 million children have a disability and UNICEF’ has emphasized the specific considerations needed for children with disabilities. For example, girls and boys with disabilities may be at risk of exclusion from education if remote/distance learning programs are not accessible or they do not have assistive devices to allow participation and accommodate learning needs.

The importance of having an inclusive response to coronavirus towards C/PWDs is supported by Article 11 of the United Nation’s Convention of Rights for People with Disabilities (CRPD). Article 11  establishes that states will ensure the protection and safety of persons with disabilities in the national response to humanitarian emergencies. In addition to the CRPD, Article 2 of UN Convention of Rights of the Child, states that signatory countries respect that children within their jurisdiction, including those with a disability, do not suffer discrimination. It also calls for measures to ensure protection against negative attitudes, isolation, and stigmatization that may arise in the midst of a crisis such as the coronavirus.

Including Children with Disabilities During COVID-19

A briefing published by UNICEF on the considerations for PWDs includes recommendations that have been written by many disability-centered organizations such as the European Disability Forum and the World Federation of the Deaf (WFD). Recommendations from the European Disability Forum include:

  • Disabled People Organizations (DPOs) are the best placed to advise authorities on the specific requirements and most appropriate solutions on policies providing accessible and inclusive services. Similarly, children with disabilities are best placed to speak to their specific barriers, and should be proactively consulted.
  • All COVID-19 containment and mitigation activities must be planned and implemented with the active participation of persons with disabilities and DPOs. Children should not be left out of this process, child-friendly information and mechanisms should be included as part of these activities.
  • Involving women and girls with disabilities in all stages of responses and decision-making is critical. Girls with disabilities are especially vulnerable and hard to reach, so special efforts must be made to insure they are not left behind.

The World Federation of the Deaf focuses on how to engage with the deaf community, but their recommendations can be also incorporated for the general disability community:

  • National governments should work with deaf people through their representative organization – the national associations of the deaf – to ensure the provision of adequate information and safeguarding access to health and education services.
  • National governments, in partnership with the national associations of the deaf, must implement accessible emergency services for deaf children who are victim of physical, psychological and sexual abuse. This service must be accessible, ideally via direct communication, but also through SMS texting and via remote interpreting through Video Relay Services.
  • Governments at all levels, must undertake all possible measures to ensure deaf children and youth are protected from physical, psychological and sexual abuse and violence during the confinement period.

Recommendations from UNICEF’s Considerations for Children and Adults with Disabilities include:

  • Considering information channels that will be accessed by persons with disabilities. For example, as many children with disabilities are out of school, any information campaigns delivered through schools may not reach children with disabilities.
  • Provide support to education actors to ensure that distance learning platforms are safe and accessible to children with disabilities; teachers are trained on supporting children with disabilities remotely; and that any special education programs are included in measures to ensure continuity of education.
  • Women and girls with disabilities who experience disruption of essential services, restricted movements and have primary responsibility for caring for their families are at increased risk of gender-based violence (GBV). Ensure that any programs to prevent and respond to GBV are inclusive of women and girls with disabilities (e.g. ensuring that information and reporting channels are available in multiple and accessible formats).

For governments to uphold protections for P/CWDs during COVID-19 they should familiarize themselves and follow the recommendations provided by the disability centered organizations. The aim of these recommendations is to reduce the bad practices that have occurred since the beginning of the pandemic. These recommendations are made in the spirit of the disability rights movement saying, “nothing about us without us.”

Using Data to Advocate for Children: How Save the Children’s Open-Access Assessment Tool Helped Expand Pre-School in Rwanda

Written by Caroline Dusabe, Lauren Pisani and Frannie Noble

Access to quality preschool, also known as early childhood education (ECE), provides children with strong foundations for future academic achievement and learning. There is evidence of the vital importance of the early childhood years from countries all over the world, but the vast majority comes from high-income countries like the United States. The lack of local research and evidence often leaves governments in low- and middle-income countries, like Rwanda, wondering whether these ECE programs will have the same effects in their countries, and how to invest in ECE appropriately.

The number of national policies supporting ECE across low and middle income countries has been increasing, due in large part to Sustainable Development Goal 4.2, which calls for all boys and girls to have access to quality early childhood development, care and preprimary education. However, investment and changes in practice have been slower to follow. This is particularly true in Sub-Saharan Africa. There, though ECE enrollment rates are starting to rise, less than half of children have access to these services and the quality of existing programs is generally poor.

Source: World Development Indicators, https://data.worldbank.org/indicator/se.pre.enrr

What We Did

Faced with this challenge in Rwanda, Save the Children used a data-driven approach to strategically advocate for greater investment in ECE. Our work highlighted local evidence about the positive impact of ECE on children’s learning and development. First, we identified key education advocates and decision makers at different levels of the Rwandan government, and determined opportunities for affecting change at those levels. Then, we designed evaluations of different ECE approaches to test the effectiveness of these initiatives for improving children’s development. Most importantly, we worked with local experts and staff to zero in on specific strengths and weaknesses existing in the Rwandan system and identify potential solutions for improving ECE quality for all children in the country.

What We Used

A critical tool in this research process was the International Development and Early Learning Assessment (IDELA). IDELA is an open-access, holistic assessment tool that measures literacy, numeracy, social-emotional and motor development for 3 – 6 year old children. IDELA was developed by Save the Children and is now used by 100+ partners around the world, free of cost. Using IDELA as the key outcome across multiple studies allowed us to easily compare the results of different trials to one another.


Lessons learned were shared with other NGO partners in the country through the Rwanda Education NGOs Coordination Platform (RENCP), and were used to develop targeted advocacy messages. The RENCP group created policy briefs, position papers, and made presentations for the key ECD actors identified at the beginning of the project.

As a result of the research and targeted advocacy of Save the Children and other NGOs, the Ministry of Education in Rwanda committed to building preschool classrooms in all communities, including purchasing storybooks and other age-appropriate toys for all classrooms. The Ministry of Education of Rwanda also agreed to create a national preprimary teacher training system, and budgeted for preprimary teacher salaries for the first time. Previously, parents were responsible for paying volunteer teachers’ incentives, which meant that often teachers were not paid consistently and that many of the poorest families did not send their children to school. Providing teacher salaries was a critical step toward ensuring preschool teacher motivation and retention, and enabled even the poorest children to access preschool for the first time.

What IDELA Helped Us Learn about ECE in Rwanda

Without IDELA we would not have been able to demonstrate the strong connections between the quality of children’s classroom and home environments and their learning outcomes. IDELA allowed us to share rigorous, relevant information with the Ministry of Education, local NGO partners, and communities. A few of the most important lessons learned were:

  • High quality learning environments, at home or in a school setting, are strongly correlated with improvements in school readiness
  • Quality learning environments for Rwandan children require a play-based curriculum that leverages age-appropriate learning and teaching materials
  • Professionalization of ECE teachers and ongoing teacher training is critical for maintaining quality
  • Parenting education on simple strategies and activities for promoting learning at home is effective in improving children’s school readiness beyond the school walls, especially for those who don’t have access to pre-schools yet.

Now What?

Many low- and middle-income countries are also in the early stages of adopting preprimary education into their basic education systems. The stage and scope of ECE policies in different countries varies, but the access and quality challenges seen in Rwanda are common. By leveraging free tools like IDELA, Save the Children and our partners can determine how to address these challenges in a very resource-efficient way. As we saw in Rwanda, using this data to create focused advocacy and harmonized messages while working with a network of like-minded organizations can be highly effective. Deliberately using locally generated evidence is also critical when sharing our work with policy makers. These examples and experiences help them connect the dots on the benefits children and families stand to gain from their policies. Using data-driven approaches, as we did in with IDELA in Rwanda, ensures that we understand and can advocate for the most effective approaches for children.

More information about this project is available here.

#GenerationEquality Starts in Childhood!

Photo credit: Save the Children

The year 2020 is a crucial opportunity to look back at international commitments to achieve girls’ rights, assess our progress and take concrete, forward-looking action. For girls, this has never been so urgent.

All over the world, too many girls remain in danger of being left behind on global progress, risking their futures, as well as the prospects of sustainable development, global peace and the achievement of girls’ universal human rights. However, today, girls risk falling through the gaps of a new global process intended to accelerate progress for gender equality over the critical next five years.

With this letter – 37 leading child rights and women’s rights organizations, including Save the Children, call for the Generation Equality Leads to ensure that girls’ rights are addressed through the Beijing +25 process with a standalone action coalition.

#GenerationEquality starts in childhood!

The International Community Must Ensure That No Girl Is Left Behind

Written by Carolyn Miles, Advisor, Gender Equality and Girls’ Empowerment at Save the Children

The world’s girls deserve an action coalition that is focused holistically on their lives and includes their participation. #GenerationEquality starts in childhood. Let’s work together with girls to ensure that no girl is left behind!

The year 2020 is a crucial opportunity to look back at international commitments to achieve girls’ rights, assess our progress and take concrete, forward-looking action. For girls, this has never been so urgent. All over the world, too many girls remain in danger of being left behind on global progress, risking their futures, as well as the prospects of sustainable development, global peace and the achievement of girls’ universal human rights. However, today, girls risk falling through the gaps of a new global process intended to accelerate progress for gender equality over the critical next five years.

Today, UN Women released its plans to rally the international community to accelerate progress for gender equality over the next five years by creating a set of “action coalitions” to drive concrete progress on gender equality.

Despite the fact that a 16-year-old girl was named Time magazine’s person of the year, the world’s girls continue to face rights violations. An estimated 12 million girls continue to be married each year,[ii] contributing to the leading cause of death for adolescent girls between the ages of 15 and 19: pregnancy and childbirth-related complications. The second most common cause is suicide.[iii] In countries where female genital mutilation is most concentrated, the majority of girls are cut by the time they are 14.[iv] If there was a time to bring about a step change in girls’ rights, then 2020 is the year. 

Twenty-five years ago, the international community came together and adopted what is considered to be the most progressive blueprint written on women’s and girls’ rights. The Beijing Declaration and Platform for Action, adopted in 1995 at the Fourth World Conference for Women, was endorsed by 189 countries and later adopted unanimously by the United Nations General Assembly.

Crucially, the Beijing Declaration and Platform for Action was the first global document that recognized girls as a distinct group, facing specific rights violations and needs due to the intersection of age and gender. It dedicated a standalone section to addressing the specific rights violations that girls experience – affirming their rights not only to health and education, but also to have a voice in shaping the decisions that impact their lives.

Yet despite comprehensive commitments to girls, 25 years later, girls continue to fall through programmatic and policy gap, and girls’ voices – their hopes and dreams for the futures – too often go unheard.

A failure to systematically and consistently include girls’ voices and perspectives in policy making and accountability processes compounds the issue. As governments, UN agencies, civil society and other actors come together on the 25th anniversary of the Beijing Declaration and Platform for Action, we must seize this opportunity. This is a watershed moment for girls, and the international community must not fail them.

I recently met a girl named Khadra while visiting a Somali refugee camp. After her husband, to whom she was married at age 13, left her behind to marry another girl in the village, Khadra was struggling to support her two small children on her own. Though Khadra told me she had done well in her studies and was ready to go on to secondary school, the decision to get married at age 13 and to stop her education was not her own.

Tackling issues such as child marriage are complex. They often reflect compounding forms of discrimination and require holistic investment – in education, health care as well as in voice and agency. At the national level, many countries are developing integrated costed national action plans to accelerate progress for girls; a global system that mirrors and supports that ambition is critical.

Photo credit: Save the Children
Anxhela, Cecelia and Keren hold signs supporting girls’ rights during Save the Children’s Bridge the Gap for Girls event in Brooklyn, New York on International Day of the Girl. “That day, I felt more energetic, optimistic and motivated to continue my fight for girls’ rights, said 16-year old Anxhela, “and empowerment that can lead them to a better life and future.”Photo credit: Save the Children, 2019.

All over the world, when given the slightest opportunity or encouragement, we see girls demanding their own seat at the table. Just this past October, three girls, Anxhela from North-East Albania, Cecelia from Malawi and Keren from Peru, joined me in leading Save the Children’s Bridge the Gap for Girls walk across the Brooklyn Bridge. They also participated in a panel discussion at the U.S. Senate, where they spoke about the importance of girls’ voices and the meaningful participation of girls in policy spaces. Anxhela, Cecelia and Keren, along with so many other girl champions, are making their voices heard and their communities stronger and healthier, taking on some of the toughest challenges of their societies.

As the international community, we must stand with girls like these across the globe and ensure that they have a strong platform to use to shape their future – and that we are accountable to them. The best opportunity for this to happen is for there to be an action coalition focused on adolescent girls that looks holistically at their lives and that includes their participation throughout the process.

We know from experience that girls face distinct rights violations, and they need a concrete action plan tailored to address their specific gender- and age-driven needs.

#GenerationEquality starts in childhood. Let’s work together with girls to ensure that they are not left behind!

 

[i] UNESCO UNESCO; UNICEF, Save the Children, Many Faces of Exclusion

[ii] Girls Not Brides

[iii] WHO

[iv] UNICEF

 

 

 

 

Photo credit: CJ Clarke / Save the Children, 2015

Scaling-up first-time and young parent access to postpartum family planning: Could small shifts change the game?

In many contexts, the youngest mothers (ages 15-24) are less likely than older mothers to use health services, including postpartum family planning (PPFP), for themselves and their children, increasing their vulnerability to rapid repeat pregnancy and poor health outcomes. At this life stage, a period of rapid change and vulnerability, it is vital young mothers get the support they need, and it is increasingly seen as a window of opportunity to shape life-long practices. A growing body of program experiences have shed light on first-time parents’ (FTPs) needs and related programming considerations. Evidence shows that comprehensive approaches addressing individual, family, community, and health system factors can increase FTPs’ use of PPFP and other essential health services. While showing promising impact, these comprehensive approaches have proven challenging to scale.

In Save the Children’s large-scale projects, we have long seen that the mothers bringing young children to immunization services, participating in community nutrition groups, or receiving household visits from community health workers are often young themselves. FTPs are often being reached, but not necessarily targeted with interventions addressing their family planning needs—despite evidence that improving birth spacing through PPFP contributes to diverse project goals.

This gives rise to two sets of sticky questions:

  1. Could a large-scale project be enhanced to leverage its reach and connect FTPs to PPFP?

Could we add an activity, or rework an existing activity, to take advantage of a large-scale initiative’s reach of FTPs? For example, a community group for pregnant women or mothers could strengthen referral systems to connect the youngest members to health facilities. Alternatively, for FTPs delivering in facilities, we might augment counseling to address their unique needs, facilitating PPFP uptake before discharge. Such a “program enhancement” could maximize impact with limited resources, reducing missed opportunities to target a vulnerable population.

We need to understand whether such an enhancement could be effective in increasing PPFP use. But to be truly instructive, we also need to understand how the enhancement interacts with and is shaped by the “host project” and the broader health system—and how it can be sustained through existing platforms at scale.

Which brings us to the second, stickier question, one that is often ignored in evaluations of this kind.

2. What factors would shape implementation and impact of an enhancement to a large-scale project?

We know that context matters: country- and host project-specific factors—goals, strategies, supervision mechanisms, health worker workloads, even intrinsic and extrinsic motivators—will make or break design, implementation, and scale of even a simple tweak to planned activities. We also know that over time, approaches adapt to context and implementation learning—so that what started as Plan A evolves to become Plan D or H or even Plan M by the time we evaluate and scale up.

In other words, to sustainably embed an enhancement into the health system—and to inform similar endeavors—we’d need to unpack the “black box” between implementation and impact. What unique elements of the host project and health system influence an enhancement—and what questions would others need to raise to layer an enhancement in a different setting? How do the enhancement and its implementation evolve over time and in scale-up, and why? What unintended effects emerge from the interplay between the enhancement, the host project, and the broader health system?

Introducing Connect

Connect, with support from the Bill & Melinda Gates Foundation, is poised to grapple with these questions. Over 4 years, Connect will build on two Save the Children-led projects and design, scale, and evaluate an incremental enhancement to reach FTPs at scale.

In Bangladesh, Connect will partner with the USAID-funded MaMoni-Maternal and Newborn Care Strengthening Project (MaMoni MNCSP), which supports the Ministry of Health and Family Welfare to improve maternal and newborn health in ten focus districts. In Tanzania, Connect leverages the USAID-funded Lishe Endelevu project, which aims to reduce stunting in children under five and improve the diet of 1.5 million women of reproductive age.

Connect will rigorously evaluate the impact on FP use and, drawing from realist evaluation principles, dig into that “black box” between implementation and results. Connect will yield practical how-to guidance, informing other efforts to more efficiently and effectively target FTPs with PPFP.

Connect’s partnership

Save the Children, the project lead, leverages our FTP and health system strengthening expertise and multisectoral operating presence to spearhead the design and implementation of program enhancements with MaMoni MNCSP and Lishe Endelevu and country stakeholders.

The George Washington University Milken School of Public Health (GWU) evaluates the impact of the program enhancements through rigorous quantitative methods and contributes to a qualitative realist-inspired evaluation exploring factors shaping implementation, scale, and sustainability.

We’re excited to dive into these complex questions and look forward to sharing Connect’s results and lessons. For more information, check out Connect’s fact sheet or contact myahner@savechildren.org 

Ending Child Marriage in Humanitarian Settings: Ensuring Accountability to Girls Through Improved Data, Collection, Analysis and Use

Written by Leslie Archambeault, Director of Gender Policy & Advocacy Policy

Child marriage is form of gender-based violence that robs girls of their agency to make decisions about their lives, disrupts their education, and drives vulnerability to ongoing violence, discrimination and abuse. It  prevents girls’ full participation in economic, political, and social spheres throughout their lives. Despite global progress, 12 million girls marry each year before they reach the age of 18. By 2030, over 150 million more girls will before they are 18, and 28.1 million will marry before the age of 15, based on current rates.

Girls who marry under the age of 18 are also at higher risk of experiencing dangerous complications in pregnancy and childbirth. Complications during pregnancy and childbirth is the number one killer of girls aged 15-19 worldwide. Significantly, 90% of births to girls aged 15-19 occur within a marriage.

Girls living in countries affected by conflict or other humanitarian crises are often the most vulnerable of all to child marriage. Factors that put girls at risk for child marriage in stable times such as poverty, lack of education, and insecurity are exacerbated during times of instability. In fact, 9 out of the 10 countries with the highest rates of child marriage are considered fragile or extremely fragile states.   

One of the reasons why child marriage in humanitarian settings continues to persist is a significant lack of data. The complex and often under-resourced humanitarian environments present a number of barriers to addressing this issue, even as humanitarian actors continue to flag this critical problem.

A newly published white paper commissioned by Save the Children, Addressing Data Gaps on Child, Early and Forced Marriage in Humanitarian Settings analyzes the current evidence and knowledge base on child marriage in humanitarian settings to see why such data gaps persist. It proposes recommendations for enhancing current data collection tools, analysis, and use in order to effectively address the issue through prevention and response efforts.

The white paper, published during the final days of the annual 16 Days of Activism to End Gender-Based Violence, is the culmination of extensive interviews with key actors across the humanitarian system, as well as with technical experts on gender-based violence prevention and response, and child marriage more specifically.

The research found that current data collection tools measuring prevalence of child marriage in different contexts, fail to adequately account for child marriage in humanitarian settings because of a few key reasons:

  • The tools currently used are mainly carried out in stable settings, due to limitations in the tools themselves;
  • Current data collection tools are used every 3-10 years, meaning critical data from periods of fragility may be missed;
  • Collection of data on forcibly displaced populations, including refugees and internally displaced persons, is not consistent and difficult to capture;
  • Data collected is primarily country-level but does not get to community or more local analysis, which is needed for humanitarian contexts;
  • The data only provides information on prevalence, and not incidence.

The resounding conclusion of these interviews and the paper’s analysis was that the ongoing data gaps on child marriage in humanitarian settings are a complicated and daunting issue to tackle – yet there are potential ways forward if the international community is willing to work together.

Building on existing data collection mechanisms would allow for a much greater understanding of the complexity of child marriage in humanitarian crises. This would require a great deal of cooperation and alignment across the various humanitarian response actors, particularly within the United Nations’ humanitarian architecture.

Humanitarian actors across the United Nations, government, and civil society, must demonstrate commitment to urgently addressing child marriage in humanitarian settings – and must make addressing data gaps a priority. This includes a commitment to sustained financial and human resources to support the collection, coordination, analysis, disaggregation and use of enhanced data on child marriage in humanitarian settings.

Without consistent and sustained data collection, analysis and use on child marriage in humanitarian settings, a fundamental rights violation impacting millions of girls across the globe will remain largely invisible. Humanitarian Needs Assessments and Response Plans will fail to adequately provide for addressing child marriage, and funding needs will not be met. Even more significantly, girls will be unable to hold governments and other duty-bearers accountable for commitments they have made to end child marriage in every context, including under such international legal and policy frameworks as the Convention on the Rights of the Child, the 2030 Agenda for Sustainable Development, and the Beijing Declaration and Platform for Action.

The humanitarian community must take action now to end child marriage – and must work together to address data gaps through enhancing current data collection tools and developing new ways of working that break down sector and agency silos. Girls everywhere have the right to grow up healthy, educated, and protected from violence.

 

Anxhela, a 16-year old from North-East Albania, is a student in 12 grade, a storyteller, a painter and an advocate for children and specifically girls’ rights. Photo credit: Save the Children

Diary of a Girl Champion: Advocating for Girls’ Education and Empowerment

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

I’m Anxhela, 16 years old from North-East Albania, one of the poorest areas where poverty and unemployment dominate. I’m a student in 12 grade, a storyteller, a painter and an advocate for children and specifically girls’ rights. 

In my country children make up over 35% of the population and over 20% of them live in absolute poverty. Poverty is a widespread and rising phenomenon that affects children’s success and progress in school. As per the ‘Young Voice’ Albania 2017 report, 83.3% of children consider poverty, exclusion, and disability as areas of particular concern.

Violence against children is widespread and is used as a way of disciplining children. Children lack opportunities to participate in decision making processes and their interests are frequently disregarded in school and community. Many girls are victims of violence, discrimination and are enforced or convinced to get married at early age, due to tradition and lack of support to follow education.

I think that the most important thing for girls to overcome barriers is to get educated, equip with knowledge and skills and empower to speak up for the realization of their rights. When girls overcome barriers and empower, they are able to lead, influence and inspire the world for a better life for all.

These were some of my views and messages I shared and conveyed through my participation and remarks held during the International Day of Girl events in New York and Washington DC. I was invited by Save the Children to bring the voice of girls from Albania and around the world and advocate for their rights and wellbeing.

For more than a week, I had the opportunity to meet with girls and young women, listened to their life stories and empowerment journey. I was impressed how many things we have in common as regards barriers and struggles as well as the will and commitment to bring about a change and make the world better for all.

Photo credit: Save the Children

My visit in U.S. was the first one for me abroad and most impressive and inspiring ever. I felt happy, important, supported, motivated and very responsible to do my best for promoting girls’ voice and rights.

A special part of my advocacy mission in US, was also meeting with two other wonderful girls – Cecilia from Malawi and Keren from Peru. Being together, sharing feelings and experiences, going around and taking photos as well, I felt better and stronger. I have so much to talk about my U.S. visit – it was an experience of my life that I will never forget.

The two main events I went to were – ‘Girls Speak Out’ event at UN Assembly and “Bridge the Gap for Girls” in NY. ‘Bridge the gap for Girls’ was one of the big events by Save the Children where I had the opportunity to meet a lot of amazing people including Gina Torres, a famous actor.  On that day I raised my voice and bridged the gaps for girls’ protection. That day, Cecilia, Keren and I led the walk across the Brooklyn Bridge and hundreds of people joined us in that walk. It was such an empowerment and wonderful feeling. That day, I felt more energetic, optimistic and motivated to continue my fight for girls’ rights and empowerment that can lead them to a better life and future.

In Washington DC, I had some other important meetings with members of Congress and had the opportunity to speak with influential women and men who are vocal and supportive to girls’ rights.

The last event I attended and spoke at was hosted by the World Bank Group – “Learning Poverty”. I participated in a Facebook Live interview on the importance of leadership by girls and children at school and community levels. In the meeting I was a special speaker invitee and was part of a very important panel with Word Bank Group President David Malpass, Save the Children UK CEO Kevin Watkins, Vice President of Human Development of WBG Annette Dixon, Ghana Senior Minister, Morocco Minister of Economy and Mayor of Sobral, Brasil and the moderator Kaya Henderson, former Chancellor of DC schools.

At the beginning of my speech, I felt a bit nervous but soon after I was able to control my emotions and gave my remarks that received a lot of applause. Through my remarks I highlighted that: “Children and youth are the future. When we are educated, we are the ones who can make change and make the world better”.

Now I can say that as a girl and child activist, I am happy to have had the opportunity to raise my voice and advocate for girls and children rights globally. This trip was a new experience for me. I learned new knowledge and gained new skills. Now I feel much more empowered, confident and motivated to go on with my advocacy and inspire my peers to follow education and speak out for their issues and realization of their rights.

 

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

A Tanzanian Doctor’s Insight into the Barriers to Fewer Healthcare-Acquired Infections

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 Dr. Joseph Obure
Maternal and Reproductive Health Advisor, Save the Children

Save the Children President Janti Soeripto and I had to cover a lot of ground in just 90 seconds in the video that introduces  BASICS (Bold Action to Stop Infections in Clinical Settings) – from why so many millions of mothers and infants acquire debilitating infections in health facilities to how BASICS’ scalable and sustainable solution will prevent many of these infections.

Having been educated in and practiced clinical obstetric and gynecology medicine in Tanzania – one of the four countries where BASICS will be launched with 100&Change funding – I know firsthand of the challenges of preventing infections in places where resources can be precious and where dedicated, overworked staff labor daily to deliver the best care they can.

What does the situation look like in Tanzania when it comes to health care and hygiene? What does a day look like for a doctor in a Tanzanian government hospital?
Like any other developing country, Tanzania faces health systems bottlenecks that affect the provision of quality health care. While there have been significant gains in improving access to services, quality continues to be a problem.

Many health posts, particularly those at the primary care level (health centers and dispensaries) do not have adequate water, sanitation and hygiene (WASH) facilities. These places serve approximately 80% of the people in Tanzania’s rural areas, therefore impacting a huge population.

The lack of reliable clean water is just one problem. Toilets and bathrooms may not be available, and those that are available  can be dirty. Without a place to wash hands and no supplies,  hygiene and infection control practices are poor.

These problems underscore the need to increase investments and support for sustainable solutions like BASICS that improve clinical outcomes, reduce patient and health system costs and lead to a more positive care experiences.

What are the biggest barriers to implementing hygiene protocols?
Funding to support hygiene interventions and health facility infrastructure is limited due to many competing priorities and there’s a focus on coverage of primary care rather than the  quality of care. Health systems have only a limited capacity to operationalize WASH protocols; both health providers and communities have poor behaviors relating to hygiene; and there is little understanding of the cost benefit of improved quality of care on clinical and economic levels.

Lastly, there is a lack of evidence-based policies for hygiene and limited use of simple and feasible solutions based on the context.

Why is BASICS a good solution?
BASICS is unique in that it applies simple, effective and feasible interventions to improve the quality of care, with particular focus on WASH and infection prevention control. It focuses on maternal and newborn delivery points because these environments are quite complicated and overloaded. It’s in these wards that BASICS can achieve a major impact, where we will learn what works best and then scale up the intervention to other service delivery points in health facilities.

 

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.

Knowing and Respecting Support Staff: A Vital Step in the Journey to Reducing Healthcare-Associated Infections

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 Lydia Di Stefano
Research Assistant, Maternal and Newborn Health Group – London School of Hygiene and Tropical Medicine

 

I met Dorcas Gwata during the London School of Hygiene and Tropical Medicine’s 120th anniversary celebrations. An alumni, Dorcas had returned to present on her inspiring career as a public health specialist and activist.

While her achievements are remarkable and many, they weren’t what caught my attention. Rather, it was what she had done at the beginning of her career that intrigued me: Dorcas began in the relatively unglamorous role of a hospital cleaner.

Through my work with BASICS (Bold Action to Stop Infections in Clinical Settings), I know  the importance of support workers in healthcare settings – cleaners, porters and security guards – in contributing to a functioning system. In particular, their vital role in hygiene: low-cost interventions aimed at educating and training workers in water, sanitation and hygiene (WASH) are an important way to reduce healthcare-associated infections.  But there are barriers to their education and training.

One barrier is the lack of value and respect for cleaners and their exclusion from the umbrella term “health workers.” BASICS pioneer Professor Wendy Graham has written about how to overcome such barriers elsewhere.   

I was intrigued about Dorcas’ journey from student in Zimbabwe, to hospital cleaner in Scotland, to specialist nurse in London. Dorcas has been on two sides of the hospital workforce – as a support worker and a professional – so I was intrigued about her view of the lack of value that cleaners can face and how to combat this. Finally, as someone with experience in  health systems in low- and high-income countries, I was curious about how she would compare the two settings.

Dorcas attended school until she was 18. However, she didn’t get the marks to pursue the nursing career her mother wanted for her. After graduating, she pursued occupational courses but nothing really stuck. She spent time volunteering in a health clinic.

When Dorcas joined her sister in Scotland, she found work as a cleaner at a local hospital. Although it wasn’t her first preference, she reflected “out of all the jobs I’ve had so far, that is probably the one where I learnt the most.” The work was demanding – carrying heavy buckets of water and hours of scrubbing.

She received no training – in cleaning, let alone education on infection prevention – and was told in two weeks she’d lose her job if she wasn’t good enough. It was hard, physical work. It was also challenging socially.

Despite the difficulties of their job, Dorcas felt that she and the other cleaners were barely acknowledged, let alone thanked by most of the hospital staff. She had come to expect so little in the way of respect, that she would be shocked if clinical staff said “good morning” when they walked past her.

She said that staff should not just see cleaners by their job title, but should look past this to explore the other side of who they are. We should be more curious and ask people about their stories: where they’re from, what they do on weekends, who their children and grandchildren are.

Imagining how things might be different in a low-income setting like Zimbabwe, Dorcas suggested that cleaners may actually be more respected there, where they would be known by their totem (tribe name). Dorcas feels that there is strong sense of cultural capital that comes with respect and validation in Zimbabwe, which is lacking in high-income countries.

Dorcas was ambitious to move to a clinician role. She once asked a matron what she could do to join the profession and was ignored, yet this did not put her off. Eventually, she moved to London, where she visited hospitals to offer her services. After a day, she had two job offers: one as a cleaner and the other as a healthcare assistant. She took the assistant job and has worked her way up to where she is today.

When we spoke, Dorcas wondered where she would be now, had she been offered two cleaning jobs that day.

I think everyone who works in hospitals can take Dorcas’ advice and try a little harder to acknowledge all staff, including cleaners. My challenge to health workers reading this is to get to know the cleaners on your ward. Although their jobs aren’t necessarily the most glamorous, they are essential to a functioning health care system and are key to infection prevention efforts.