#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.

Photo credit: Save the Children

Basics: Scaling Up Affordable and High-Impact Healthcare Practices

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

Written by the BASICS Team

Bold Action to Stop Infections in Clinical Settings (BASICS) is centered on an important principle: low-cost interventions accompanied by minimal changes in healthcare practices will have a considerable impact on disease incidence. The cost of preventing an infection is a fraction of the cost of treating one. High infection prevalence and infection-related mortality are a sizeable economic and social burden, especially in low-income countries. BASICS will catalyze marginal resources in four demonstration countries – Bangladesh, Cambodia, Nigeria and Tanzania – to reduce that burden significantly.

The evidence from high-income countries on the economic impact of reducing healthcare-associated infections (HAIs) is compelling, and suggestive of what might be achieved in lower resource settings (though with different cost structures). One study estimated that the costs of one single severe lower respiratory infection in a U.S.-based hospital would cover the annual budget for antiseptics used for hand hygiene (Boyce, 2001)1  .  A study of a Russian neonatal ICU found that one healthcare associated bloodstream infection would cover 3,265 days of hand antiseptic use (Brown, 2003)2  . A Swiss study found that the total cost of hand hygiene promotion was roughly one percent of the cost of nosocomial infections (Pittet et. al, 2004)3  .

BASICS is metric driven, which allows us to capture the economic impacts in lower-resource settings. It will establish a baseline of current expenditures, track recurrent and investment costs and link those to program outcomes.

BASICS will generate substantial savings from its projected reduction of 1.4 million patient stay days. Our economic analysis will illustrate those savings and build a government and stakeholder coalition to fund BASICS in national and local budgets.

More developed healthcare systems have learned the lessons on hygiene and taken them to scale. The past several years have seen a groundswell of global attention and support towards achieving universal access to quality of healthcare (Sustainable Development Goal 3). Many of these efforts – some listed below – directly address, or align with, water, sanitation and hygiene (WASH) and infection-related challenges in healthcare:

  • The World Health Organization’s (WHO) Global Action Plan on Antimicrobial Resistance (2015)
  • WHO’s Guidelines on Core Components of Infection Prevention and Control Programmes (2016)
  • WHO’s Supporting Countries to Achieve Health Service Resilience (2016)
  • Every Woman Every Child Global Strategy to end all preventable maternal, newborn and child deaths, including stillbirths, by 2030, and improving their overall health and wellbeing
  • Launch of the Quality, Equity, Dignity (QED) Network for pregnant women and newborn infants (2016)
  • WHO’s Standards for improving Quality of Maternal and Newborn Care in Health (2016)
  • WHO Handbook for National Quality Policy and Strategy (2018)

BASICS will develop a scaling pathway for countries with fewer resources. Global health expenditure has risen progressively since 1995 (Global Burden of Disease Health Financing Collaborator Network, 2019)4  , providing some fiscal space to allocate government resources to BASICS once the payoffs are demonstrated. Securing government commitment will be critical in the four BASICS countries, as the public budget accounts for most health expenditure in these countries. The BASICS teams will engage with health ministries on the implications of BASICS for the composition of a country’s health expenditure.

The four BASICS demonstration countries have already shown strong political will to improve infection prevention procedures.

BASICS will deliver cumulative local impacts in each country that will deepen their commitment to the approach. Our learning model will engage government, civil society and private partners on the lessons being generated on the costs and benefits of BASICS, building a powerful local coalition for change. Once that change is delivered, the economic impacts should ultimately prove irresistible to other countries interested in infection prevention.

Ways countries have demonstrated political will on this topic:

Cross-country:

  • All four of our demonstration countries have shown a commitment to improve infection prevention and broader quality of care priorities.
  • All four countries signed onto the 2019 World Health Assembly Resolution to improve WASH in healthcare facilities and are engaged in post-resolution implementation activities.
  • All four countries have national action plans to combat anti-microbial resistance.
  • Three of the four countries (Bangladesh, Nigeria, Tanzania) signed up to be initial priority countries under the QED Network.

 Bangladesh:

  • In 2017, the Community Based Health Care (CBHC) under Directorate General of Health Services of the Ministry of Health and Family Welfare conducted a rapid assessment of the state of WASH in 13,000 community clinics with help from WaterAid, WHO and UNICEF.
  • Formal guidelines on WASH for community clinics in 2019 with the support of WaterAid, WHO and UNICEF.

Cambodia:

  • In 2016, in response to a baseline study assessing the status of WASH led by the National Institute for Public Health, the Ministry of Health set water and sanitation targets as part of its National Health Strategic Plan 3.
  • In addition, the national quality of care mechanism, which has been rolled out across all public health care facilities, has WASH targets which are tied to performance-based financing mechanisms.
  • In 2019, national guidelines on WASH in health care facilities were endorsed.

Nigeria:

  • In 2018, the government created a new Infection Prevention Coordinator position within the Ministry of Health to lead the design and implementation of a national infection prevention improvement strategy.

Tanzania:

  • In 2019, the government announced a commitment to develop a national roadmap to improve WASH in healthcare facilities, implement improvements in 1,000 facilities and to integrate WASH into new health sector policies.

 

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.

 

1. Boyce JM. Antiseptic technology: access, affordability, and acceptance. Emerging Infectious Diseases. 2001;7:231–233. 

2. Brown SM, et al. Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infection Control and Hospital Epidemiology. 2001;7:231–233. 
3. Pittet, D., Sax, H., Hugonnet, S., & Harbarth, S. (2004). Cost Implications of Successful Hand Hygiene Promotion. Infection Control & Hospital Epidemiology 
4. Pittet, D., Sax, H., Hugonnet, S., & Harbarth, S. (2004). Global Burden of Disease Health Financing Collaborative. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. 2019.  The Lancet.
 

Mali: Babies Born Too Soon Can Survive and Thrive

Written by By Fatoumata Namandou Traore and Nathalie Gamache
This blog was originally published on Healthy Newborn Network

 

At 23, Fatoumata Coulibaly, a mother of two, added to her family when she gave birth to twins at the community health center of Didieni, Mali, in April 2017. Born in this rural village, 40km from a district hospital and 180km from the capital city of Bamako, the babies (a girl and a boy, weighing 1860g/4.1lbs and 1910g/4.2lbs, respectively) were small. So small, in fact, that the family did not believe they could survive.

“When my mother-in-law saw the babies, she told me we should go home, that they were too small and not viable. She did not want us to stay at the facility as she thought it would just be wasting time,” Fatoumata recalls.

Despite her family’s reticence, Fatoumata wanted to give her babies a chance, and was willing to try Kangaroo Mother Care (KMC)  1 as advised by the health center nurse. Fatoumata practiced KMC for two weeks at the health center and then was discharged to continue KMC at home, with follow-up appointments at the health center. When the family tried to leave the facility early, without an official discharge, the President of the health center management committee intervened with Fatoumata’s husband, mother-in-law and father-in-law, to convince them to stay. Two and half years later, Fatoumata is proud of her twins, who are alive today in great part to the KMC Services offered at the Didieni community health center.

Fatoumata’s story is one of many in Mali, where babies born too soon or too small are proving that they can survive and thrive.

In Mali, neonatal mortality is alarmingly high at 33 per 1,000 live births (DHS 2018). Prematurity accounts for 33% of the causes of these deaths (Lancet 2012). Among 440,688 births registered in health facilities in Mali, between January and September 2019, 5% of newborns (23,814) were recorded as low birth weight, or under 2,500 grams (Mali National DHIS2).

Although being born too soon or too small might be seen as a death sentence in Mali, stories of success are changing the norms in the country.

Since January 2019, half (46%) of low birthweight (LBW) babies benefited from KMC in the regions of Kayes, Sikasso, and Koulikoro where the USAID-funded Services de Santé à Grand Impact (SSGI) project intervenes. This is a notable increase from 30% in the same regions in 2018 (Mali National DHIS2).

Save the Children has supported the Ministry of Health and Social Affairs since 2002, seeking to understand newborn health challenges and establish actionable plans to eliminate preventable deaths in Mali. In 2006, KMC was integrated into national policies, norms and procedures as a recommended intervention for management of LBW babies, followed in 2007 by the initiation of KMC services at the Gabriel Toure University teaching hospital located in Bamako. However, access to the hospital is incredibly limited for most LBW babies such as Fatoumata’s twins.

Efforts to introduce KMC services in district referral hospitals began in 2008 through the Saving Newborn Lives program. Subsequently, the USAID-funded MCHIP, MCSP and SSGI programs – all led by Save the Children in Mali – supported service expansion. Gradually, KMC was brought closer to families and made available at community health centers (CSComs). Currently, 931 providers in 430 health facilities in 30 health districts supported by Save the Children through the USAID/SSGI project have been trained and equipped to deliver KMC services.

As evidenced by Fatoumata’s story, bringing care closer to communities is the key to saving premature and low birthweight babies. It requires not only health provider training, but also behavior change interventions among providers, families, and community leaders to recognize and support mothers practicing KMC as the primary intervention for preterm and low birthweight management.

As Mali celebrates World Prematurity Day, we salute premature babies like Fatoumata’s twins, who survived, mothers like her, who accepted to practice KMC, family members that support the mothers and even practice KMC themselves, and health workers who have integrated this practice into everyday service delivery.

 

1. Kangaroo Mother Care (KMC) involves continuously carrying a premature or low birthweight baby on the chest, using early and prolonged skin-to-skin contact, combined with exclusive breastfeeding (direct suckling or cup). This practice helps improve health and prevent the death of premature and small newborns by protecting them against infection, regulating body temperature, breathing, and brain activity, and supporting bonding between mother and baby. Once the baby is stable and gains weight, and the mother is confident she can continue KMC at home, mother and baby are discharged. They return to the health facility for monitoring of weight gain, feeding practices and to ensure that there are no signs of infection or other health complications, till the baby graduates from KMC. 

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.

 

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