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Mozambique, Kate Holt/MCSP

Child Health

The world has made substantial progress in reducing child mortality in the past few decades. Globally, the under-five mortality rate dropped from 93 deaths per 1,000 live births in 1990 to 41 in 2016. This remarkable progress in improving child survival since 2000 has saved the lives of 50 million children under age five. While tremendous achievements have been made, the degree of these advances varies greatly from region to region. In sub-Saharan Africa, for example, 1 in 9 children dies before their fifth birthday — more than 15 times the average for developed regions. Common causes of death in children, such as pneumonia, diarrhea, malnutrition and malaria, are preventable and treatable with proven child health interventions.

MCSP was a vital contributor to the global movement to prevent child deaths. We strove to protect children from diseases and to improve their access to lifesaving treatments globally and in select USAID priority countries. In those countries and regions with greatest need, we built the capacity to plan, leverage resources, and scale up high-impact, cost-effective child health interventions, and extended them to hard-to-reach populations and those with limited access to child health services.

We assisted countries in setting achievable child survival targets, while establishing mechanisms for regular review and joint accountability for results. MCSP also encouraged partner coordination and supported joint work planning led by host governments and inclusive of civil society organizations and private sector partners. The Program focused on the continuum of care for children from household to hospital, building on the achievements of USAID’s predecessor Maternal and Child Health Integrated Program (MCHIP). In strengthening families’ access to child health services, MCSP focused on the health system, developing strong links between facility- and community-based services.

The Program worked at the national and local levels to support countries with:

  • Development and updating of or change in policies and guidance, strategic planning, and health systems strengthening (e.g., supply chain or human resources strategies)
  • Introduction of Emergency Triage, Assessment and Treatment training, mentoring or supervision, and/or data collection and use at referral health facilities
  • Integrated Management of Childhood Illness (or other basic sick child treatment services) pre- or in-service training, supervision and mentoring, and data collection and use at health facilities
  • Integrated Community Case Management (iCCM) training, supervision, equipment, supplies, and/or data collection and use by community-based health workers outside of facilities
  • Activities that create demand for child health services and activities or approaches that promote appropriate family practices
  • Systematic efforts to improve the quality of child health services provided at the facility or community levels and data collection on quality improvement activities (including outcome measurements)
  • Technical assistance and support to advocate for and mobilize resources available for child health services

MCSP also served as the Secretariat of the Child Health Task Force (CHTF) (formerly the iCCM TF, 2009-2017). The mandate of the task force expanded from iCCM to child health after recognizing that increasing access to curative care through iCCM alone was not enough to achieve the health-related Sustainable Development Goals for children.

The Program led the work of the CHTF, a global and country-level multi-stakeholder group led by a Steering Committee comprising UNICEF, the World Health Organization (WHO), USAID, Global Financing Facility (GFF), the UK Department for International Development (DFID), CORE Group, and ministries of health. The goal of the CHTF was to strengthen equitable and comprehensive child health programs focused on children aged 0 to 18 in line with Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030). As Secretariat, MCSP was the convener of the Steering Committee and the nine Subgroups of the Child Health Task Force. The Program also led knowledge management of the Task Force.

Key Results

  • MCSP participated in and contributed to the WHO meeting to guide the strategic global review of integrated management of childhood illness. Simultaneously, the Program initiated and completed the review of Mapping Global Leadership in Child Health in an effort to evaluate the evolution of child health since 2000 and the networks of stakeholders and leaders involved. Recommendations from the reviews offer insight on how to strengthen and re-position global leadership for child health to attain better outcomes under the Sustainable Development Goals. Both reports have informed the development of USAID’s forthcoming child health strategy and reinvigorated the partnership of WHO/UNICEF for child health leadership.
  • MCSP prepared and disseminated five Global Fund New Funding Model Concept Note Review reports, which highlight iCCM for malaria, diarrhea and pneumonia in five countries: Ghana, Kenya, Uganda, Nigeria and Zambia. The reports, which promote collaboration to more efficiently scale up iCCM, were shared with relevant fora (global and in-country) to inform resource mobilization efforts.
  • The Program documented successes and challenges encountered in applying different quality improvement approaches to child health services. Based on findings from the related report, MCSP took more of a holistic view of quality, and adopted the eight domains of WHO’s quality of care (QoC) framework to identify areas of priority to improve the provision and experience of care for children and their caregivers. The Program  supported the development of a pediatric QoC framework and worked internally and with WHO to ensure the pediatric and maternal and newborn health QoC frameworks were rolled out on a single platform.
  • The iCCM Monitoring & Evaluation Subgroup of the iCCM Task Force updated the iCCM indicator guidance, including the list of recommended iCCM indicators collected in routine health information systems (HIS). MCSP examined Health Management Information System (HMIS) registers and forms to determine which indicators were collected and reported across 26 countries’ systems. MCSP was thus well positioned to recommend new indicators and data points for inclusion into DHIS 2 and into other HMIS tools. The collection of high-quality data allowed countries to identify and address bottlenecks and improve policies and programs.
  • Through the iCCM Financing Task Team, MCSP provided technical assistance to 21 priority countries to integrate iCCM into their malaria and/or health systems strengthening Global Fund New Funding Model (NFM) concept notes. As a result, 18 countries submitted iCCM-enhanced concept notes to the Global Fund. Based on the approved concept notes and the additional leveraged co-financing data, an estimated USD$212 million was leveraged to implement and expand iCCM in 12 countries. Based on experience providing support to countries (Ghana, Kenya, Nigeria, Uganda and Zambia) that applied for funding through the NFM as well as key informant interviews, MCSP generated lessons learned and recommendations for strengthening partner coordination and developing stronger concept notes for future funding. Application of these recommendations facilitated more equitable access to integrated care for under-fives.
  • In September 2017, USAID, in collaboration with MCSP, hosted the Africa Regional Workshop on Improving Routine Data for Child Health in National Health Information Systems in Johannesburg, South Africa to strengthen routine monitoring of child health and nutrition services. Over 90 participants attended from more than 15 countries. The workshop focused on indicators and data elements, national and sub-national HIS strengthening, community data, and digital solutions. Six country delegations (from the DR Congo, Ethiopia, Mozambique, Nigeria, Uganda and Zimbabwe) developed action plans to address child health and nutrition data gaps in their current HIS. (All workshop presentations, documents and resources are accessible here.)
  • MCSP hosted and led the first in-person meeting in Washington, D.C., of the Child Health Task Force Steering Committee in fall 2017. This was an opportunity to solidify the new direction of the Task Force, which officially changed its mandate from iCCM to a broader integrated approach to child health. The SC drafted a Terms of Reference for the new Task Force, proposed subgroups, and suggested an expanded membership of the SC (including DFID, the Gates Foundation, GFF, CORE Group, and a country and south academic/research institution representative).
  • MCSP launched two eLearning courses — on pneumonia and case management of childhood illness — to further education about managing child illnesses and the important child health strategies used to improve case management.

Country Highlights

Evidence-based child health policies and plans:

  • In DR Congo, MCSP assisted the Ministry of Health and its partners to scale up and improve the effectiveness of the national iCCM program. After 12 years of country efforts, iCCM is implemented in 6,968 sites across 402 health zones (among 461 eligible), but the package of services provided and the performance of the program differ among sites. To achieve effective coverage and sustain the program, the National Child Health Technical Working Group — revitalized with MCSP’s support — developed the National Strategic Plan for Integrated Management of Neonatal and Child Illnesses (IMNCI), a broad plan that provided for the continuum of care from household to community to health facility to hospital. The plan, approved in August 2017, covered five years from 2017 to 2021, with a budget of over USD $223 million. It recommended 8,000 additional iCCM sites to cover 70% of the country’s need. After DR Congo’s commitment made during the 2017 Institutionalizing Community Health Conference, the technical working group, with MCSP support, initiated the development of the National Community Health Strategic Plan. The IMNCI plan and the community health plan were essential national policies that will inform provincial and health zone teams in their development of relevant and realistic operational plans.
  • In Nigeria, MCSP supported the first-ever costed Kogi and Ebonyi State Ministry of Health 2018 Annual Operational Plan for Child Health — a milestone in the planning for child health services in both states.
  • Due to MCSP support in DR Congo, the number of children seen at facility and community levels for fever, pneumonia and diarrhea steadily increased since the introduction of a full IMNCI and iCCM package in January 2017, with over 137,000 children seen at 106 facilities and 119 community care sites where previously no treatment for diarrhea or pneumonia was offered.
  • In Kenya, MCSP assistance helped over 38,000 children get treated for diarrhea and over 20,000 treated for pneumonia.