Health Research Program
Rebekah King, Program and Research Manager, CIRCLE Project

Over the past thirty years, significant progress has been made in improving child health around the world. Between 1990 and 2015, the mortality rate for children under five declined by 53%.1 In addition, sixty-two countries achieved the fourth millennium development goal of reducing child mortality by two-thirds. Despite these successes, disparities in child health still exist, particularly in Sub-Saharan Africa where the majority of child deaths are preventable.2 Greater attention is needed on child health to address the “unfinished agenda.3” 

The Child Health Country Perspectives Study

Photo credit: Elizabeth Macgregor-Skinner, CIRCLE Project

In 2015, USAID commissioned a mapping of global leadership in child health to understand its  evolution since the year 2000. This landscape analysis documented the state of global child health leadership and relationships between stakeholders. Findings revealed a loss of momentum, fragmentation, and lack of clear leadership within global child health during the MDG era. Understanding these dynamics and challenges helped to shed light on ways to reposition child health to improve outcomes. Study recommendations focused on keeping countries at the center of reframing the future of the child health agenda to achieve Sustainable Development Goals (SDGs) for 2030.4

Photo credit: Africare

As a follow-on to the 2015 global mapping study, the USAID CIRCLE project is conducting a  new study to capture the perspectives of country level stakeholders to complement the global findings. Using qualitative interviews and organizational network analysis, the Child Health Country Perspectives Study documents the drivers of change in child health outcomes from 2000 to present in Mozambique, Tanzania and Uganda, with an emphasis on country leadership, political commitment and stakeholder networks. These countries were chosen based on several factors including: the amount of USAID MCH funding, annual under 5 mortality reduction rate, political stability, domestic resources for health, PMI presence, GFF engagement, and the feasibility of USAID Mission and Ministry of Health participation. The study also assesses how these factors can be leveraged to improve child health outcomes in the future.  Findings are intended to inform future investments, policy, and programmatic decisions and enhance collaboration among stakeholders in the study countries. 

Engaging Stakeholders to Improve Buy-in and Uptake of Research

Photo credit: Sarah Day Smith, PEPFAR

As part of its mandate, the CIRCLE project works to advance implementation research and promote translation and uptake of findings among target audiences. As a result, the Child Health Country Perspective study has focused on including relevant stakeholders at critical points in the research process to increase the likelihood of buy-in and use of study findings. The primary stakeholder engagement activity for the study was the Cross Country Review Meeting.

In October 2019, CIRCLE convened the Cross-Country Review Meeting in Dar es Salaam, Tanzania, to bring together the study team, USAID Mission child health staff, local child health experts, and representatives of the respective country Ministries of Health. The objectives of the meeting were: 1) to review and gather input on country findings; 2) identify common themes across countries; and 3) discuss possible recommendations for improving child health under the SDGs. 

“…This particular meeting has helped generate a lot of discussion that has beefed up these perceptions and [findings]…. In Uganda this needs to feed into existing frameworks that are going to lead to real change. We have the National Development Plan Three that is being developed at the minute. This would neatly feed into that. Now I know, [and] I’m going to get the documents and make noise about the perceptions [from this study] and try to fit that into policy and implementation plans.”  

– Uganda stakeholder 

Overview of Meeting:

Participants and Activities

Photo credit: Rebekah King, CIRCLE Project

Eighteen study team members and stakeholders from four countries (Mozambique, Tanzania, Uganda and the United States) attended over the two days. Participants represented five organizations including USAID, UNICEF, the President’s Office, Regional Planning and Local Government (PO-RALG) of Tanzania,, the Pediatric Association of Tanzania, and CIRCLE. 

Meeting Outcomes

Through the meeting the CIRCLE project: 

  • Convened 18 stakeholders who provided input during a critical phase of the study to inform and facilitate the translation of findings; 
  • Presented preliminary country case study findings and obtained stakeholder feedback  based on their knowledge of country context;
  • Identified similarities and differences in findings across countries; 
  • Developed thematic areas for recommendations to improve child health outcomes;
  • Obtained concrete guidance on addressing gaps and improving final reports, and the best approach for continued discussion of the findings and dissemination in each country; and 
  • Identified potential champions who can advocate for the use of findings in each study country.

The Cross Country Meeting succeeded in achieving its objectives. Participants contributed to rich, candid discussions on drivers of child health in each country; the current state of country leadership and stakeholder networks; and ideas for improving child health outcomes across the three countries. While some study limitations were identified and discussed, participants had positive impressions of the meeting. They also appreciated the opportunity to give input on study findings and share feedback with USAID to inform future programs.  Most importantly, the meeting produced informal champions who expressed interest in and commitment to advocating for the use of study findings in their respective countries.

Looking Forward 

The Cross Country Review Meeting was an important step in the study implementation process. This intentional stakeholder engagement strategy has the potential to influence whether the findings are used by intended audiences in Mozambique, Tanzania, and Uganda, and more broadly among donors and global partners.  

Given the work we need to continue to do to further accelerate declines in child mortality, I am so pleased and excited by the candid discussion of the study findings throughout the meeting!  I am also hopeful that participants will further discuss study findings with other key country level stakeholders not present in Dar Es Salaam, to identify how to take collective action to elevate the findings and implement recommendations to drive improvements in child health outcomes.

– Malia Boggs, Senior Technical Advisor, USAID

The three country case study reports are currently being finalized and will be disseminated in December 2019. Findings will also be shared through in country presentations and global webinars. Please visit for more details on the schedule of upcoming webinars.

  1. UNICEF, 2015  Retrieved from
  2. UNICEF, 2015  Retrieved from
  3. Bryce, J., Victoria, C.G., Black, R.E. 2013. The unfinished agenda in child survival. The Lancet, 382 (9897) Retrieved from
  4. Taylor, M.E., Schumacher, R., Davis, N. 2016. Mapping global leadership in child health. Maternal Child Survival Program. Retrieved from