Child Health Country Perspectives Study
Associate Professor, University of Tromsø The Arctic University of Norway
In the past five years since the Millennium Development Goals (MDG) concluded with a stunning decline in child mortality, several studies have characterized leadership in child health, calling for greater collaboration and commitment.1,2,3 What have we learned about country and global leadership and the networks of stakeholders in child health?
Global child health mapping study
In 2015, USAID supported a study to explore global child health leadership, stakeholder networks, and political commitment to improving child health. As the world shifted its sights to reaching the Sustainable Development Goals (SDGs) by 2030, the study recommended changes in how people framed child health and how they worked together for impact.
In the later part of the MDG era, as child health interventions and resources to scale them expanded, programs became more siloed, and fragmented the field into its parts either by topic such as pneumonia, immunization, or HIV/AIDS – or by age group such as newborns and older children under five. Separate networks evolved to advocate and provide technical leadership sometimes competing rather than cooperating to move a child agenda forward. Thus, the study recommended that child health be re-framed more holistically to include newborns and older children together and to couple it with a better defined aim for equity in the era of the SDGs. To make this work, existing networks would need to bring child health interventions together in a more collaborative engagement supported by funders.
The study also recommended that leadership for child health among key organizations at the global level be clearly and very publicly re-established. Coming after a period of expanding health agendas and more diffuse leadership in child health, it was important to champion the need and the urgency. Further, a key finding of the study reported by a majority of respondents was that countries and their leaders are best positioned and capable of driving the changes needed to ensure children survive and thrive. For future progress, empowering country leadership and decision making was and is essential. To make progress more likely, all leaders whether in global organizations or countries should be held accountable for child health with robust evidence.
Child Health Country Perspectives Study
To complement these global findings with country voice, the USAID CIRCLE project supported country case studies in Mozambique, Tanzania, and Uganda, in 2019.4,5,6 All three countries had reduced child mortality during the MDG era and after, largely through the scaling up of immunization, malaria control, and integrated management of childhood illness (IMCI) or its component parts.
As child health improved overall, the three countries had shifted focus to reducing newborn mortality – a more difficult challenge. This aligned well with increased interest in addressing maternal mortality but left the unfinished agenda for older children neglected. From the country perspective, this also meant interventions that cut across a broader spectrum of health and survival issues such as nutrition, or that issues that were best served by strengthening health systems, were less likely to be included. This led to a recommendation similar to the global study – to frame child health to include all children under five and further to approach it through integration of health strategies and systems. At this time, SDGs were being promoted more widely to communities and civil society in countries and this presented an opportunity to incorporate the broader framing including multisectoral action to reach a national vision for child health and wellbeing.
The critical need for respected national leadership also emerged as a central theme and recommendation in the country studies. For instance, Tanzania had high level political leaders champion child health globally as well as locally, and national leaders that led technical networks that coordinated resources and guidelines. By contrast, Mozambique had technical leadership but gaps at policy levels with limited influence on the priorities of local health care staff. As with the global level, leadership was more effective when accountability mechanisms existed such as scorecards and performance based contracts in Tanzania or civil society organization (CSO) involvement and advocacy in districts in Uganda. Country respondents urged that the next generation of child health champions be fostered by mentoring, by providing them access to public advocacy platforms, and by acknowledging successful actions.
In contrast to findings about stakeholders and working groups at the global level, more centralized, child health networks were active at country levels. These networks led by the ministry of health and its divisions were actively engaged in policy development, resource mobilization, planning, monitoring, evaluation, and improvement. Other organizations such as WHO and UNICEF were central to network activity and there were many connections with USAID and other technical assistance actors. Mirroring the global finding on country leadership, country respondents stated that district leadership, including active child health networks at local levels, would make the most difference in health outcomes. However, most often networks had been successful at coordinating work but none had yet developed consistent collaboration over time.
What common themes are emerging?
- Child health has been reframed since the time of the MDGs, most clearly by the remarkable reduction of mortality and then by the SDGs. It is poised to be more inclusive of ages, risks, and conditions.
- Country leadership is essential to motivate, decide, prioritize, and hold stakeholders accountable to commitments.
- How well child health networks collaborate at global, national, or subnational levels matters to progress. There has been less attention to learning how to effectively build capacity to collaborate.
- Measurement and reporting of performance and outcomes, coupled with public accountability mechanisms help drive improvement – without them we will not know what to do next.
This child health study is an excellent example of how a Health Research Program study identified the drivers of progress on child health and how government leadership and stakeholder networks can improve child health. The study also identified governance and collaboration features that can be applied by countries in policy and systems strengthening to prioritize better child health in the context of the SDGs. For more information, please visit the Child Health Country Perspectives Study page, or see the blog post on the stakeholder engagement process.
1 Costello A and Dalglish S. Towards a grand convergence for child survival and health: a strategic review of options for the future building on lessons learnt from IMNCI. Geneva: World Health Organization, 2016.
2 Taylor ME, Mrisho M, and Ruducha J. Child health networks and leadership from 2000 to the present: Country perspectives from Mozambique, Tanzania and Uganda. CIRCLE Project, USAID, March 2020.
3 Taylor ME, Schumacher R, and Davis N. Mapping global leadership in child health. MCSP Program, USAID, April 2016