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Reducing child mortality: cash transfers can help
A new report by Save the Children UK released today argues that reductions in child mortality can be accelerated if regular, predictable transfers of cash, or cash transfers, are provided to households or individuals by the government. Unlike traditional welfare programs, cash transfers in this case are conditional upon parents seeking and receiving certain services for their children. If children do not regularly attend school or get regular check-ups at health clinics, the cash transfer program will not pay out.
Cash transfers work to break down one barrier to families’ ability to access social services, namely the cost of the service. By addressing the ‘demand-side’ of issues related to alleviating poverty, cash transfer programs offer a complement to the ‘supply-side’ interventions which focus on increasing the availability of health, education, and nutrition services and programs.
The Save the Children report offers the following five recommendations:
- Maternal and child benefits should be an integral part of child survival efforts in countries experiencing high rates of maternal and child mortality. Targets for expanding coverage should be set by the government in a way that makes sense for their national budget and administrative capacity.
- Cash transfers should be implemented in combination with other policies and programmes.
- Equity should be incorporated into the existing MDG framework so that the poorest and marginalized are not left behind. Reporting statistics on whether the poorest groups are receiving services intended for them should happen routinely.
- The Partnership for Maternal, Newborn, and Child Health should include child and maternal benefits in the package of interventions it recommends for the Countdown to 2015 countries.
- On the donor side, social protection programs – including cash transfers - should receive increased investment.
-Lisa Fleisher
Talking Health in Geneva
Last week I attended a high-level taskforce meeting on climate change and innovative financing that was part of the 62nd World Health Assembly in Geneva, Switzerland. This precedes a big conference in Paris this week on innovative financing for health.
Dr Philippe Douste-Blazy, Special Advisor to the Secretary-General of the UN in charge of Innovative Financing, proposed the creation of the I-8 Group for the Millennium Development Goals, which brings together United Nations agencies and civil society representatives.
The 8 finance mechanisms are (be prepared for a mouthful):
- The International Finance Facility for Immunization, supporting the Global Alliance for Vaccines and Immunizations
- UNITAID
- The Advance Market Commitments for vaccines
- The ‘Debt 2 Health’ initiative of the Global Fund to Fight AIDS, Tuberculosis and Malaria
- (PRODUCT) RED
- The Responsible Social Investment initiative of the Agence Française de Développement
- The use of revenues from the Carbon Market
- The Millennium Foundation for Innovative Finance for Health
Last week’s meeting in Geneva was the first meeting of the group. And it was certainly an impressive set of people sat around the table, including Ban Ki-moon (Secretary-General of the UN), Dr Margaret Chan (Director-General of the World Health Organization) and Michel Sidibé (Executive Director of UNAIDS).
Due to the current economic crisis, Ban Ki-moon pointed out that traditional forms of financing for health are under threat as commodity prices are falling and overseas development assistance is under pressure. He made a plea for innovative ideas and for innovative financing to close the gap between what is available and what we need to meet the Millennium Development Goals. He also emphasized that there is a need for creativity around innovative financing and new opportunities but that it is also critically important to strengthen current mechanisms.
Margaret Chan noted that there were 19 men around the table and only one woman, herself. She talked about maternal mortality and made the stark point that in some countries, women are not allowed to give birth when in labour unless they have the permission of the man.
Michel Sidibe, followed on from Chan, and said that this meeting could not have been more timely. The AfDB recently projected that another 27 million people in Africa are at risk of ill health and poverty. Predictable and sustainable financing is key and this innovative financing scheme must help build a fairer globalization. He concluded by saying the following: “If we are going to reach the Millennium Development Goals, we must avoid duplication, resist competition, and put people at the centre”.
-Eloise Todd
A Success in Addis Ababa
Last night, I held a “Idol Gives Back” watch party here in Columbus, Ohio. After watching a segment on AIDS orphans Melanie Berichon, a ONE member who attended, shared the below story with us. I had her write it down so I could share it with all of you.
“This past summer, I was in Addis Ababa. I was able to spend quite some time at a wonderful orphanage for HIV+ children.
Once they started getting the ARVs that were needed and at a fair price, children stopped dying. And so money that they used to save to pay for children’s coffins is now being used for growth and development, empowering the organization to grow and help so many more people.
There aren’t words to describe the feeling I had when seeing so many life saving drugs arrive at the orphanage.”
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I just wanted to share. Looking forward to seeing tonight’s show too.
-Katie Andrews, ONE regional field organizer
Maternal, Newborn, and Child Health at a Crossroads
The Partnership for Maternal, Newborn, and Child Health (PMNCH) and the World Bank co-hosted a seminar last Wednesday on how to achieve MDGs 4 and 5 through strengthening health systems and increasing international and domestic financing for key maternal and child health interventions. MDG 4 calls for a two-thirds reduction in child mortality, and MDG 5 calls for a three quarters reduction in maternal mortality and increased access to reproductive health services. Countries are off-track to achieve these MDGs, and there has been almost no progress in reducing maternal mortality in Africa. Seminar participants discussed how to jump-start progress through more effective and efficient financing.
Financing for health systems has been dwarfed in recent years by financing for infectious diseases. While some progress has been made in the prevention and control of diseases like HIV, tuberculosis, and malaria, too many women and children in poor countries still die every year of diseases that are no longer issues in the wealthier world. The global community is now increasing its attention on building health systems in developing countries to maximize and sustain investments in infectious diseases and to address the root causes of poor maternal and child health.
The High-Level Task Force on Innovative International Financing for Health Systems is at the center of global efforts to estimate the resource needs to strengthen health systems and define the mechanisms that can accomplish this goal. Launched in September 2008 and co-chaired by World Bank President Robert Zoellick and UK Prime Minister Gordon Brown, the Task Force has among its members high-level policymakers from key donor and recipient country governments. Operating under the premise that more aid is necessary – but better aid is absolutely critical – the Task Force has two working groups estimating the global price tags and country-level costs of achieving the MDGs. A key emphasis of the ongoing work is on the right mix of innovative financing mechanisms to deliver aid more effectively and efficiently. Accountability for funding and the results it achieves is high priority for donors, recipient countries, and civil society. The Task Force will deliver the results of the working groups at the G8 meeting in July, including recommendations on the appropriate mix of financing mechanisms to strengthen health systems and ultimately improve maternal and child health outcomes.
-Lisa Fleisher
Meeting at the Global Health Council
ONE rubbed elbows with some of its many partners Friday at the Global Health Council’s community meeting with Dr. Christoph Benn, the Director of Partnerships, Communication and Resource Mobilization at the Global Fund to Fight AIDS, Tuberculosis and Malaria (a very lengthy title with an even longer list of responsibilities). The Global Fund is a partnership of many organizations created to increase and disburse performance-based grants to fight HIV/AIDS, TB, and Malaria, and it has helped drastically improve global health since its inception seven years ago. Nevertheless, many challenges remain. I had the opportunity to talk with Dr. Benn after the presentation, and he gladly accepted a ONE band to show his support.
Dr. Benn was proud to announce that HIV/AIDS treatment has expanded; however, prevention remains the dominant challenge. TB poses its own obstacles due to its extreme drug resistance and its complex/ expensive treatment. However, the Global Fund is beginning to see a decline in infection in Asia, though progress in Africa is slower. This may be in relation to the high prevalence of HIV in Africa; in effect weakening people’s immune systems and making them more susceptible to TB. Child mortality due to Malaria decreased 50- 70% in some countries thanks to mosquito net disbursement and increased access to affordable treatment and disease control mechanisms. We are making progress, and looking to the future, it is no secret that we are accelerating.
The demand for Global Fund grants is increasing at unprecedented levels, but with the global economic downturn tightening public budgets, the Fund is now facing critical funding gaps. As ONE members, will need to get out and make their voices heard!
-Ian McGroarty
New UNICEF Report: State of the World’s Children
Yesterday, UNICEF released its new State of the World’s Children report which calls for the big gap in maternal and child death rates between the developing world and industrialized countries to be addressed more aggressively. The report examines maternal mortality in developing countries and reports that too many women and children are dying of causes that could be prevented or easily treated.
In the world’s least developed countries, having a baby is among the most serious health risks for women. Every day, 1,500 women die from complications of pregnancy or childbirth – mostly in Africa and South Asia. And the younger the mother, the higher the risk: girls who have children before they turn 15 are five times more likely to die in childbirth than women in their 20’s. While the child mortality rate in developing countries has decreased by 27% since 1995, a child born in a developing country is still 14 times more likely to die during the first month of life than a child born in a developed country. Most of these deaths are preventable. UNICEF’s Executive Director Ann Veneman states: “Progress has been made in reducing child mortality, but much more must be done especially in addressing maternal and newborn health.” Proven, cost-effective interventions exist which can save mothers’ lives and consequently, improve the chances that their children will survive too.
The barriers to bringing these interventions to the women and girls most in need are significant, but not insurmountable. The report cites weak health systems and a shortage of trained health workers as two of the biggest obstacles to reducing maternal mortality rates (and address other key health issues) in Asia and Africa. The health worker shortage is felt most acutely in Africa, which has 24% of the global disease burden but only 3% of the global health workforce. In countries where fertility rates are high and where women are not empowered to make decisions about their healthcare, these problems are compounded.
Efforts to address these problems and generate declines in maternal mortality are increasing. Just within the past five years, the number of new initiatives designed to generate new money for health systems and expand the reach of maternal and child programs have increased dramatically. Donor funding for maternal, neonatal, and child health has (more…)
Back to the Basics
Government ministers and global health advocates from across the world are making their way to Almaty, Kazakhstan this week to focus on primary health care. The summit marks the 30th anniversary of the Alma-Ata Conference, which took place in the Kazakhstani city before the collapse of the USSR.
In the years since 1978, Alma-Ata has become somewhat of a hallmark and source of nostalgia in global health circles. The conference was the first of its kind to put the concept of health equity on the international agenda. Aiming to launch a campaign for health for all, attendees laid out their vision of primary health care. Identifying health as a fundamental human right, they argued that health care should not only be universal and affordable, but should be delivered in collaboration with local citizens in a way that is appropriate to the context.
These tenets were laid out in the Alma-Ata Declaration, which gave countries and international organizations a target date of 2000 for implementation.
Thirty years later the ideals of Alma Ata are far from being realized. Here at ONE, we know the stats on the global health deficit all too well: over 9 million children die before their fifth birthday every year from preventable, treatable causes; half a million mothers die every year during childbirth. While many at the time branded Alma-Ata and utopian, in retrospect its failure was more a result of unforeseen social and economic challenges that shaped the global health landscape of the 1980s and 1990s. WHO Director-General, Dr. Margaret Chan, speaks to this in a recent article featured in the Lancet:
Nor could the visionary thinkers in 1978 have foreseen world events: an oil crisis, a global recession, and the introduction, by development banks, of structural adjustment programs that shifted national budgets away from the social services, including health…The emergence of HIV/AIDS, the associated resurgence of tuberculosis, and an increase in malaria cases moved the focus of international public health away from broad-based programs and towards the urgent management of high-mortality emergencies.
Birth & Death in Sierra Leone
The plight of mothers in Sierra Leone graced the cover of yesterday’s Washington Post. Sierra Leone is home to the world’s highest maternal mortality rate: mothers face a 1 in 8 chance of dying in childbirth. This is compared to 1 in 4,800 in the United States and 1 in 20 in the rest of sub-Saharan Africa.
The story of Saio Marah highlights some of the factors behind these high mortality rates. Marah arrived at the hospital by motorbike, the predominant mode of transport in the rural Sierra Leone. She is examined by Dr. Konteh (an ophthalmologist by training), who informs that her that she had waited too long to come to the hospital: the baby’s heart rate is too fast and she needs an emergency caesarian section. But all of the surgical nurses had gone home and the operation will have to wait until the team can track its way back to the hospital.
The article continues:
It was a Monday evening, and her husband, Mohamed Barrie, said she had gone into labor on Saturday. Both of them were worried about the expense of going to the hospital, he said, and were sure she could deliver easily enough without assistance from hospital doctors. So they had gone to a neighborhood clinic where a nurse examined her and sent her home. Now she was three centimeters dilated, her water had broken and she had finally come to the only hospital in Koinadugu, a sprawling and rural expanse in the far northeastern corner of this West African nation.
The 2008 G8 Summit: Outcomes for Africa
African development was again the subject of G8 discussions as world leaders gathered in Toyako, Hokkaido in northern Japan from July 7-9 for the 2008 G8 Summit. While the G8 was confronted with multiple global challenges, including climate change and a weakening global economy, the 2008 Hokkaido Summit marked an important “mid point” moment in the fight against poverty. The Hokkaido Summit came at the critical halfway point to both the Millennium Development Goals (MDGs) and the G8 Gleneagles promises to Africa. The G8 are dangerously behind on their landmark commitments to the region, having delivered only $3 billion of the promised $25 billion in additional assistance to Africa by 2010, according to the 2008 DATA Report.
After difficult negotiations, the G8 summit yielded small gains for the poorest. The bulk of G8 agreements on development and Africa and food security reiterated previous pledges rather than outlining new measures to get the group back on track. The G8 did announce plans for a new effort to tackle the global food crisis, though more details are needed to ensure its effectiveness and delivery. They highlighted the UN High-level meeting on the MDGs in September as an important opportunity to review progress and identify actions needed to overcome remaining challenges.
At a time when G8 credibility is at risk due to slow progress in delivering on commitments, there was a strong call for greater accountability in the G8 Communique. The G8 agreed to track progress against previous commitments in health, education, water and agriculture, as well as its compliance with anti-corruption measures.
Overall, the US, UK and Germany provided strong leadership in negotiations and have significantly increased their funding for Africa in recent years.
After the jump, the following brief overview of outcomes for Africa from the 2008 G8 Summit.
-Ben Hubbard
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Pre-G8 in Japan, Maternity Health with Mrs. Fukuda
Mikiko Imai works for ONE in Japan. She’ll be reporting in throughout this week on the 2008 G8 Summit in Toyako.
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I’ve just come back from an afternoon tea party on maternal health issues hosted by the wives of two G8 leaders - Mrs. Sarah Brown, wife of the British Prime Minister and Mrs. Kiyoko Fukuda, wife of the Japanese Prime Minister. Mrs. Brown, a Patron of the White Ribbon Alliance, flew in a day earlier than her husband (who’s coming to Japan for the G8, just in case anyone’s wondering…) to talk about maternal health alongside Mrs. Fukuda.
In Mrs. Brown’s speech, she talked about the devastating situation surrounding expectant mothers, babies and infant children in developing countries and how neglected this issue is - the global goal to reduce the number of mothers dying in childbirth by three-quarters by 2015 has made absolutely no progress. She cited the global shortage of 4 million health workers and appealed for the G8 to answer to the calls to secure the investments in women’s health care needed to save lives at the forthcoming Summit in Hokkaido.
Mrs. Fukuda talked about how Japan had managed to overcome high levels of maternal mortality in the recent past and raised the success of the Boshi-Techo (Mother and Child Health Handbook), a book that allows pregnant women and mothers to track their pregnancy and baby’s growth. This initiative started 60 years ago when Japan had a devastatingly high maternity death rate and has had remarkable success since.
After hearing the speeches, there was a traditional English tea (it was at the British Embassy…) and a chance to view an exhibition of beautiful but disturbing quilts made in memory to mothers lost from all over the world. Every piece of quilt had a personal story to it. One quilt depicted a pregnant woman bleeding to death - her name was Khatiza Mai from Pakistan and she had no health care during her pregnancy. As I left the embassy complex, in the middle of sunny Tokyo, I tried to imagine myself in her situation. It was hard - I was born in a modern hospital. Apparently in many developing countries families say goodbye to a woman when she goes into labour - how long will it be before all women are free not to see childbirth as a potential death sentence? I hope the G8 will make progress this week…
-Mikiko Imai (more…)
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The International ONE Blog is a daily log of the anti-poverty movement. The site is operated by ONE staff, with guest contributions from ONE volunteers, members and allies.
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TAGS: Maternal and Child Health, Policy News