Health
More than just a bar on a chart in New York: Why the MDGs matter
This blog originally appeared in the New Statesman.
This time of year always seems particularly hectic for the ONE Campaign and others in the movement against extreme poverty. The run-up to the annual G8 summit, which this year is hosted by David Cameron near Enniskillen in mid-June, is our equivalent of Sir Alex Ferguson’s “squeaky bum time”. Within a few weeks we’ll know what we’ve won and what we’ve lost, and the implications will be felt for a long time.
Yesterday I wrote up on my office wall nine big moments for ONE in this period. The first is today, with the launch of our 2013 DATA Report. The report shows that while aid and investment from wealthier countries is critically important, perhaps its greatest value is in leveraging and supporting resources closer to home – the resources that developing countries themselves can provide – which will ensure that one day, aid from outside will be rarely needed.
We’ll continue to push governments in Europe and beyond to stick to the commitments they’ve made. But African governments have made promises too, and in the DATA report we look at some of the big ones.
Overall, things are getting better. The report explodes the myth that all advances against poverty and disease are thanks to China; in fact, in six of the eight MDG targets, at least half of sub-Saharan African countries are fully or partially on-track. However the performance of leading countries like Ethiopia, Malawi, Ghana, Benin and Burkina Faso is undermined by persistent underperformance by a handful of others, including the Democratic Republic of the Congo, Zimbabwe, Chad and Burundi.
There is also a clear correlation between countries that are allocating a greater share of government spending to health, education and agriculture over the past decade and improved progress in those areas. From 2000 to 2011, Ethiopia lifted an estimated 10 million people out of extreme poverty, and over the same period the government spent nearly 45 per cent of its total budget on health, education and agriculture, a third more than the average in sub-Saharan Africa. The fact that increased resources go hand in hand with better results might be considered a statement of the obvious. But in these sceptical times, it’s helpful that a hard-headed look at the numbers demonstrates the link is strong.
However, no African government is on course to meet the promises it has made for investment in all three of these sectors. In the next three years as the 2015 MDG deadline approaches, sub-Saharan Africa as a whole could add $243bn to its health, education and agriculture efforts. The difference this could make is clear in one country after another: for example, by meeting its health spending commitment between now and 2015, Nigeria could provide an anti-malarial bednet for every citizen, vaccinations against killer diseases for every child and life-saving treatment for everyone who is HIV positive in Nigeria – and still have billions to spare in its health budget.
As the G8 leaders meet in Enniskillen this report should remind the world’s decision makers of the task immediately ahead. On Friday, David Cameron delivers the report of the High Level Panel he has co-chaired, on what should replace the MDGs after 2015, to the UN Secretary General in New York. It’s important of course. But it’s hard to avoid the feeling that if there were the same level of interest in the pre-2015 agenda, the world could get a lot closer to achieving the goals we already have. That’s not just a bar on a chart in New York: it means kids in school, small farmers with more chance to work their way out of poverty, people alive in 2015 who would otherwise die if we fail to act. There are less than a thousand days left until the end of 2015 – we need to make every one of them count.
In the days before the G8 summit, leaders of a wider group of countries will meet for a “Nutrition for Growth” event, dedicated to tackling the scourge of malnutrition. If this event is to succeed, it will need to drum up resources from both developed and developing countries, as well as companies, foundations and charities. ONE’s report couldn’t be clearer on this: you get out what you put in.
But the G8’s core agenda is also hugely relevant. David Cameron has called for a “transparency revolution”. With greater transparency – whether in the extractives industries, aid, public spending, company ownership or tax information – governments and citizens in developing countries will be able to ensure that funds intended for the fight against extreme poverty do not end up in the wrong hands. If that revolution succeeds, developing countries will be able to claim more of what is rightfully theirs – and have more resources to build a better future for all, accountable to all.
All of this requires leadership. David Cameron’s government has been resolute thus far. It has built on the excellent work of its predecessors and finally met the historic 0.7 per cent GNI spending target. But this test is a different one. In the coming weeks, as the UN High Level Panel delivers its report and Cameron hosts the series of gatherings culminating in the Enniskillen summit, he has a real opportunity to be remembered as a true global leader on development. It will require determination and vision. I hope he will find both.
Is the world forgetting about sanitation?
ONE’s Health Research Assistant Anupama Dathan checks out the latest findings from UNICEF and the World Health Organisation.
Water, water everywhere…but not enough that’s clean, says a new WHO and UNICEF report released this week.
As part of the Millennium Development Goals, the world aimed to halve by 2015 the population without access to clean drinking water and basic sanitation.
The good news is that we met the drinking water goal back in 2010. But, with less than one thousand days to go until the deadline, the report warns the global community that it is not on track to meet the sanitation target by over half a billion people. It projects that in all, 2.4 billion people – one-third of the world’s population – will be without access to basic sanitation in 2015.
What does that number mean? Well, it’s over twice the population of Africa, nearly three times that of Europe, and about half that of Asia. In short, it’s a lot of people without access to basic sanitation measures like toilets and a way to wash hands with soap and clean water.
When we talk about health, we talk a lot about the transmission of HIV and the prevalence of malaria, but it’s important to keep in mind the role basic sanitation plays. Diarrhoea, the third biggest killer of children in developing countries (responsible for 11% of all childhood deaths), is most often caused by poor sanitation.
Other big diseases among adults and children like cholera, schistosomiasis and trachoma, are also common thanks to lack of sanitation. That’s why the WHO and UNICEF report is calling on the global community to join together and keep working to improve sanitation even after the Millennium Development Goal deadline of 2015 is past.
Do more. Donate your Twitter or Facebook accounts to Water.org and let them share facts and stats about the global water crisis to your social networks.
MTV Africa’s Vanessa Mdee: ‘This is a new dawn for young African women’
Our guest blogger today is the MTV Africa VJ, singer and activist from Tanzania, Vanessa Mdee. Writing as an ambassador for the GAVI Alliance, her post celebrates the recent news that the HPV vaccine to protect women and girls from cervical cancer is set to drop in price for 50 of the world’s poorest countries.
I’m trying to think of the first time my mother had ‘The Talk’ (yes the birds and the bees talk) with me. The talk that I’d heard my friends refer to as the most embarrassing moment of their lives, the talk that officially indicted you into teen-hood, the talk that signified your maturity – your parents decided you were old enough to speak of natural human interaction between a man and a woman. I’m still eagerly awaiting this talk.
Now don’t be fooled, my mother knows all too well that I’m aware of physical interaction. Not because I told her but because she’s got that sixth sense like all mothers do. Besides, I am of age and slightly adventurous (for lack of a better word).
I gather I never put my parents in a place where they felt the need to have this conversation with me. I did after all grow up in a Muslim turned every Sunday church-going Roman Catholic home – where I obviously wasn’t having sex. My parents were right – not because I was holier than the next but the mere thought of them finding out crippled me. You see, growing up in an African home as exposed and worldly as my upbringing was, meant certain things were not discussed. This remains the case to date. My line of work has allowed me to converse intimately with young African women and girls, and their stories are similar. Sex talk is a no go.
When I started DynamitesMission – my awareness blog sponsored by UNAIDS and MTV’s Staying Alive – I wanted to lend my voice and extend my ear to the streets. I was learning about grassroots organisations and their efforts to educate their communities. I was moved and in turn spoke from my perspective – pretty layman but clear to other laymen.
A year in, I get a BBM from one of my best friends Michelle. It read, ‘ You’re trying to tell me that above all the heartache we take from these men, they also pass HPV (the virus that causes cervical cancer) to us?’ – I chuckled and said ‘ Yes Elle, they do – talk about short end of the stick’. Many women are unaware of cervical cancer and HPV, mostly about how exposed we are to the virus through our everyday interaction.
My first personal encounter with cervical cancer was in my early teens. My aunt was diagnosed with it at a very late stage and when her health deteriorated I remember wondering what she had done to deserve this and why the meds weren’t working. I kept asking my father – why she wasn’t getting better. Only to properly understand the severity as she passed away after being bed ridden for two weeks.
When a woman is diagnosed with cervical cancer in Tanzania there is a 70% chance she will not survive. Experts agree that the low survival rate is due to late diagnosis and treatment by a healthcare provider. It wasn’t until I was approached by GAVI that I found out that there now is a vaccine and that if administered early (before young women become sexually active) then we can ensure a brighter future for our women and decrease the numbers of cervical cancer cases.
Young women need to be aware of these opportunities that can be availed but most importantly the knowledge of HPV and cervical cancer – I truly believe these formative years will define their sexual reproductive health and nurture a generation of healthier women. It starts with open communication about sex and sexual reproductive health.
2013 is the beginning of a dramatic shift in women’s health. A record low price for a HPV vaccine has been negotiated by GAVI for the 50+ countries eligible for GAVI support (including my home country, Tanzania), opening the door for millions of girls in the world’s poorest countries to be immunized against a devastating women’s cancer.
This not only is the beginning of a shift in the overall eradication of cervical cancer but a new dawn for young African women around the continent. An opportunity that myself and many other young African women did not have.
It breaks my heart to see lives cut short due to ailments. In Africa these losses happen often and deprive our societies. It’s about time proper healthcare is administered for all, especially the future generation. GAVI is making this possible by pioneering the administration of the HPV vaccine. Giving my younger sisters a chance – that’s one less killer to worry about.
Find out more about the great news on the price drop for HPV vaccines on the GAVI Alliance website.
Why Now is the Time to Invest in Child Health
Ricardo Cortés Lastra is a Member of the European Parliament, and Chair of the European Parliament Delegation to the EU-Mexico Joint Parliamentary Group. He is an active member of the Development Committee where he acts as the Coordinator for the Group of the Progressive Alliance of Socialists & Democrats. He is also part of the Delegation to the Euro-Latin American Parliamentary Assembly.
This week we are celebrating World Immunization Week. What better occasion to look back on progress made, but also to look at challenges for scaling up and improving child health?
Every day 19,000 children die, mainly of preventable diseases, although the world has made progress over the last 25 years. A 40% reduction in child deaths from 12 million in 1990 to 6.2 million in 2011 demonstrates our ability to implement effective programs that have the power to save thousands of lives.
Nevertheless, most of these 6.2 million child deaths could be prevented through the provision of an integrated program of high-impact, low-cost interventions, especially focusing on maternal and child health during the first thousand days, from conception until the age of two.
This essential service package includes interventions such as pre- and post- natal check-ups, immunizations, promoting exclusive breastfeeding for six months and timely introduction of adequate complementary foods, access to treatment for basic childhood disease, and improved sanitation. If these interventions, which have been shown to be affordable and effective in reducing child mortality, are delivered at scale they could have the power to save millions of lives.
Investing in child health not only saves lives, it also makes sense economically. Because some of the most effective interventions are cheap to deliver and are implemented early in a child’s life, they have a very high return on investment (as the amount spent on the child will be very small when spread out over a child’s life). For example, encouraging exclusive breastfeeding for six months costs very little, but can reduce a child’s chance of death from diarrhea and pneumonia by more than half. Providing micronutrient supplements or fortified foods to children can reduce anaemia, which improves a child’s physical and cognitive development and allows the child to reach his or her full potential. It is estimated that maternal and newborn mortality costs countries nearly $15 billion in lost productivity. Countries with high levels of under-nutrition lose 2-3% of their GDP each year.
We know what works, and many countries have successfully reduced maternal and child mortality, as well as under-nutrition. Brazil managed to reduce stunting from 36.1% to 7% over a 20- year period by investing in an integrated programme (the largest cash transfer programme in the world), which included cash transfers to poor families with children on the condition they had their children vaccinated, participated in growth monitoring, and sent their children to school.
However, despite evidence that we know what interventions are effective, many countries are still struggling. Interventions that tackle only one aspect of health cannot effectively tackle child mortality. For instance, delivering improved nutrition alone will not improve a child’s nutritional status if they are constantly contracting diseases from poor sanitation.
We must scale up our support to global initiatives, such as the GAVI Alliance, that have shown their effectiveness. The GAVI Alliance helps strengthen routine health systems as well as increasing access to life saving vaccines in poor countries. In a complementary approach, we must invest in integrated health sector programs, especially while promoting free health care at the point of use for essential services.
If integrated, coordinated programs are implemented in an effective way, they will reach as much of the population as possible, including the poorest and hardest to reach. Again, Brazil is a good example, reducing stunting in the poorest segment of society from 59% to 11%. Interventions must reach the entire population, especially the poorest and most vulnerable, to effectively reduce child mortality and under-nutrition.
This is a once-in-a-generation opportunity to bring about a substantial decline in child mortality and improve child survival, thus breaking intergenerational cycles and helping to enable all people to reach their full potential. We need to show the political will necessary to ensure every child reaches his or her fifth birthday.
Meet Ghana’s vaccine king
Dr. K.O. Antwi-Agyei at the Ghana Health Service Disease control unit vaccination cold storage facilities in Accra, Ghana. Photo: Bill & Melinda Gates Foundation
This is a guest post from the Bill and Melinda Gates Foundation, originally published on their Impatient Optimists blog.
Dr. K.O. Antwi-Agyei manages the Expanded Programme on Immunisation in Ghana, where he oversees the day-to-day work to ensure vaccines reach children across the country.
Ghana’s health care system has put a lot of its resources into vaccines. Why?
We can see a lot of achievements in reducing child deaths by investing in delivering vaccines. The returns are high, so the politicians and policy makers are convinced that it’s worth investing in vaccines. That is why at least every year within our budget we ensure that we pay for all our traditional vaccines.
Our communities have also been great because they embrace vaccination. They even testify that “Oh, our children used to die from measles. Now with vaccination, we don’t see measles.” And of course, they allow our staff into their homes. There is trust. We can now return to the communities with other vaccination campaigns. It’s marvelous.
What impact have vaccines had on the health of Ghana’s population?
Around 1974, immunisation coverage was around 1.6 percent. Today, well over 90 percent of our population is covered by immunisation services, reducing the burden of disease.
For example, measles used to be the number two killer of children. Now it’s no longer a cause of death for the past 10 years in Ghana. So a lot has been achieved through immunisations.
Last year, you were the first immunisation chief in Africa to simultaneously roll out two vaccines, one protecting children against pneumonia and the other against rotavirus. Why did you decide to do that and, and what was the result?
Our desire to reach the Millennium Development Goal to reduce childhood death was a very big motivating factor. Apart from malaria, pneumonia and diarrhea are the two highest killing diseases. So we thought, if there is no vaccine against malaria now, and there are vaccines against pneumonia and diarrhea, then it’s worth fighting. So we decided to fight the two together. We thought it would be difficult, but not an impossibility. And with careful planning, we could succeed.
How important are Ghana’s community health workers in delivering the vaccines?
They are very important. The front line health workers, they are in touch with the communities. They help improve our public health services, not only through vaccinations but also by treating minor illnesses offering family planning and providing other health-related services.
How does Ghana use data collection to improve immunisation coverage?
Data is used for making decisions. If your data is not good, then of course your decisions will also be faulty, and you won’t be able to achieve your objectives. So a lot of effort has gone into data reporting. We developed tally and register books for the basic level so that they are able to pick the necessary data on children vaccinated, and also on what vaccines have been used. We firmly believe that if you won’t use the data, then don’t collect it. So once we collect the data, we use it. If a region’s coverage is low, we immediately ask, “What is happening there?” We go and investigate and then give us feedback. Then, whatever the error is, we discuss it and correct it.
What is your long term goal for Ghana’s immunisation program?
To reach the top is difficult, but to remain at the top is even more difficult. For Ghana, our goal is to remain as a leader in the area of immunisation and to show our commitment and to develop initiatives which can spread to other areas. Whatever is happening in other countries has a bearing on us. We want to have success stories which can be shared so that together we can get rid of diseases which are killing our children and mothers.
This week is World Immunisation Week. Find out more about how ONE is supporting access to vaccinations.
Join our Google+ Hangout on World Malaria Day
World Malaria Day is on Thursday 25 April, we’re marking it by inviting you to our Google+ Hangout where you can hear first hand from the people who dedicate their lives to fighting malaria around the world.
If no have no idea what a Google+ Hangout is and are about to click away, WAIT! It’s a really easy way to get people in different places all talking to each other on your screen. You can interact by posting questions and comments, or just sit back and enjoy. You can watch the conversation live on either Google+ or YouTube. Still with us? Good.
Together, our guests will cut through the clutter and answer questions like:
- I know it’s World Malaria Day, but why should I actually care about the disease?
- Control? Elimination? Eradication? What does it all mean, and how much progress are we really making?
- I’m not a scientist, a doctor or Bill Gates. What can I do about a problem that is so far away from my everyday life?
We promise there will be no jargon or complicated science—just the truth about this incredible global battle to save lives and how you can contribute to it.
Our resident global health expert Erin Hohlfelder will be hosting some special guests and talking about how we can eradicate malaria, the technology that’s available, current on the ground projects, the progress already made and the challenges ahead.
If you have a question for any of our guests, leave it as a comment below and we’ll try and answer as many of them as we can during the event.
On the day, you can join the hangout on Google+ or YouTube. RSVP and let us know if you can join.
Good news! Price of vaccinations for 5 deadly diseases to drop
Children playing at break time at Mwangaza Tumaini school in Kenya. Vaccinations mean more children stay healthy and in school for those essential early years of learning. Photo: Morgana Wingward
Today the GAVI Alliance announced that the cost of immunising millions of the world’s most vulnerable children against five deadly and debilitating diseases is set to fall, thanks to a major price reduction of one third for pentavalent vaccine.
Pentavalent vaccines target five infectious diseases (diphtheria, tetanus, pertussis, hepatitis B and influenzae type B) in a single shot.
GAVI, which uses an innovative public-private partnership model to introduce new and affordable vaccines to children in particular in the poorest countries, secured a supply agreement with Biological E Ltd of India, which makes the five-in-one shot available to GAVI for just US$1.19 per dose, compared to the 2012 price of US$2.17.
By the end of the year, an additional 200 million children will be protected from five deadly diseases, and US$ 150mn will be saved over the next four years. By 2020, more than 7 million deaths can this way be averted.
Back in 2011, ONE members played an important part in ensuring that donors gave GAVI the funding it needed for its 2011-15 funding cycle. Having ensured this funding is a feat in itself, but the rewards – millions of lives saved – is an achievement worth celebrating. Thank you!
The announcement comes shortly before the Global Vaccine Summit that will be held in Abu Dhabi on 24-25 April, during World Immunisation Week. We’ll be sharing at the latest news from the summit next week, plus featuring stories from all our partners working on the front line of vaccinations around the world.
The world is only a few cases away from killing polio forever
Today’s guest blogger is Stephen Brown, Campaigns Manager at Global Poverty Project UK.
A little under a month ago Britain became the first G8 country to spend 0.7% of its national income on aid and development. After years of campaigning this historic achievement was reached despite a domestic agenda of public sector cuts and high unemployment.
We can point to hundreds of people, moments, organisations and statistics that could claim some responsibility for making it all happen. But the greatest demonstration of ‘good aid’ must be the huge strides we’ve made in the eradicating diseases like the Poliovirus, which has been reduced by 99% and now exists in only three countries – Pakistan, Afghanistan and Nigeria.
Right now, this week, we have a chance to go even further than just reducing the number of polio cases – we have the opportunity to completely eradicate the second-ever human disease in history.
The last time a child was paralysed in the Americas was over 20 years ago and Europe was declared polio-free in 2002. But this huge progress is threatened.
Next week, at the Global Vaccine Summit in Abu Dhabi, the Crown Prince of Abu Dhabi, UN Secretary-General Ban Ki-moon and Bill Gates, will host world leaders and representatives to announce new funding commitments that will help us rid the world of polio.
Failure to act on this plan and commitment could lead to an estimated 200,000 paralysed children a year within a decade. Nonendemic countries remain at risk for cases easily imported from the remaining countries so immunisation must continue everywhere to ensure that polio is eradicated worldwide. It is now a leadership question of political will and public pressure.
Countries like the UK, US and Canada have been huge supporters of polio eradication so far and whilst many of them recognise the significance of the opportunity before us, we are yet to hear any firm funding commitments. If we are to finish the job, we must exert some public pressure and call for multi year commitments from each. If countries like the UK, for example, commit to five years of funding experts are confident that will unlock other contributions and take us down the path of complete eradication.
At the Global Poverty Project we’re working with our global partners, including the ONE Campaign, to make enough public noise around polio – in the hope this will convince the UK government and others to commit to making polio the first disease to be eradicated in the 21st century – a fantastic legacy for our aid spending.
The world is only a few cases away from killing polio forever. Help make it happen by signing The End of Polio Petition calling on world leaders to finish the job by making funding commitments that will see a polio-free world.
High blood pressure in Africa? New trends on World Health Day
This post is by Katri Kemppainen-Bertram, ONE’s Policy Associate on Global Health.
Today is World Health Day and this year’s theme is high blood pressure – not something you often hear about at ONE.
It’s an issue that is mostly seen as a rich world disease, whereas infectious diseases (such as HIV, tuberculosis or malaria) are associated with developing countries. However, health issues like heart disease, cancer, asthma or diabetes (so-called non-communicable diseases, or NCDs) are also on the rise in Africa.
By 2030, NCDs are projected to be the main cause of death in Africa. So inevitably, they will represent a growing set of challenges for the global health community and the world’s poorest countries.
A mother and her baby at a HIV testing clinic in Cote d’Ivoire. Photo: Olivier Asselin
Today is also a time to for us to reflect on some immense achievements that have been accomplished in global health in the past years. Coinciding with the last 1,000 days before the 2015 expiration date of the Millennium Development Goals (MDGs), we should think about we’re heading in the years – and decades – to come.
Many of the current MDGs focus on the most pressing health challenges in the developing world such as AIDS, TB, malaria, and maternal and child deaths. ONE has just published a report on how far we have come on those goals– and how we can sprint to the finish line in 2015.
Sprinting to 2015 is vital, but people working on development – and people living in developing countries, will not stop then. A second date looms in the future: 2030, the target date for the next MDGs. A change in disease burden around the world – and how we are able to combat these health problems – is part of what is currently being discussed. What is realistically achievable – in a cost-effective way that targets those most in need – poses another set of questions.
Each sprint, and every long race, consists of many, many single steps. Our health challenges and the work we do to combat them may look different in two years or two decades, but fighting to significantly reduce or even eradicate deaths from both infectious and non-communicable diseases will inevitably be an important global effort for years to come.
Why women and girls are the secret weapon in ending poverty
To celebrate International Women’s Day we’ve picked some of our favourite images and matched them up with facts to show why investing in women and girls is so important here at ONE.
Pupils at Kidoti Primary School in Zanzibar, Tanzania. Photo: Morgana Wingward / ONE.
Women farmers growing sweet potatoes in Tanzania. Photo: ONE.
An employee picking roses at Golden Rose Agrofarms in Ethiopia, where 85% of the workers are young women who have never had a job before. Photo: Morgana Wingward / ONE.
Liberian President Ellen Johnson Sirleaf meets with ONE representatives at the Foreign Ministry in Monrovia. Photo: Morgana Wingward / ONE.
A mother and her baby at a breastfeeding clinic in Ghana. Photo: ONE
Join us in celebrating International Women’s Day by sharing this post with your friends and family.
And make sure you tell the women and girls in your life that they are awesome.
Sources
Education: United Nations Population Fund, State of World Population 1990; UNESCO Education Statistics; UNICEF, Millennium Development Goals: Promote Gender Equality and Empower Women
Agriculture: IFAD (2001) Assessment of Rural Poverty: Western and Central Africa; The Chicago Council on Global Affairs, Girls Grow: A Vital Force in Rural Economies; USAID, Women in Development: Country Snapshot: Kenya and Agriculture & Micro-enterprise
Employment: Phil Borges (2007) Women Empowered: Inspiring Change in the Emerging World. New York; World Bank (2008) Doing Business: Women in Africa; United Nations Development Programme
Politics: D. Dollar, R. Fisman and R. Gatti, Are Women Really the ‘Fairer’ Sex? Corruption and Women in Government, Policy Research Report on Gender and Development Working Paper Series No. 4; Africa Progress Report (2012) Jobs, Justice and Equity – Seizing Opportunities in Times of Global Change
Health:UNICEF (2009) State of the World’s Children: Maternal and Newborn Health; UNAIDS (2012) Together We Will End AIDS; WHO (2012) Trends in Maternal Mortality: 1990 to 2010
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About the Blog
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.
The content of each post and each comment represents the views of that author and does not necessarily reflect the views of ONE. ONE does not support or oppose any candidate for elected office, and any post expressing support or opposition for a candidate is not endorsed by ONE.
TAGS: Africa, Agriculture, Aid Effectiveness, DATA Report, Development Assistance, Education, Food, Governance and Security, Health, HIV/AIDS, Immunisation, Maternal and Child Health, Millennium Development Goals, SMART Aid, Transparency, Vaccines