Save the Children's Global Experience is Moving the Needle for Children's Survival
For 100 years, Save the Children has worked to address the root causes of preventable child deaths, and has in total reached over 1 billion children. The fundamental driver of our success in leveraging profound change in their lives is our theory of change.
The theory of change focuses on four key strategies to scale up our most successful programs and create maximum impact for children: we are the innovator with evidence-based, replicable best practices; we elevate the voice of children through advocacy; we build partnerships with real stakeholders including communities, governments and civil society; and we implement effectively to achieve results at scale.
We believe we have enough strong documentation of the theory’s practical application to use it as the blueprint for tackling healthcare-acquired infections through BASICS – and that with it, BASICS will become a global movement.
The Evidence on Which We Base Our Confidence
We’ve done projects similar to BASICS before – such as Saving Newborn Lives and our work replicating the Integrated Community Case Management approach to prevent needless deaths of children under age 5. Each has created international momentum, brought partners at the country and global levels to the table, and has contributed to institutionalizing significant changes in how countries address newborn and child survival.
This track record leads us to believe that BASICS will be a success with the right kind of funding.
Saving Newborn Lives
We launched Saving Newborn Lives in 2000 with support from the Bill & Melinda Gates Foundation by assessing the state of newborns in eight countries and developing the Lancet series on newborn health in 2005. Saving Newborn Lives is completing its second decade of researching, implementing and scaling up evidence-based, newborn survival interventions and improved measurement in low- and middle-income countries with high neonatal mortality. Over 35 Save the Children country offices in Asia, Africa, Latin America and the Middle East have implemented elements of the program to help governments, policymakers and multi-lateral agencies ensure that newborns and mothers have access to lifesaving care.
Here are three examples of how Saving Newborn Lives has influenced governments to institutionalize these elements:
- In Nepal, we contributed to the development of several national policies and plans and supported the national roll-out of newborn care interventions and packages in collaboration with the Ministry of Health and Population and others. With our support, newborn health in Nepal is well-reflected in many health policies and plans.
- In Bangladesh, we brought government and professional organizations together to advocate and mobilize commitment around newborn health. We showed key Bangladeshi government officials that effective implementation of a national program for newborns was possible, and we were instrumental in formal approval of an action plan for the national neonatal health strategy. Following a district-level pilot by the government with Saving Newborn Lives’ support, the government is now implementing and scaling up a national newborn health plan.
- In Ethiopia, India and Nigeria, Saving Newborn Lives has helped to develop and inform policies, program experience and evidence to promote sustainable scale-up of interventions. In India, it contributed to piloting guidelines for the management of neonatal infections at lower-level facilities, leading to changes in national guidelines. In Ethiopia, lessons learned led to the rollout of the national Community-Based Newborn Care strategy and a recent realignment of national newborn and child health strategies to complement one another. In Nigeria, we carried out and assessed the implementation of the Kangaroo Mother Care method for premature babies, leading to commitments to improvements in hospital services.
Through Saving Newborn Lives, we’ve also generated evidence that applying Chlorhexidine (CHX) to a newborn’s umbilical cord on the day of birth significantly reduced all-cause neonatal mortality in Bangladesh. Together with similar studies from Nepal and Pakistan, this provided the evidence for the World Health Organization to recommend CHX as a life-saving intervention. Save the Children has since been one of the global leaders to facilitate policy adoption, introduction, and implementation of CHX cord care, with adoption and implementation in nine countries.
More than any other agency, we’ve contributed to an understanding of what can be done affordably and sustainably to save newborn lives in low-resource, high-mortality settings. We’ve put newborn health on the global map.
Integrated Community Case Management (ICCM)
Integrated Community Case Management (ICCM) helps prevent the tragic, needless deaths of children under age 5 by training, supporting and supervising local frontline health workers and volunteers to deliver health services in remote communities. These dedicated women and men extend the reach of public health services to places far from the nearest health post – they diagnose and treat children with pneumonia, diarrhea and malaria, and refer severe cases to the nearest health facility.
We were one of the first organizations to support governments to implement iCCM programs, among them Nepal, Ethiopia, Mozambique, Pakistan and Nicaragua. In total, over 17 years we’ve supported ICCM’s rollout in over 20 countries to aid the diagnosis and treatment of these diseases, and the diagnosis and treatment of malnourished children. Our teams partner with ministries of health to ensure that ICCM services are accessible, high quality, in demand by the community and supported by national policies. The main element of success has been institutionalization of these elements; for example:
- Nicaragua: Our decade-plus of working with the Ministry of Health led to the Ministry adopting ICCM as national policy for all rural communities at least two hours from the nearest health facility. Our collaboration has documented decreases of over 50% in the rates of child mortality due to pneumonia, diarrhea and dysentery in participating areas.
- Ethiopia: We’ve worked with the Ministry of Health to scale up ICCM in five regions, strengthening the capacity of 9,500 health workers and their supervisors to cover a population of 5.1 million children. We demonstrated that those trained in ICCM provided quality care at scale in a remote area of Ethiopia, which encouraged the government to integrate ICCM into its Health Extension Program.
- Globally: We’ve supported the expansion of the role of community health workers to address other maternal and child health needs, and are steadily building the evidence base for the institutionalization of newborn case management into the ICCM package. This includes documenting and disseminating the results of training, conducting trials on the treatment of possible serious bacterial infection in newborns and by advocating with national government for policy change and scale up.
As the lead member of BASICS, Save the Children is on familiar ground. As our Saving Newborn Lives and ICCM experiences demonstrate, we have the roadmap we need to take BASICS from ambition to global impact.
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