We’re here to try and ensure that preparations for this year’s World Health Assembly reflect Save the Children’s priority issues.

The Board discussed two new papers prepared by the WHO on the importance of nutrition for the health and wellbeing of women and children.

Well received plan

One of the papers included an implementation plan for maternal, infant and young child nutrition, which was well received by the Executive Board and other member states.

There was broad consensus that the problem of malnutrition needed to be tackled in order to achieve the Millennium Development Goals and to improve the health, development and productivity of populations.

My chance to speak

I had the opportunity to make a statement in front of government officials from around the world and the WHO’s Director-General. This was nerve-wracking! But it was a great opportunity to set out some of our positions on nutrition.

I said that progress on nutrition has been far too slow and as a result 300 children die every hour from malnutrition-related causes and an estimated 178 million children have stunted growth.

I said that Save the Children welcomed the new plan and the WHO’s efforts to establish bold targets for reducing malnutrition and stunting.

I commented that the plan could be strengthened by having a greater focus on reducing inequities in the nutritional status of women and children within countries.

For example, they should make sure that the indicators chosen to measure progress are designed to ensure that the poorest and most marginalised groups are not left behind.

The global health worker gap

I also proposed stronger language on health workers.

Having enough fully trained and supported health workers is essential for preventing and treating malnutrition, yet the current draft of the report makes no reference to the global health worker gap.

I was really pleased that the delegation from Canada echoed our calls for equity, stronger health workforces and for further information on how WHO calculated its global nutrition targets. Ours were the only interventions that made explicit reference to these issues.

Comments taken on board

The WHO Director General concluded the session by calling for the plan to be revised based on the comments received today and for a background paper to be produced setting out the rationale for the global targets.

The plan will then be made available online for further consultation before being submitted to the World Health Assembly in May.

This was a great outcome for the first day of the Executive Board meeting. I hope the rest of the week will be as productive!

Save the Children UK is one of the major health partners in Kalela district.

Headed by Senior Health Officer Ato Beyene Yirga – the most skilled health worker in the district, Kalela Health Centre has 37 staff.

For this reason, it is the referral health centre for the whole district, which has a population of almost 150,000 people.

Five other district health centres, each serving a cluster of kelebe (neighbourhood) health posts within their catchment areas, feed into the Kalela centre.

As a result, the staff at Kalela were desperately in need of more space.

A new unit for women and children

In response, we recently supported the construction of a new reproductive, maternal, newborn and child health unit at Kalela, which means many more patients can be seen every day.

Tibebu Girma, and Sister Adefash Gdaffi — the two senior clinical nurses — kindly showed us around with several other colleagues.

Here’s a picture of Tibebu at the new outpatient clinic for children under the age of five.

We heard of the ongoing challenges they face:

Drug shortages

At the health centre, the top three causes of illness in children under five are diarrhoea, parasites and pneumonia.

Yet, the drugs to help treat such conditions are unavailable because of budget constraints.

Unlike vaccines and long-term contraceptives — which are provided directly by international donors free of charge — oral rehydration salts, de-worming pills and antibiotics have to be purchased on the facility’s budget.

Since the Government of Ethiopia’s recent health financing reforms, facilities are responsible for covering the costs of maintenance, drugs and supplies, through raising revenues from charging user fees.

In Kalela, few households can afford these fees. As a result, the income raised is inadequate, and shortages of essential drugs and supplies prevail. Facilities in poorer areas, with fewer paying patients and a higher burden of disease, will suffer more.

A malnourished child is far more vulnerable to disease. In Kalela, malnutrition is endemic, yet there are no therapeutic feeding facilities available.

Better skills to serve the people’s needs

The second most important challenge is insufficient skills amongst the health workers.

Tibebu was enthusiastic for additional training so that he and his colleagues could provide better quality care.

Safe delivery and the integrated management of childhood illnesses were priority areas.

Long distances but limited transport

Transportation was cited as the third major challenge that Tibebu and his colleagues face.

If Kalela had more motorbikes, the health workers at the centre could undertake their essential roles in providing supportive supervision to Health Extension Workers based in the kebele health posts within their cluster, conducting monitoring and evaluation, as well as outreach.

The one ambulance that the health centre has — which was donated by a non-governmental organisation — is insufficient to support the many patients who are referred from across the district.

More concerning is the fact that poor patients cannot afford to pay for the fuel and driver, and are thereby denied access to the ambulance.

The effect on children

Whilst we were at Kalela, a child arrived on a stretcher constructed using scraps of wood and cloth, having been referred from another health centre.

He was carried by two men, with a third holding an umbrella to shade the sick patient from sunlight and rain. They had walked for many hours.

It is because of poverty that this boy was slow to access care.

Support our campaign for more health workers

What they really wanted, was CHANGE.

They wanted to stay true to their campaign’s slogan: “Mama en pikin welbodi na ol man biznes“, meaning ”Women and children’s health is everyone’s business”.

So they turned the question on its head and asked their supporters:

What do you plan to do to improve women and children’s health in Sierra Leone?

The result was this video — and hundreds of other pledges made on the day, as people took the streets to show the government they were serious.

The message was simple but effective:

Women and children are dying.

This is unacceptable.

Working together, we can stop this.

Here’s what we plan to do, now you tell us what YOU plan to do.

The Ministry of Health is currently responding to the recommendations of Sierra Leone’s EVERY ONE campaign but more importantly, the people of Sierra Leone are taking this issue to their villages, streets and homes.

No mother or child should die from preventable causes.

Support our campaign to fill the global shortfall of health workers

They have spoken out loud and clear. Women and children in poor countries must have access to a trained and supported health worker.

Midwives unite

More than 5,000 midwives from 76 countries have signed a petition calling on leaders everywhere to show bold leadership and put midwives and other health workers at the heart of efforts to improve the health of mothers and their children.

When world leaders meet at the UN General Assembly this September to measure progress on the global strategy for women and children’s health, midwives are calling on them to take action and strengthen or increase their commitment to the education, recruitment and retention of midwives and health workers.

All around the world

The petition began as a joint initiative between Save the Children, the White Ribbon Alliance and the International Confederation of Midwives (ICM).
 
The first signatures were collected at the annual conference of the ICM, held in Durban in May. Impassioned midwives took the petition back to their home countries and called on their colleagues to join the call for more health workers.

In Nigeria, a rally for midwives was held and those who attended were asked to add their voice. In Tanzania, the local midwives association crossed the country with the petition, explaining the opportunity to midwives and garnering their support.

Now the signatures have been collected, midwives are making sure that the petition reaches the people who can bring about the changes they are looking for. Handovers are currently being organised in countries all over the world and some have already taken place.

Uganda takes action

In Uganda we handed over the petition to the Speaker of Parliament. As a result of the petition, the Social Services Parliamentary Committee has identified 34 billion Ugandan shillings ($12 million) in the health sector budget to be re-allocated to recruiting and retaining health workers with a focus on midwives. The government of Uganda has put this up on their website. 

Read about the hand over of the petition in Uganda

UK promises support
 
Yesterday the petition was handed over in the UK to DFID Minister Stephen O’Brien by Frances Day-Strik, President of the International Confederation of Midwives, and representatives from the White Ribbon Alliance and Save the Children.

Read Louise Holly’s blog post about delivering the petition to the UK government.

Grabbing headlines in Sierra Leone

In Sierra Leone, we worked closely with the Sierra Leone Midwives Association, gathering around 370 signatures. The petition was presented to the Minister for Health and other government officials, along with our policy paper on midwifery.

In Sierra Leone the petition was launched at a press conference at the Children's Hospital in Freetown.

In Sierra Leone, the campaign was covered in five newspaper articles, six radio discussion panels and two TV interviews.

Just the beginning
 
Deliveries of the petition have also taken place in Liberia, Japan and Nigeria. The details of each handover will be circulated soon. Handovers are being prepared for the coming days and weeks in Kenya, Tanzania, Canada, Australia, India, Malawi, Pakistan, Bangladesh and the USA.

Read our Missing Midwives report

Support our campaign for more health workers

After the huge success of the Pledging Conference in London last month, we need to make sure donors also recognise the (much more difficult) challenge of building health systems in developing countries.

Save the Children threw its weight behind the GAVI Pledging Conference and, alongside many other NGOs and civil society groups, helped to ensure that the target for pledges was exceeded and $4.34billion was pledged on 13 June.

Measurable

The fact that the GAVI board and donors recognise the important role that we all played needs to give us increased influence.  GAVI already has strategies and approaches which Save the Children strongly supports – see our report here.

They already see the need to help countries deliver vaccines, not just buy them.  This is why they are putting together a Health Systems Funding Platform.

Donor governments like the UK are very attracted to supporting vaccines because vaccines are clear, measureable products.

Vaccination is a quick intervention with lifelong benefits. The funding goes to a Geneva-based institution rather than straight to developing country governments. The donors can attribute specific results as a link between how aid money is being spent and outcomes.

More than vaccines

However, to improve child health, as well as to deliver vaccines, donors need to be doing things which are much more complicated and more challenging.

Historically, the UK has been a leader in getting donors to pool their money to support health systems. They led initatives like the International Health Partnership+ which aims to put funding behind government-led health plans.

Much of this is difficult to measure. It is risky as it gives money directly to the governments of poor countries. It is very hard to show results which can be attributed to UK money, especially as it is pooled with other money.

Functioning systems

However, it is incredibly important. Poor children in poor countries need functioning health systems, with enough staff properly paid, with sufficient funding and the right principles for universal access.

If these were in place, they would be able to ensure vaccination, maternal and newborn care, HIV treatments and deal with the thousand other problems that health services must cope with.

The money that GAVI has for this purpose is a small drop. Donors now need to take proper action to ensure sustainable health systems and accept that showing simple outcomes from their spending is not always possible.

Leaders from around the world gathered at a summit for the Global Alliance for Vaccines and Immunisation in London. They had to decide whether or not to fill a $3.7 billion funding gap that would provide vaccines for 250 million of the world’s poorest children. This will save 4 million children’s lives – a phenomenal achievement.

Massive success

Four hours later Andrew Mitchell, the UK’s international development secretary, announced to the world’s amassed media that GAVI, and our campaign to save 4 million lives, had smashed our target reaching a total of $4.34 billion dollars; $600 million more than the target.

UK Leadership

Prime Minister David Cameron set the pace of the summit when he announced in his opening speech, that: “In addition to our existing support for GAVI we will contribute £814 million pounds of new funding up to 2015. This will help vaccinate over 80 million children and save 1.4 million lives.”

Through the morning more and more leaders pledged hundreds of millions of dollars. On the day following his global campaign call with usBill Gates seized the moment and announced a contribution from The Bill and Melinda Gates Foundation of $1bn.

Saving lives

Save the Children’s chief executive Justin Forsyth responded to the great news by saying:

“By pledging more than expected, leaders have given a huge boost to the world’s poorest children.  Millions will now survive common childhood illnesses like pneumonia and diarrhoea, enabling them to grow up and fulfil their potential.

“UK leadership has been critical to this success, but as David Cameron said today, promises to the world’s poorest have to be kept.

“The hard work begins now to keep these historic commitments on track and make sure the vaccines get to the children who need them most.”

Next steps

This funding is a huge step forward.

We now need to make sure that the funding is spent as best it can be and reaches those children who need support the most.

In today’s press conference Bill Gates said that he ‘thinks of it in terms of equity’ for him it’s incredibly important that the vaccines he and other donors are paying for reach the poorest, most marginalised children in the world.

We also need to ensure that commitments at today’s conference to use GAVI mechanisms to continue to drive down vaccine prices are followed through in order that this vital work continues to get more and more effective.

(To listen to our Global Campaign Call shown above click here.)

Finally we need to make sure that the health workers; nurses, vaccine delivery people, doctors and more, are in place to get those vaccines into the children that need it most.

GAVI needs to ensure that at least $600million supports health systems including recruiting, training and retaining those health workers; because vaccines don’t inject themselves.

When I started blogging 15 months ago I didn’t believe that my little voice would bring me all the way to Mozambique. I never dreamed that one of my blog posts would be scooped up by the Bill and Melinda Gates Foundation and featured on their front page. I would’ve laughed if you had told me that I would be going to Downing Street next week to present our petition to the Prime Minister.

My little voice.

Standing up and being counted.

Sign it, now and ask all your friends to do the same. Encourage your children to sign it too for all the children in the world who don’t get vaccinated, then their voices will be heard too.

This is why.

Today I followed our vaccine on the next and final stage of his journey (he’s been tweeting as @MrVaccine, he’s a bit cheeky but he does a good job).

We visited the district health clinic in Guija and a wonderful woman called Mary of the Pains showed us how women receive healthcare  information with the use of her faithful flip chart.

We had a look at the vaccine fridges and watched as our vaccine was packed into his little box for the journey out to the village. He whizzed off and I got to follow him riding pillion!

I shall never complain about potholes in Somerset again, I did have to cling on pretty tightly but it was wonderful to be bumping along through open country rather than being confined to a jeep. My bottom may be bruised but it was the ride of a lifetime!

We arrived in April the 7^th village (April the 7^th is national women’s day in Mozambique) to find women already gathered at the health clinic under a tree.

They queued as I queued with mine, waiting to have their babies weighed and passing the time of day with the other mothers.

Babies and small children were weighed just as mine were.

If you are still wondering if signing the petition is worth it these should sway you.

This is the little girl who got our vaccine.

Isn’t she worth it?

Are they?

I had a fantastic day looking at what aid does best, this is where it works and it needs to be allowed to do more.

(I have more to say about today but I have been up since 5am it is now 10.45pm and I have other stuff still to do!)

Chris Mosler is one of three ‘Mummy bloggers’ currently visiting Mozambique with Save the Children to follow the journey of a vaccine. Her blog is called Thinly Spread. 

Follow the mummy bloggers’ journey, learn more about it, and tell world leaders they have 4 hours to save 4 million lives when they meet to decide vaccine funding on 13 June 13.

Naturally, civil society observers are only entitled to speak after the official government delegations have spoken, although oddly, we usually speak when it is too late to influence the decision. The topic under discussion is a progress report on the Global Immunisation and Vaccines Strategy (GIVS). There is no overt disagreement on this – no-one is against vaccines of course. In fact, for these health ministry officials, overseeing vaccination programmes is their core business. However, there are important subtle differences emphasised in their speeches. Some countries are stronger than others in their call for the price of vaccines to be driven down. Some countries have more anxiety about the sustainability of vaccines that are introduced with donor money. Some countries want to really emphasise the need to support production by manufacturers from outside Europe and America. Some countries want to question why GAVI support is only available to the poorest countries and are arguing that the criteria could be changed.

What is clear is that there is strong support for GAVI, alongside lots of discussion about building on its success so far and maximising its resources by improving efficiciency. When I get called to speak, I want to mention the need for some other key donors to join the UK government in pledging substantial funds to GAVI. In particular, France, Germany and the United States. But I will also mention the importance of disaggregating data by wealth so that we know whether the poorest children are getting vaccinated. And a very important reminder is that buying vaccines is one small part of the story. Donors need to be reminded that support poor countries to build health systems and employ health workers is vital if vaccines and other health interventions are going to reach the poor.

UPDATE: So many countries wants to speak that the WHA ran out of time today. Apparently finishing this off will be the first discussion tomorrow morning.

We were approached by Tanzanian Midwives Association (TAMA) only last week to help them organise events around the International Day of the Midwife on 5 May. The deadline was short, but it was such a pleasure working with them. We recognised that there was a common goal and commitment to saving newborns’ and mothers’ lives, and common understanding of the importance of health workers.

TAMA was impressed by our Every One campaign and provided us with an opportunity to collect thumbprints from participants during the conference they were organising, and invited us to make a speech about the campaign. We happily accepted, but didn’t really see what was coming…

Stopping traffic

Today, we joined TAMA and many other organisations for the march in Dar Es Salaam, stopping traffic and drawing people’s minds to the issues of preventable maternal and newborn deaths, and the need for midwives and family planning. The banners, brass band and dancing while walking certainly helped.

Finally, we came to Mnazi Mmoja grounds where the official programme started, with speeches from TAMA representatives, music, dancing and drama.

But it was when our Health Programme Manager, Dr Rachel Makunde, gave a speech that we could see media representatives coming quickly, taking notes, cameras flashing. Dr Makunde talked about the 1.3 million mothers in Tanzania who give birth without skilled birth attendants, about the 13,000 mothers who die during childbirth every year, and about the 50,000 babies who die before reaching their first birthday. She called on the Tanzanian government to act and ensure recruitment, training, retention and deployment of midwives and other health workers in order to close the gap of 88,700 health workers: every child has a right to live and every baby needs a midwife.

Support for midwives

Around 500 people listening to her cheered their support.

Dr Donald Mmbarado, a representative of the Ministry of Health, provided his thumbprint in support of our Every One campaign, adding to 222 thumbprints collected at the rally. He also gave a speech on behalf of the Ministry of Health where he promised to improve working conditions for midwives. He informed midwives that the ministry will be providing delivery kits to all health centres and delivery packs for supporting deliveries outside of health facilities. He recognised that the ministry needs to work more on community awareness and called for improved birth registration.

Spreading the message

During this time, we kept collecting thumbprints. Obviously inspired, famous Tanzanian artist Mrisho Mpoto, who was entertaining participants at the rally, took our thumbprint collection poster and went among the crowds to get their support, singing about Every One, the Millennium Development Goals and Save the Children.

The event ended with Dr Makunde giving final interviews to TV stations as we left the grounds. The small Save the Children team couldn’t be happier. We all felt that we really contributed to spreading the message that will eventually help to save children’s lives.

Dragana Strinic works for Save the Children Tanzania

The day after our arrival there was a very colourful race where every participant running seemed cheerful and joyous. Health messages rang out over microphones fixed on vehicles, and as runners passed lake Hawssa, the cold air from the lake helped refresh them.  

In the middle of the 7k race, I saw one girl of about 11. She looked very tired, and had slowed down to a walk. Someone threw her some words of encouragement and she said “yes, I’ll keep running and finish the whole race”. What motivation! I was really inspired by her enthusiasm.     

Renewing our our motivation and commitment

I strongly believe this campaign has great importance for countries like Ethiopia, in raising the awareness of the general public that they have the right to use health services. This simple message has the power to save the lives of mothers and children.

Ethiopia’s maternal mortality is showing significant reduction over the last five years; from 673 down to 590 deaths per 100,000 births between 2005 and 2010. This indicates that there’s better use of health services now than in the past.

Child mortality is also declining. But the figures are still too high and totally unacceptable, and there needs to be much more consolidated and strengthened effort to tackle them.

Keep running to the finish line

That little girl decided: “no matter how long it takes, I will finish the race”. I think we have to say too, that whatever time and resources it takes, we have to reduce these figures, and it really is possible with the continued political support, with the generous help of supporters, and of course with the efforts of motivated and dedicated health workers.

Read more about vital health workers and join our No Child Born to Die campaign — part of the global EVERY ONE campaign to save childrnen’s lives.