MATERNAL, NEWBORN AND CHILD HEALTH: CANADIANS DELIVER

www.savethechildren.ca

As the world’s leading independent child rights organization, Save the Children’s mission is to inspire breakthroughs in the way the world treats children, and to achieve immediate and lasting change in their lives. We work to create a world in which every child attains the right to survival, protection, development and participation.

Save the Children Canada is a member of Save the Children International, a network of 29 member organizations raising funds and operating programs in 126 countries, including Canada, focusing on the issues of health and nutrition, education, HIV and AIDS, child protection, livelihoods and food security, emergency relief and child rights governance. Learn more about our work at www.savethechildren.ca.


PHOTO TOPCredit: Naomi Kalemba/Save the Children

PHOTO OPPOSITECredit: Naomi Kalemba/Save the Children

This project goes beyond helping children access medicine and treatment,it is also building a health workforce to benefit the country after Save the Children leaves.

Chisomo, the village health worker, visited Mercy Benson and her children as often as he could. The family couldn’t afford much food, their drinking water was unsafe, and they had no access to sanitary cooking facilities. Chisomo was especially worried about Anthony, the youngest, who had been sick with malaria and diarrhea.

Because of the training and support provided by Save the Children, Chisomo was able to help Mercy and her children. He treated Anthony’s malaria and diarrhea. He also taught Mercy the nutritional value of the staple foods she could afford so she could maximize the quality of the meals she prepares for her family.

Chisomo checked back with the Bensons a few weeks later: “I noticed great improvements!” he said. “The family responded to my advice. They improved their hygiene to prevent diarrhea. Anthony is no longer malnourished. And I was very pleased to see Mercy breastfeeding during my visit.”

How Save the Children works

Every year, nearly 7.6 million children—nearly half of them newborn babies—die needlessly. The main killers are malaria, pneumonia, and diarrhea, and the tragedy is that these diseases are easily prevented and treated. Children could survive if only they had access to things like basic health care, nutritious food, and vaccines.

EVERY ONE is Save the Children’s global response to save the lives of millions of children under 5 each year, along with the mothers who are dying in childbirth due to lack of a skilled birth attendant.

One of Save the Children’s key strategies to address child mortality is “Community Case Management.” This is proving very effective in the countries where it has been implemented: Malawi, Mozambique, and South Sudan.

Community Case Management involves training community health workers in remote communities. These frontline workers provide life-saving treatments for common, but life-threatening, childhood illnesses and malnutrition.

2011 results

Save the Children’s work in Malawi provides a snapshot of the Community Case Management approach. Results in Malawi include:

Training 838 community health workers to provide frontline care in remote villages Health workers treated 718,000 cases of malaria and pneumonia among children under 5A mid-term evaluation found that people considered the village clinic to be a valued resource. Mothers trusted in the quality of care they received

The success of the work in Malawi in 2011 led to the project’s expansion into Mali and Pakistan in 2012.

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Health Worker Helps Malnourished and Sick Baby

PHOTO TOPCredit: Naomi Kalemba/Save the Children

PHOTO OPPOSITECredit: Naomi Kalemba/Save the Children

www.plancanada.ca

Founded in 1937, Plan is one of the world’s oldest and largest international development agencies, working in partnership with millions of people around the world to end global poverty. Not for profit, independent and inclusive of all faiths and cultures, Plan has only one agenda: to improve the lives of children. Because I am a Girl is Plan’s global initiative to end gender inequality, promote girls’ rights and lift millions of girls – and everyone around them – out of poverty. Visit www.plancanada.ca and www.becauseiamagirl.ca for more information.


Plan Canada’s Continued Commitment to the Health of Women and Children Through the Muskoka Initiative

Shruti’s Story:Shruti is 24 years old and born into a poor family in rural Bangladesh. Married off to a local labourer at a young age resulting in a divorce, she then remarried a man many years her senior and soon became pregnant.

Like most women in her village, she received no critical antenatal care (ANC). An untrained traditional birth attendant conducted the home delivery. The consequences were dire – Shruti suffered a prolapsed uterus and severe bleeding, and her baby died during delivery.

Within a year, Shruti got pregnant again but continued to have occasional vaginal bleeding. Jobeda, a Community Health Worker from a Plan Bangladesh, convinced her to join a health information session for women. Shruti soon felt comfortable confiding in Jobeda and started to visit the Family Welfare Centre where she was diagnosed with a uterine problem and anaemia. Although she was advised to return for regular ANC visits, Shruti faced barriers including an unsupportive husband and mother-in-law and demanding household responsibilities. During her eighth month of pregnancy, she became unconscious due to vaginal bleeding. She was resuscitated at the Family Welfare Centre then referred to her sub-district Health Complex where Jobeda joined her and convinced her husband to admit her. After seven days Shruti delivered a healthy baby.

Shruti has suffered, but she is a survivor – in large part due to the unfailing support of her Community Health Worker, Jobeda. Shruti and her child are now healthy, and she has adopted family planning. She now advises other pregnant women in her neighborhood on the importance of ANC and hospital delivery by a skilled attendant.

Plan Canada’s Commitment to Maternal and Child Health Care

Shruti is just one example of the many women that Plan Canada has been supporting with funds from CIDA and our 180,000 individual Canadian donors. Every day 1,000 women in developing countries die from preventable causes related to pregnancy and childbirth. Over the past two years, Plan Canada has been a leader in the call to make MNCH a top priority at the G8 meeting in Muskoka. With funding from the MNCH Muskoka Initiative, Plan is implementing the Women and Their Children’s Health (WATCH) Project in Bangladesh, Ethiopia, Ghana, Mali and Zimbabwe. Recognizing the importance of an integrated model, the WATCH Project takes a two-pronged approach addressing:

1) Demand side issues (from the community and client perspective such as increasing awareness of men, women and children on the importance of accessing skilled health care,

adopting positive health behaviours and involvement in community health management); and

2) Supply side issues (from the health service provision side such as improving quantity and quality of health care services, staff MNCH skills and outreach capacity). This integrated strategy of community and facility-based MNCH health programming will: maximize local stakeholder involvement, particularly that of local community women; encourage the scale up of cost-effective packages of proven interventions; strengthen joint accountabilities; and encourage sustainable, locally-rooted solutions.

In addition to the WATCH Project under the Muskoka Initiative, with support from CIDA, Plan Canada is currently helping women and children through the $14.7 million CAMINAS Project in Bolivia and the $13.8 million “Wazazi na Mwana” Project in Tanzania to help the most vulnerable women and children.

PHOTO TOPAt one of World Vision’s Child Friendly Recreation Centres, a nurse feeds a malnourished child with “Sprinkles” provided by World Vision. The impact of nutrition lasts a lifetime, because it allows children to have improved intellectual and physical development. If children lose weight at an early age due to a lack of proper care, they may become unable to grow with competencies in life both physically and mentally.

PHOTO OPPOSITEAt age three Otgonbayar was unhealthy as he was underweight, had a bloated stomach, big head and rickets. As part of World Vision’s program in Mongolia his mother received nutrition support and Sprinkles to add essential micronutrients to his food. Within a couple of months he had gained weight, grew teeth and developed a good appetite.

www.worldvision.ca

World Vision is a Christian relief, development and advocacy organization dedicated to working with children, families and communities to overcome poverty and injustice. World Vision serves all people regardless of religion, race, ethnicity or gender. Visit our News Centre at worldvision.ca


World Vision Mongolia’s Nutrition Program is a healthy example of parents, community and district leaders working together with the Ministry of Health to nourish children. Through the program, World Vision has helped protect children from conditions that stunt and deform their bodies and impair proper mental development, and seriously limit their futures.

Healthy competition

Through provincial working groups, government leaders organized annual competitions among towns and sub-districts for best health services, community participation and improved health and nutrition. The competitions were extremely successful, due in part to the local working groups that were charged with mobilizing communities and recruiting volunteers.

At both provincial and local levels, government officials signed performance agreements featuring health and nutrition goals. High-performing communities were given prizes according to their stated needs, such as computers, latrines or motorcycles. As a result, in Selenge, stunting dropped from 24 per cent to nine per cent and previously increasing anemia rates in children under age two were reversed. In addition, vitamin D deficiency (rickets) was drastically reduced, from 58 per cent to 29 per cent.

Introducing Sprinkles

The program was an integrated approach to child nutrition that included working with families to provide them with micronutrient powder Sprinkles. These Sprinkles are high in essential nutrients

and when added to children’s meals work to combat malnutrition. What started with a pilot project in 2000, scaled up to cover all of Selenge province in 2005 and then expanded to the national level in 2009.

Turning a life around

When World Vision workers first met Otgonbayar, he was three years old. He had a bloated stomach, big head and rickets. He was far below the average weight for a child his size and he couldn’t speak clearly. As a sponsored child through World Vision, Otgonbayar was included in a special nutrition program and this, along with Sprinkles—a micronutrient powder that includes iron and vitamin D—helped to turn his health

around. After receiving these vitamins and minerals, his mother quickly began to see the changes.

After two months of taking Sprinkles, Otgonbayar began gaining weight, grew teeth and he had a good appetite. After three months, his health had improved significantly. He became more active and more cheerful.

“I really see the improvements in my son. Now he is almost a new son. He is now very alive and really likes his school,” said Otgonbayar’s mother. “ I like to tell everyone about the wonderful improvement Sprinkles makes to children. I wish that all the parents could give Sprinkles to their children.”

Mongolia: Working Together to Nourish Children

www.care.ca

Founded in 1945, CARE is a leading international humanitarian organization fighting global poverty. In over 80 countries, CARE works with the poorest communities to improve basic health and education, enhance rural livelihoods and food security, increase access to clean water and sanitation, expand economic opportunity, help vulnerable people adapt to climate change and provide lifesaving assistance during emergencies. CARE places special focus on working alongside women and girls living in poverty because, equipped with the proper resources, women and girls have the power to help whole families and entire communities escape poverty. To learn more, visit www.care.ca.


Want to help a community lift itself from poverty? Start with the mothers. For more than six decades, mothers and children have been central to CARE Canada. As a leading international humanitarian organization, our experience has shown that improving women’s health is essential for helping communities lift themselves out of poverty.

The Canadian International Development Agency’s important investments made through the Muskoka Initiative have allowed CARE Canada to significantly upscale our efforts on maternal, newborn and child health (MNCH) programs. This work has specifically targeted four countries where the need is greatest: Ethiopia, Malawi, Tanzania and Zimbabwe.

And it could not come a moment too soon.

Thanks to the support of the Government of Canada, our teams are on the ground working closely with families and villages along with regional and national governments to address underlying socio-economic, structural and governance challenges.

In Ethiopia, Zimbabwe and Malawi, CARE is focused on improving the nutrition of mothers and children in areas where chronic malnutrition and maternal and infant mortality rates are high. This means:

Improving the nutrition of mothers;Increasing the access to a more nutritious diet; Addressing factors that affect the nutrition and health of communities (e.g. hygiene, water and sanitation, etc.) so that improvements for mothers and children are sustained; andEmpowering women with a greater voice to make decisions on what food to buy and consume in the household.

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In Tanzania, CARE is working on improving the maternal and reproductive health of vulnerable women and adolescent girls in one rural district that has the highest maternal mortality rates in the country. More than 500,000 women and 100,000 newborns are expected to benefit. Our efforts are focused on:

Increasing the knowledge, awareness and access to financial resources of women and adolescent girls;Improving the maternal and reproductive services at health facilities;Bringing health services closer to the women and adolescent girls who need them most; and

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Increasing the capacity of health authorities in the management of maternal and reproductive health services, as well as their responsiveness to the needs of their communities.

These MNCH programs will not only improve the lives of mothers and children, they will ripple across entire communities. By the time these projects are completed in 2015, they are expected to reach nearly three million people.

Overall, CARE Canada’s MNCH work will serve as a significant starting point for dramatic change in the lives of future generations.

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Dramatic Change Starts with Mothers and Children

www.unicef.ca

UNICEF has saved more children’s lives than any other humanitarian organization. We work tirelessly to help children and their families, doing whatever it takes to ensure children survive. We provide children with healthcare and immunization, clean water, and food security, education, emergency relief and more.

UNICEF is supported entirely by voluntary donations and helps children regardless of race, religion or politics. As part of the UN, we are active in over 190 countries – more than any other organization. Our determination and our reach are unparalleled. Because nowhere is too far to go to help a child survive. For more information about UNICEF Canada and its work visit: www.unicef.ca

PHOTO TOPSix-month-old Maniratou Mahamadou, held by her mother, Habsatou Salou, smiles after a nutrition screening at the Boukoki Integrated Health Centre in Niamey, Niger. Credit: ©UNICEF/NYHQ2012-0156/Nyani Quarmyne

PHOTO OPPOSITEA woman prepares a solution of oral rehydration salts, in the village of Sarkin Yamma Soffoua, in Niger, as a part of the Catalytic Initiative.Credit: ©UNICEF/NYHQ2010-3076/Giacomo PirozziMATERNAL, NEWBORN AND CHILD HEALTH: CANADIANS DELIVER

The village of Tiegouecourani in Mali has seen the death of many children before their fifth birthday. They have died mainly from pneumonia, malaria and diarrhoea.

Their weak immune systems, made weaker by a poor diet have put them at risk of these deadly diseases. But this is changing. Mothers from the village, like Ramata Traoré, have reason to hope that their children will survive and thrive.

What is bringing about this change in Tiegouecourani and in many other rural villages across Mali and in other parts of sub-Saharan Africa? It is the arrival of newly trained community health workers – men and women who are now based in far flung villages to reach the most isolated populations furthest from the health centres. In Ethiopia, Ghana, Malawi, Mali, Mozambique, and Niger children are receiving life saving health services like never before.

These community health workers have been trained through a joint partnership between UNICEF and CIDA known as the Catalytic Initiative, Integrated Health Systems Strengthening Program (CI/IHSS). The program aims to bring healthcare to regions where child mortality is high and access to healthcare is low. This community based strategy uses trained, supervised community health workers living in areas without access to medical facilities to deliver healthcare services in an integrated fashion – addressing cases of diarrhoea, malaria, pneumonia and malnutrition. In the first 4 years, funding has supported the training of nearly 30,000 community health workers, as well as the distribution of 3 million anti-malarial treatments, 1.1 million antibiotic treatments for pneumonia, and 1.8 million oral rehydration therapy and zinc treatments for diarrhoea.

Diallo Aramatou Niamélé is the community health worker who has brought hope to mothers like Ramata in Tiegouecourani. Ramata’s two young children have both seen Diallo when they

were ill, including her son Adama. Diallo was able to quickly diagnose Adama’s severe case of malaria. Before the arrival of the community health worker it is unlikely that Adama would have ever received any formal healthcare, but Diallo was able to impress upon Ramata the severity of Adama’s illness and given how sick he was, refer him for treatment at the nearest health centre. Adama received treatment and is doing well.

This type of story is being played out in communities across sub-Saharan Africa. CIDA has provided UNICEF with $105 million over a 5 year period in support of the CI/IHSS. Working with Ministries of Health, the health systems of the program countries are being strengthened through a sustainable approach to providing healthcare in remote communities. These efforts have contributed to an impressive 34 percent drop in child deaths in Niger alone. The CIDA funded CI/IHSS program is bringing healthcare to isolated communities, but more importantly, it is giving children a future, no matter how far they are.

Community Health Workers Bring Hope for the Future

www.results-resultats.ca

RESULTS Canada is the leading national grassroots advocacy organization committed to creating the political will to end extreme poverty.

PHOTO TOPA newborn infant receiving the BCG vaccine to prevent tuberculosis in rural Morogoro, Tanzania.Credit: Niya Chari

PHOTO OPPOSITEA happy mother and child receive a post-natal check-up in rural Ethiopia.


RESULTS Canada’s parliamentary delegations provide an opportunity for decision-makers to not only learn more about the challenges associated with global poverty, but also to hear stories full of hope and solutions for overcoming these challenges.

On a recent delegation three MPs joined RESULTS Canada staff in Tanzania and met with families and children affected by preventable and treatable diseases such as tuberculosis, pneumonia and rotavirus and saw first-hand how Canadian aid is working to save lives.

In the remote village of Doma, Tanzania delegates met Daniel, a 10 month old Masai child, hospitalized in a local health center because of pneumonia. While Daniel was fortunate enough to receive treatment for his condition, many children his age are not as lucky. However, with the introduction of the pneumococcal vaccine in Tanzania this year, young children like Daniel will be protected from pneumonia with a vaccine that costs just $3.50 per dose. In fact, when children are dually vaccinated against pneumonia and diarrheal disease, Tanzania’s child mortality rate is estimated to drop by up to 30 percent. It was when meeting children like Daniel that participating parliamentarians were challenged to consider where and how Canada’s aid budget can have the most impact improving maternal and child health around the world.

Canadian Investments Save Lives

In the last ten years Canada’s support has helped make it possible to

successfully treat more than four million tuberculosis (TB) patients and save half a million lives, through the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria, TB-REACH and other aid mechanisms. Canadian investments in the Global Alliance for Vaccines and Immunizations (GAVI Alliance) will support the vaccination against pneumonia and diarrheal disease - two of the biggest killers of children under five - for an additional quarter billion children by 2015 and will help to save four million lives. Investments in basic education have helped to reduce the number of out-of-school children by 46 million.

Investing in girls’ education specifically has a proven multiplying effect, such as reducing deaths due to preventable childhood diseases and lowering rates of maternal mortality. While Canada has played a vital role in the global effort to improve the lives of mothers and children, many challenges remain, and Canada must continue to show leadership in this critical area.

Bringing the Story Home

www.micronutrient.org

The Micronutrient Initiative is the leading organization working exclusively to eliminate vitamin and mineral deficiencies in the world’s most vulnerable populations. In 2010-2011, MI reached almost 500 million people in more than 70 countries.

PHOTO TOPA young girl holds a bottle of vitamin A at the Heroes’ Academy.

PHOTO OPPOSITEHealth care volunteer Virginia walks through the alleys of the Lunga Lunga slum of Nairobi.


Health care volunteer Virginia threads through the alleys in the Lunga Lunga slum of Nairobi. “There’s a school here we must get to,” she says. “There are children there that need the capsule and the shot.”

She leads a nurse and another health worker to the Heroes’ Academy, where dozens of three and four-year-old children welcome them. Virginia speaks with the teacher and checks children for marks on their fingers. Those children without marks will be getting a measles vaccination and a dose of vitamin A today. Many tears will be shed. Virginia’s quest to reach these children is part of an immunization and vitamin A supplementation “mop-up” campaign to reach children who haven’t been reached by the Kenya Ministry of Public Health and Sanitation’s routine Malezi Bora campaign.

Vitamin A supplementation has played a significant role in reducing child deaths in Kenya and around the world. Twice-annual supplementation for children in vitamin A-deficient regions helps boost immune systems to better fight off deadly childhood diseases such as measles. What started as an exciting Canadian-led initiative 20 years ago – to take on the scale-up of a nascent but promising health intervention – has developed into a core element of child health programs globally. Today, vitamin A supplementation programs reach as many as 80 percent of the world’s children and experts say that this simple, inexpensive intervention has led to millions of lives saved.

Each vitamin A capsule looks simple, but is in fact a technological and organizational marvel. Costing a mere two cents to manufacture and roughly 50 cents to reach a child in need, each vitamin A supplement must survive transport to some of the world’s most remote locations. Even then, the success of this global effort rests in the hands of an army of dedicated health workers,

like Virginia and countless others, in communities around the world who are committed to progress.

Over the past two decades, with CIDA support, the Micronutrient Initiative has procured more than 7 billion vitamin A capsules and, working closely with national governments and many other partners including UNICEF, has ensured that every year vitamin A programs reach more than 200 million children in need in over 70 countries. Over the years, vitamin A programs have evolved from being an add-on activity, delivered during National Immunization Days (NIDs), to being an integral part of systematic, integrated child health events. As health systems are strengthened, vitamin A programs will be increasingly incorporated into routine health care services, allowing children to receive their first dose as soon as they are six months old.

What was once a fledgling program has become a flagship Canadian success story, and a powerful child survival legacy.

Vitamin A: A Canadian Child Survival Legacy

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