UNICEF in action: Strategies and priorities
Despite the challenges, Eastern and Southern Africa has seen some important progress when it comes to improving the chances of children to survive and thrive. Countries such as Eritrea, Madagascar and Malawi, while not fully on track to meet MDG4, registered a reduction of under-five mortality by 39 percent or more between 1990 and 2008, demonstrating that even in resource poor settings, the reduction of child deaths is entirely possible.
UNICEF is supporting all countries in the region with a combination of strategies aimed at strengthening national and local health systems, promoting high-impact interventions, as well as improving the capacity of communities and families to prevent diseases and treat them adequately when necessary.
The focus is on reaching the most deprived and disadvantaged children, which has proven to be the most effective way to reduce maternal and child mortality and achieve progress towards the health-related MDGs.
‘Continuum of care’
The ‘continuum of care’ is a core organizing principle for health systems that emphasizes seamless linkages between healthcare packages across time and through various service delivery points. It aims to integrate essential maternal, newborn and child health and nutrition packages, since evidence has shown that such services are most effective when they are delivered at critical points in the life cycle of mothers and children. The continuum of care thus focuses on adolescence, pre-pregnancy, pregnancy and childbirth, postpartum and newborn periods, up into infancy and childhood. It combines essential health care services at household and community level to health centres and hospitals. UNICEF promotes this holistic approach as an efficient, cost-effective way to accelerate progress on child survival in Eastern and Southern Africa.
Strengthening health systemsUNICEF supports governments to strengthen their health systems. Priority is placed on investments based on demand and on reliable data related to under-nutrition and disease patterns. The aim is to narrow the gaps in coverage, quality and equity. UNICEF assists countries in reducing financial barriers to healthcare access through, for example, cash transfer programmes, voucher schemes and results-based financing.
Child Health Days
Child Health Days (CHDs) are a platform to deliver integrated interventions and achieve high coverage. Services are delivered free of charge and reach out to households and communities beyond health facilities. In the past, safe motherhood and child survival programmes often operated separately, leaving disconnections in care that affected both mothers and newborns. Now it is being recognized that delivering integrated interventions at pivotal points in the continuum of care has multiple benefits.
Child Health Days were introduced in Eastern and Southern Africa in 2004. Twice a year, they bring a set of high-impact, life-saving health interventions to young children, including immunization, vitamin A supplements, growth monitoring, and de-worming. The package also includes antenatal care for women, immunization against neonatal tetanus, distribution of insecticide treated nets, and the promotion of practices that lead to better family health overall. Today, CHDs are being implemented in almost all 20 countries in the region as an effective strategy to reduce child mortality.
Community case management
Because most children die outside of health facilities, and families in most rural and poor communities do not have access to treatment of killer diseases, UNICEF aims to prevent child deaths by ensuring that illnesses are diagnosed and dealt with where children live. UNICEF supports a community-based approach to identifying and treating pneumonia, diarrhoea, malaria and acute malnutrition in Eastern and Southern Africa. Through the Integrated Management of Childhood Illnesses and Acute Malnutrition, health workers and members of the local community are trained in identifying signs of deteriorating nutrition and of illnesses and to provide appropriate care including timely referral to hospitals. In the area of water, sanitation and hygiene, UNICEF works with communities to increase household access to safe drinking water, adequate sanitation facilities, and help them master simple household water treatment and safe storage techniques to prevent water-borne diseases and unnecessary deaths.
Behaviour change communication
There is a direct link between healthy behaviours and good health. Health-promoting practices in homes and communities can address many of the preventable causes of disease and death. Working in partnership with health authorities, health workers and communities, UNICEF helps to promote practices at the household and community levels that are proven to save children’s lives and help them thrive. These include breastfeeding, improving nutrition and care, managing diarrhoea and strengthening personal hygiene. Just helping a community adopt hand washing with soap can lower diarrhoea by almost 40 percent.
No single actor can take on the challenge of achieving the health MDGs alone. Reaching every child with a basic package of essential, proven interventions requires joint efforts of governments, bilateral and multilateral agencies, NGOs, civil society, researchers and the private sector. UNICEF therefore works in close cooperation with a number of stakeholders, using these partnerships to scale up programmes, leverage resources and generate evidence for policy and programming.
UNICEF supports the development and implementation of national health policies and helps governments access major funding from innovative public-private partnerships such as the Global Alliances for Vaccines and Immunization (GAVI) or the Global Fund to fight AIDS, Tuberculosis and Malaria. It works with regional bodies like the African Union on the development of strategies to improve child nutrition and combat maternal mortality, and with international NGOs such as Oxfam or Plan International in the area of water and sanitation. Universities such as Tulane (New Orleans) are key partners in research, for instance, on nutrition trends in Eastern and Southern Africa.
As Co-Chair of the health team of the UN Development Group for Eastern and Southern Africa, UNICEF works to ensure that activities are harmonized and countries receive technical support based on their demand and needs.
Moreover, UNICEF is a founding member of the Harmonization for Health in Africa partnerships. In that role, UNICEF works with partners to support countries in developing health sector plans which are based on evidence, and which include cost estimates and mechanisms for monitoring results.
Equity-focused data collection and monitoring of progressEffective programme development and implementation needs to be informed by reliable and accurate data and continuous monitoring of progress. UNICEF supports governments and other partners in strengthening their capacity to generate evidence related to maternal, newborn and child survival and development, putting particular emphasis on collecting disaggregated data to analyze the impact of factors such as gender, residence and the education level of mothers on health outcomes.
Household water treatment and safe storage techniques – known as HWTS – are simple, cost-effective ways to prevent disease and improve the lives of children and their families.