Even countries facing the most difficult circumstances – including poverty, armed conflict, natural disaster or complex emergencies involving displaced populations, food insecurity and disease – can take proactive steps to boost maternal, newborn and child health. While investment is undoubtedly a factor in preventing unnecessary deaths, the examples of child survival initiatives below offer proof of how much can be achieved using extremely limited resources. The key to all of these victories is community knowledge, involvement and empowerment.
Cambodia: How mothers embraced exclusive breastfeeding practices
In just over four years Cambodia has dramatically increased the number of children who are exclusively breastfed. Rates increased dramatically from 7 per cent in 2000 to 69 per cent in 2006. The number of infants younger than six months who received both breast milk and plain water decreased from 67 per cent in 2000 to 28 per cent in 2005. The result was achieved through a high level and concerted media campaign as well as the creation of mother support groups that operate in each village. They actively promote breastfeeding and provide community support.
India: A private-public approach to addressing inequities
In 2005, the Gujarat provincial government launched Chiranjeevi Sojna or “A Scheme for a long and health life” in five districts. The government financed programme offers free maternity services at private hospitals for pregnant women living below the poverty line, particularly members of scheduled castes and tribes. As a result the women do not have to travel long distances to public facilities or resort to home deliveries with unprofessional attendants. Already has been a surge in demand for deliveries at private hospitals in far-flung places and so far 95,000 deliveries have been conducted under these schemes.
Lao PDR: Creating demand for childhood immunization
The country’s vaccination rated markedly across populations groups, especially for poorer ethnic minority families who spoke a different language than the health worker. The Lao Government, in partnership with UNICEF, the Asian Development Bank and Glaxo Smith Kline supported a project to initiate a community based trial that used a child-centered, right-based approach. The project aimed to create demands for immunization services in underserved areas. Activities involved educating village leaders on importance of immunization through radio broadcasts in their language, using well organized peer-education and small group leaning forums for parents. In the four pilot districts, during the year period the project was underway, routine vaccination coverage almost doubled and in one district almost tripled.
Malaysia: Political will
Malaysia’s success in sustaining improvements in maternal, newborn and child health among the most vulnerable populations has been a result of strong political will and combined national anti-poverty and pro-poor strategies. Rural health services, especially those connected to maternal and child health are provided for free or at very low cost. A reliance on trained nurses in child health services meant that the Government could sustain these programmes while expanding coverage and reaching the most underserved communities. They have a three tier health system with community nurses trained in basic child and maternal health care, ranging from newborn screening and care to immunization, growth monitoring and treatment of common childhood.
Mongolia: Involving the community
In past the approach to poverty had been mostly top-down with little community consultation. The introduction of the Integrated Management of Childhood Illness, a community based strategy to reduce infant and child mortality and morbidity in 2000, has produced dramatic results. Now operating in about 90 per cent of the country, it has helped to ensure the sustainability of primary health-care services, through creating local demand for better services and involving local community in management of services.
Papua New Guinea: Creating a ‘home fit for children‘
“A Home Fit for Children’ is an attempt to educate and mobilize individual families to create a safe, healthy and hygienic environment for infants and young children. Started by a Catholic priest, the programme initially trained 30 families from the Keita District in better health practices in the home and now expanded to 10 districts. It consists of a package of community-based interventions designed to address a wider range of child survival issues including; promotion of antenatal visits, breastfeeding and complementary feeding, use of anti malaria mosquito nets, use of iodized salt and improved hygiene practice.
Sri Lanka: A long-term commitment to health and education
Despite more than two decades of war, Sri Lanka has the best health indicators in South Asia with an under-five mortality rate of 13 per 1,000 in 2006 and a maternal mortality rate of 58 per 10,000 live births. Almost all infants received all routine vaccines by age one, 94 per cent of households consume iodized salt, and 91 per cent of the population has access to adequate sanitation. Success has been based on focus on primary care, especially maternal and child health, ensuring adequate provision of basic services at the community level.
South Asia: Lady Health workers and their cultural acceptability in traditional societies
Strict adherence to social and religious customs has long hampered women’s ability to work as health workers and seek health care in many parts of South Asia. An initiative to train female health workers has been pivotal to improve maternal mortality rates in South Asia, especially in remote areas.