Child Health Days
Children’s health needs are often multiple and overlapping: they need to be vaccinated against the preventable diseases of childhood, they may be under- or malnourished, they may suffer intestinal parasites, and, in malaria-prone areas, they are highly vulnerable if not sleeping under an insecticide-treated bed net. The best way to tackle these issues is through a high-impact package of integrated services delivered directly to children where they live.
Child Health Days (CHDs) were introduced as a health-promoting strategy, initiated in Eastern and Southern Africa as an innovative way of delivering such a package free to all eligible children and their mothers. Reaching even the most under-served areas and targeting every child in a community, Child Health Days deliver cost-effective healthcare. As a ‘one stop shop’, children receive vitamin A supplements to boost immunity and prevent blindness; de-worming tablets to treat parasitic infections and the iron-deficiency anemia they can cause; routine immunization; monitoring for nutritional status; and insecticide-treated mosquito nets to prevent malaria. Other interventions may be added (often measles vaccination, sometimes hepatitis B). Women of child-bearing age receive tetanus toxide vaccination.
UNICEF in action
Child Health Days are now being regularly implemented by the Ministries of Health in countries in Eastern and Southern Africa. Conducted twice yearly, these activities last from one week to one month. Through concerted support, staff are deployed to health centres to gear up for big crowds and long days, while outreach is made by whatever means necessary to the most remote communities, where face-to-face contact with health professionals has often been non-existent.
Despite proven effectiveness, Child Health Days are institutionalised within only a few of the region’s national and sub-national planning priorities (Madagascar, Malawi, Tanzania, Uganda and Zambia) and largely remain dependent on external aid for budgeting. Developing national capacity in micro-planning and implementation is also a challenge. Though Child Health Days are an effective means of reaching large numbers of children and women with a bundle of services, the long-term goal is to phase out campaign-type approaches to delivering healthcare and ensure that quality routine health services are available and public demand for these is increased.
Results for children
Child Health Days have become a common platform to deliver integrated health and nutrition interventions in almost all of the region’s 20 countries. In 10 countries, the coverage rate of vitamin A supplementation increased to 80 percent as a result of Child Health Days. Since adequate intake of vitamin A alone can reduce child deaths by 23 percent, this achievement makes a significant contribution towards realizing the Millennium Development Goal of reducing child mortality.
A study in Uganda has shown that scaled-up coverage for de-worming improves child growth, which also demonstrates the effectiveness of Child Health Days. Before the campaign was established most countries would only reach children in school with anti-parasite medication. However, with health staff and volunteers now deployed for the bi-annual interventions, children who do not attend school can also benefit. Eighty percent coverage is now generally achieved for the eligible age group.
Child Health Days are also contributing towards the fight against malaria. Impressive results have been achieved in distributing Long-lasting Insecticide Treated Nets (LLINs) in several countries. In Angola, for example, Child Health Days led to a dramatic spike in the use of LLINs, from 5 percent to 60 percent. Similar approaches in Ethiopia have seen almost 19 million LLINs distributed since 2006.
In Zambia, Child Health Weeks are reaching 2.5 million children under the age of five twice a year. To reduce HIV, the Government has added the component of paediatric AIDS care and treatment to the integrated package of interventions. Testing and counseling of pregnant women ensures they get help and advice for their delivery and treatment for their babies. Community volunteers such as Safe Motherhood Committees are trained so they can explain the benefits to mothers.
In Malawi, twice yearly Child Health Days are reaching 2.3 million children (95 percent) with a package of life-saving interventions, and the caretakers with high impact communication messages on exclusive breastfeeding, feeding a sick child, vitamin A rich foods, de-worming, hand washing with soap, use of iodized salt and ITNs.
Somalia is a country with one of the world’s lowest immunization coverage rates. The Child Health Weeks have demonstrated that these can rapidly be raised, even in the most difficult circumstances. During the first Child Health Week in late 2009, supported by UNICEF and WHO, 1 million children were immunized. During the second round, 1.6 million children and 800,000 women of child-bearing age were reached.
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