Mapping Global Health Leadership in Child Health

1. Mapping Global Health Leadership in
Child Health
CORE Group Fall Conference
October 14, 2016
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2. •Understand the evolution of child health as a global
health issue and its network of stakeholders and
leaders
•Explore leadership and child health repositioning
Study Aims and Methods
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3. •Data collection: 33 in-depth interviews and desk review
•Data analysis: Stakeholder SWOT, process timelines for MDGs-
SDGs, IMCI-iCCM, Pneumonia-Diarrhea, summarized by theme
and elements of Shiffman’s framework
•Limitations: Country-level interviews, higher political
perspective, second round of consultation, private sector
Study Approach
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4. Findings and Conclusions
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5. Child Health Characteristics
0
50
100
150
200
1990 1995 2000 2005 2010 2015
Deathsper1,000livebirths
Year
Trends in Under-Five Mortality
Rates
Developing Regions
sub Saharan Africa
• 53% reduction in U5MR
• 47% reduction in NMR
• 62 countries achieved
MDG4
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Mortality reduction is a stunning success story

6. Child Health Characteristics
There is a significant unfinished agenda:
•Neonatal mortality is now 46% of U5 mortality
•Poorest quintile of children are 1.9 times as likely to
die as richest quintile
•Preventable post-neonatal mortality remains
significantly high especially in sub Saharan Africa (60%
of U5MR) and in some populous countries
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7. Framing Child Health
Where are we now?
•There is a complacency that we’ve done the job with child
health and we need to move on to newborn health and
maternal mortality and family planning.
•Child health has been framed as ending preventable
deaths or as one of its elements (population, disease,
intervention)
•Little consensus on what equity means and how to
address it
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8. Policy Environment
• Competing priorities, often for large, vertically
managed initiatives (immunization, HIV/AIDS, polio
eradication, crisis management) sometimes slowed
progress in other child health components
• Some initiatives have raised the visibility of child
health or its components, but this has not necessarily
led to increased resources and/or political
commitment for broad-based child health
• Multiple initiatives,“branding,” and competition
among organizations have undermined momentum
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9. Policy Environment
Where are we now?
• Large vertically funded projects and partnerships will continue
• Poor coordination among key child health actors persists
despite aligned technical priorities
• High level of uncertainty in the broader policy environment
(start of SDGs, partner environment more complex, multi-
sectoral, initiative fatigue)
• If commitment or funding for SDGs are “zero-sum,” child
health (other than immunization) may be working with less
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10. Network Leadership and Governance
• Weak leadership for child health over past two
decades in important organizations with child health
mandates
• No individual, effective champion for child health
• Child health is highly fragmented and siloed in the
global arena and within organizations
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11. Network Leadership and Governance
Where are we now?
•Next generation of effective leaders and champions
•Place and priority of child health in the high level core
architecture for RMNCAH
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12. Every Woman
Every Child
( Global RMNCAH Strategy 2.0)
(Special Advisor)
PMNCH
Global
Financing
Facility
Host: UNSG
Host:World Bank Host: WHO
Technical Support Agencies
• UNICEF
• USAID
• WHO
• UNFPA
• + other H8
POLICY
COMMITMENTS
INVESTMENT CASES
FINANCING
CONSULTATIONWITH
CONSTITUENCIES
ACCOUNTABILITY
‘New’ Countdown
forTracking &
Accountability
• Technical Guidance
• Regional Hubs
• Country capacity
building
M&E Reference
Group
• Indicators
• Methodology
• Data quality
Host:WHO
High-Level Global Architecture Related to RMNCAH
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13. Country Leadership and Systems
• Persistent health system platform challenges have slowed
momentum (integrated vs vertical services, community
demand, scale-up)
• Country leadership has been a critical variable
• Country level coordination is key for achieving outcomes
but is often weak and has high transaction costs
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14. Recommendation #1:
Reframing child health and communicating it
With the shift to the SDGs, child health should be
deliberately reframed so that it emphasizes the value
of children, a more holistic approach including
“newborns and infants and children” as one, and a
clear aim for equity.
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15. Recommendation #2:
Re-establishing leadership
a) The principal global partners in child health need to
come to agreement on and then designate and support
a lead organization or alliance to consistently provide
overall messaging for child health.
b)They also need to seek and nurture over time one
or several credible champions who will speak powerfully
for child health on the global stage.
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16. Key stakeholders need to create and implement a
shared strategic approach for:
a) Raising the visibility of child health as a whole rather than
in subcomponents;
b) Ensuring a strong child health voice in Strategy 2.0, SDG3
monitoring, and the GFF; and
c) Bridging child health components of existing strategies
across institutions in such a way that country action is
more likely.
d) In addition, investments should support collaboration and
explicitly dis-incentivize fragmentation within child health.
Recommendation #3:
Reversing fragmentation, coordinating effectively
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17. Focus on a few key coordinating mechanisms for child
health and support their performance appropriate to
objectives, role and participants. Close those that do
not provide enough value at both global and country
levels.
Recommendation #4:
Reversing fragmentation, coordinating effectively
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18. Recommendation #5:
Data and accountability
Ensure that child health data and information
are well represented, packaged, and reported
within the context of the emerging evaluation
groups.
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19. Recommendation #6:
Country-level focus
Reframe child health with the country at the
center and purposely engage differently with
countries with weaker systems and leadership
to sustainably improve child health. Invest in
tracking and learning from the process.
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20. For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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