HEALTH, NUTRITION, HIV AND WASH: OUR AMBITION AND STRATEGIC COMMITMENTS

Transcription

1 HEALTH, NUTRITION, HIV AND WASH: OUR AMBITION AND STRATEGIC COMMITMENTS

2 Published by Save the Children USA 501 King s Highway East, Suite 400 Fairfield, CT Save the Children International St Vincent s House 30 Orange Street London WC2H 7HH United Kingdom +44 (0) First published 2016 Save the Children 2016 This publication is copyrighted, but may be reproduced by any method without fee or prior permission for teaching purposes, but not for resale. For copying in any other circumstances, prior written permission must be obtained from the publisher, and a fee may be payable. Front cover photo: Ahmad Baroudi/Save the Children Back cover photo: Save the Children

3 BACKGROUND THE PURPOSE OF THIS PUBLICATION This publication summarises Save the Children s ambitions and strategic commitments related to health, nutrition, HIV and water, sanitation and hygiene (WASH) between 2016 and The strategy development team reviewed both member- and country-level strategic plans and consulted with more than 150 staff from regional, country and member offices to define the direction outlined in this document. The ambitions and commitments outlined in this document represent crossorganisational consensus. They are intended to align our health and nutrition programming across all 29 members and 120 programme countries. HEALTH HIV NUTRITION WASH CONTENTS 4 Save the Children s 2030 Ambition 8 Global trends in Maternal and Child Health 13 Our Health and Nutrition Ambitions 19 Our Health and Nutrition Commitments (2016 to 2018)

4 4 SAVE THE CHILDREN S 2030 AMBITION

5 SAVE THE CHILDREN S 2030 AMBITION WE WILL INSPIRE BREAKTHROUGHS Over the past two decades, the world has made remarkable progress in how it treats children. Child deaths have been reduced by half, more children than ever before are able to learn and fulfil their potential and there is growing global consensus about the urgent need to stop violence against children. Despite this progress, each year nearly six million children still die of preventable causes before their fifth birthday, 60 million children are denied a basic education and 200 million children are directly affected by violent conflict. In our Ambition for Children 2030, Save the Children has committed to building upon this progress and completing the job. By 2030, we aim to achieve three specific breakthroughs for children: SURVIVE LEARN No child will die of preventable causes before their fifth birthday All children will learn from a quality basic education BE PROTECTED Violence against children will no longer be tolerated 5

6 SAVE THE CHILDREN S 2030 AMBITION WE WILL REACH EVERY LAST CHILD While the world has made unprecedented progress in addressing the health, education and protection needs of children, progress has been uneven. As societies have developed and human development indicators have improved, millions of children have been left behind due to poverty, their ethnic identity, because they live in remote areas or urban slums, or because they are caught up in conflicts. Reinvigorated efforts to reach these children will be key to achieving sustainable change for children over the next 15 years. In 2016, Save the Children launched a new global campaign to reach every last child. Our work will focus on identifying the most deprived children, and finding innovative ways to support delivery of life-changing services for these children. In addition to our focus on the most deprived, Save the Children will place special emphasis on creating progress around gender equity, mitigating the effects of crises and responding to the needs of children affected by emergencies. 6

7 SAVE THE CHILDREN S 2030 AMBITION WE WILL DELIVER FIVE THEMATIC RESULTS To achieve our breakthroughs, Save the Children has prioritised five thematic areas of work. Child Poverty Child Protection Child Rights Governance Health and Nutrition Education We must make progress in each of these areas if we are to achieve our breakthroughs but this alone won t be enough. These areas of work are closely related and interdependent. To succeed, we must find new ways to collaborate and coordinate across all five thematic areas. INTERDEPENDENCIES AMONG OUR THEMATIC PRIORITIES An educated mother is likely to delay her first pregnancy, earn a higher income and have healthier children; a healthy, well-nourished child is likely to miss less school, achieve more in school and earn a higher income as an adult; a child living in a wealthier household has a far greater chance of survival than a child living in a poor household; and children protected from sexual abuse, early marriage and violence in the home are more likely to grow into productive, educated adults. The plan that follows outlines Save the Children s strategic commitments in the health, nutrition, HIV and WASH thematic area. Our work in health and nutrition is the cornerstone to the achievement of Save the Children s Survive breakthrough, and will be an important contributor to the achievement of the Learn and Be Protected breakthroughs. 7

8 8 GLOBAL TRENDS IN MATERNAL AND CHILD HEALTH

9 GLOBAL TRENDS IN MATERNAL AND CHILD HEALTH THE UNFINISHED AGENDA Over the past two decades the world has made remarkable progress in reducing child deaths the number of annual child deaths has fallen from 12 million to 5.9 million. Despite this progress, 16,000 children still die every day of largely preventable causes. The world is committed as never before to eliminating these deaths. WHERE ARE CHILDREN DYING? There are large disparities in the distribution of child deaths around the world. Today, nine in every ten child deaths occur in low and middle income countries, with the vast majority concentrated in Sub-Saharan Africa and South Asia. In 2015, fourteen countries represented two-thirds of these deaths. Half occurred in just five countries: India, Nigeria, Pakistan, Democratic Republic of Congo and Ethiopia. FOURTEEN COUNTRIES REPRESENT TWO-THIRDS OF CHILD DEATHS Niger Nigeria Democratic Republic of the Congo Angola Sudan Uganda Tanzania Ethiopia Afghanistan Pakistan India Bangladesh China Indonesia Five countries account for 50% of child deaths India Nigeria Pakistan Democratic Republic Ethiopia 20 % 13 % 6 % 5 % 3 % of Congo 1 out of 12 children in Sub-Saharan Africa die before their fifth birthday 1 out of 147 children in high income countries die before their fifth birthday 9

10 GLOBAL TRENDS IN MATERNAL AND CHILD HEALTH WHICH CHILDREN ARE DYING? In addition to disparities between countries, there are widening gaps in the occurrence of child deaths within countries. THE POOR Children from the poorest 20% of households are 1.9 times more likely to die than children from the wealthiest 20% of households. THE RURAL Children living in rural areas are 1.7 times more likely to die before their fifth birthday than children living in urban areas. THE CRISIS-AFFECTED Children living in fragile or conflict-affected areas are 2 times more likely to die before their fifth birthday as children residing in stable contexts. THE SLUM-DWELLING Children living in urban slums have health outcomes comparable to those in rural areas. 10

11 GLOBAL TRENDS IN MATERNAL AND CHILD HEALTH WHAT ARE CHILDREN DYING FROM? Globally, the leading causes of death in children under-5 are pneumonia, complications during labour and delivery, diarrhoea and sepsis or meningitis. Causes differ by country and geography. In high HIV prevalence countries, HIV plays a more prominent role, while in countries with high prevalence of malaria, malaria plays a more prominent role. Undernutrition is estimated to contribute to 45% of all child deaths. Today, nearly half of all child deaths occurred within the first 28 days of birth. Deaths among children under-5 Neonatal tetanus 1% Neonatal sepsis 7% Labour and delivery complications 12% Other neonatal 8% Malnutrition 45% Pneumonia 16% Malaria 5% Injuries 6% Measles1% AIDS 1% Meningitis 2% Preterm birth complications 18% Others 15% Diarrhoea 9% Post Neonatal Neonatal 11

12 GLOBAL TRENDS IN MATERNAL AND CHILD HEALTH HOW CAN WE PREVENT THESE DEATHS? We know how to prevent these deaths. More young children are surviving today than during any time in history. This unprecedented progress is the result of years of effort and the delivery of a small set of proven health and nutrition interventions. We know, for example, that appropriate care around the time of birth could avert more than 40% of deaths attributable to labour and delivery complications; appropriate care for small or sick newborns could avert 30% of newborn deaths; the timely and appropriate treatment of pneumonia, diarrhoea and malaria could avert up to 30% of child deaths; and that exclusive breastfeeding through a child s first six months of life could avert up to 13% of child deaths. The challenge is that these services are not reaching the children most in need. Today, just one in every four newborns receives a health check within two days of delivery, just two in five children are exclusively breastfed, just three in five children with pneumonia are taken to a provider for appropriate care, and just two in five children with diarrhoea receive a low-cost sugar/water solution. The poor and marginalised represent a disproportionate share of these underserved children. By reaching all children with a small set of life-saving interventions we can save millions of lives every year. 13% potential reduction in child deaths achieved through exclusive breastfeeding 15% potential reduction in child deaths achieved through delivery of simple oral rehydration therapy for children with diarrhoea 6% potential reduction in child deaths achieved through treatment of pneumonia with antibiotics 12

13 OUR HEALTH AND NUTRITION AMBITIONS 13

14 OUR HEALTH AND NUTRITION AMBITIONS OUR GOAL UNIVERSAL HEALTH COVERAGE Save the Children will focus its health and nutrition efforts around seven primary sub-thematic areas of work to address the unique and complex causes of illness, malnutrition and death in mothers, newborns and young children with the aim of achieving universal coverage of lifesaving maternal, newborn and child health and nutrition interventions. OUR AREAS OF FOCUS Save the Children will focus its health and nutrition efforts around seven primary sub-thematic areas of work: Maternal, Newborn and Reproductive Health Child Health Maternal, Infant, and Young Child Nutrition Water, Sanitation and Hygiene Human Immunodeficiency Virus Adolescent Sexual and Reproductive Health Clinical Services in Crisis Settings 14

15 OUR HEALTH AND NUTRITION AMBITIONS OUR WORK Maternal, Newborn, and Reproductive Health (MNRH) Each year, an estimated 2.9 million children die within 28 days of being born. One-third of these deaths occur during the baby s first day. Deaths during this time represent two out of every five deaths in children under the age of five. An additional 2.6 million babies are stillborn in nearly half of these cases, the heart stops beating during labour. Over the next 15 years, Save the Children will play a global leadership role in addressing the needs of newborns and their mothers. Our work will focus on the delivery of four primary service packages: family planning and reproductive health, ante-natal care, care during labour and delivery, and post-natal care. The organisation will place particular emphasis on community-based service provision and achieving universal coverage of skilled attendance at birth. Child Health (CH) Each year an estimated 1.8 million children die of pneumonia, diarrhoea and malaria. These three diseases account for one in every three deaths in children under the age of five. The delivery of a targeted package of preventive and curative interventions such as provision of antibiotics, oral rehydration therapy and antimaliarials could avert nearly two-thirds of these deaths. Over the next 15 years, Save the Children will play a global leadership role in addressing the major childhood killers. Our work will focus on empowering frontline health workers and others to deliver life-saving vaccines, and to prevent, diagnose and treat the three major childhood killers: pneumonia, diarrhoea and malaria. Maternal, Infant, and Young Child Nutrition (MIYCN) Each year, undernutrition contributes to an estimated 2.6 million child deaths (nearly half of all child deaths). Undernourished children who survive suffer lifelong consequences: they are more susceptible to disease and are likely to have poorer educational outcomes, poorer birth outcomes and reduced economic activity into adulthood. Over the next 15 years, Save the Children will grow its global leadership role in addressing the nutritional needs of mothers and their children. Our work will focus on the delivery of evidence-based nutrition interventions during the first 1000 days, the period between pregnancy and a child s second birthday. Our programming will support efforts to ensure adequate food and nutrient intake in pregnant women and young children, effective infant and child feeding and care practices, and protection against infectious diseases. 15

16 OUR HEALTH AND NUTRITION AMBITIONS Water, Sanitation, and Hygiene (WASH) Each year an estimated 650,000 young children die of diarrhoea (9% of all deaths in children under the age of five). Many more suffer weakness and malnutrition as a result of parasites or environmental enteropathy, a sub-clinical infection of the stomach that interferes with the absorption of nutrients. Nearly all of this is attributable to unsafe drinking water, lack of access to appropriate sanitation and poor hygiene practices. Over the next 15 years, Save the Children will maintain its strong global position around the delivery of WASH-related services. Our work will focus on the delivery of enhanced infrastructure and behaviour change activities designed to reduce diarrhoea and other diseases in children under the age of five, and reduce chronic malnutrition in children under the age of two. Human Immunodeficiency Virus (HIV) In 2013, 2.1 million people contracted the Human Immunodeficiency Virus, including 200,000 young children and 360,000 adolescents. Today, nearly 1.5 million pregnant women are living with HIV. Unchecked, one in three of these women will transmit HIV to their children. In high-prevalence countries, HIV can account for up to 30% of all under the age of five deaths the single largest cause of death among this age group. The vast majority of this transmission can be averted through appropriate care and support and prevention of mother to child transmission. Over the next 15 years, Save the Children will maintain its strong global position around the prevention and treatment of HIV and AIDS. Our work will concentrate on the delivery of two primary intervention packages; the prevention of mother-to-child transmission of HIV (PMTCT); and the delivery of paediatric care and support to HIV-exposed, -infected and -affected children. Adolescent Sexual and Reproductive Health (ASRH) In low- and middle-income countries, one in every ten girls becomes a mother by the age of 16, placing them at increased risk for adverse birth outcomes, as well as complications during labour and delivery. Pregnancy, childbirth and unsafe abortions are the second-leading cause of death in young women between the ages of 15 and 18. Over the next 15 years, Save the Children will continue to test and invest in our capability to meet the sexual and reproductive health needs of adolescents. Our work will focus on empowering adolescents to practice abstinence or use contraception to delay and space childbirth and to avoid sexually transmitted infections. We will work to increase the availability and quality of reproductive health services across the adolescent lifespan, with particular attention to the needs of children between the ages of 10 and 14. Clinical services in crisis settings Children living in fragile or conflict-affected settings are twice as likely to die as children living in more stable situations. In these situations, children s access to life-saving health services and mental health services is often constrained, further exacerbating risk. Over the next 15 years, Save the Children will test and invest in growing our capability to deliver direct clinical services in large-scale crisis settings. This work will focus on the delivery of primary health care services, surgical services, mental health and psychosocial services, and the management of large-scale disease outbreaks. 16

17 OUR HEALTH AND NUTRITION AMBITIONS OUR DELIVERY APPROACH To ensure delivery of these interventions, Save the Children will collaborate with local governments, multilaterals, grassroots non-governmental organisations and others to strengthen health systems and promote healthy behaviours. Where possible, we will work through governments and partners. STRENGTHENING HEALTH SYSTEMS Save the Children will collaborate with host governments to strengthen their ability to deliver timely, quality services to children in need. This work will be focused around six health system building blocks: Service Delivery: We will support the delivery of safe, high-quality health services; Workforce: We will support the development of a responsive and competent health workforce; Information Systems: We will support the development of health information systems to generate data for decision making; Logistics: We will support the development of effective supply chains and medical logistics; Financing: We will advocate for health financing systems that fund priority services without causing financial hardship for consumers; and, Governance: We will support the development and application of policy frameworks, regulations and accountability. PROMOTING HEALTHY BEHAVIOURS While a functioning health system is critical to achieving our universal coverage ambitions, it is not sufficient. The role of individuals, households and communities is also critical in the adoption of healthy behaviours and timely, appropriate care-seeking. Save the Children will draw on its extensive experience in community-based programming to encourage the uptake of life-saving practices and services through behaviour-centered programming, social and behaviour change communication and community mobilisation and capacity building. 17

18 OUR HEALTH AND NUTRITION AMBITIONS OUR AMBITIONS ARE ACHIEVABLE: THE GLOBAL COMMUNITY IS UNITING AS NEVER BEFORE AROUND THIS AGENDA In 2012, the United Nations General Assembly adopted a resolution urging governments to move towards providing all people with access to affordable, quality healthcare services. The resolution recognises the role of health in achieving international development goals and calls for countries, civil society and international organisations to include universal health coverage in the international development agenda. In the same year, 178 governments as well as hundreds of civil society, private sector and faith-based organisations signed a pledge vowing to do everything possible to stop women and children from dying of causes that are easily avoidable. This commitment is referred to as A Promise Renewed, and commits to increasing focus on countries with the highest mortality burden, more effectively reaching under served populations and addressing the primary causes of deaths of children under the age of five. Our ambitions are clearly captured and articulated in the UN General Assembly Resolution, A Promise Renewed, and Sustainable Development Goals 2, 3 and 6. The Sustainable Development Goals (SDGs), officially known as Transforming Our World: the 2030 Agenda for Sustainable Development, are an intergovernmental set of aspirational goals with 169 targets. The Goals are contained in paragraph 54 of United Nations Resolution A/RES/70/1 of 25 September

19 OUR HEALTH AND NUTRITION COMMITMENTS (2016 TO 2018) 19

20 OUR HEALTH AND NUTRITION COMMITMENTS To enhance the impact of our work, and position for the achievement of our 2030 ambitions, between 2016 and 2018 Save the Children will redouble its efforts to achieve efficiencies and unify our health and nutrition programme directions across all 29 members and 120 countries. We will catalyse our work around 10 strategic commitments. 20

21 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 1: WE WILL REACH MORE CHILDREN To achieve our universal coverage ambition, we must dramatically expand our reach. Over the next 15 years, we will shift our focus from direct service delivery to supporting the development of policies and the strengthening of health systems within our programme countries. By doing this, we will achieve greater cost efficiencies and wider impact. Our reach will increase proportionate to this shifting emphasis. Between 2016 and 2018 we aim to achieve moderate gains in reach. While we position to achieve sustainable change in both stable and crisis contexts, Save the Children will continue to play a lead role in meeting the needs of children affected by emergencies and crises. Over the next three years, we aim to reach more emergency-affected children, and will solidify our position as a provider of clinical services on a large scale RESULTS We will have increased the number of children reached through our health and nutrition work by 20% We will have reached 25% of all children affected by category 1 and 2 emergencies We will have provided direct medical services to a minimum of 1.5 million emergency-affected people 21

22 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 2: WE WILL PRIORITISE THE MOST DEPRIVED CHILDREN Child deaths are increasingly concentrated among the poor and marginalised, both geographically and demographically. To achieve our universal coverage ambition, we must find ways to more effectively reach these children. Globally, just 14 countries account for two-thirds of all child deaths. Save the Children s investment in these countries, however, accounts for less than 40% of our overall health and nutrition expenditure. Over the next three years, we will shift the relative size of our investment from countries with smaller numbers of child deaths to countries with the highest numbers of child deaths. By enhancing our focus on high-burden countries, we will gain efficiencies in both programming and impact. We will focus particular attention on expanding our footprint in India, Nigeria and the Democratic Republic of Congo. The distribution of child deaths within countries is also highly concentrated the poor and marginalised represent a higher proportion of child deaths each year. Over the next three years, we will increase our focus on underserved areas within our programme countries, and find new ways of identifying and reaching the most deprived children. This will require embracing new ways of working, measuring success and building capability, including putting more focus on the removal of cost barriers RESULTS We will have increased our relative investment in countries with the highest proportion of childhood deaths, particularly India, Nigeria and the DRC We will have enhanced our ability to identify deprived children at country-level, and developed and delivered programmes to reach more of these children We will have expanded our urban health programming in three countries, and initiated urban health programming in three additional countries 22

23 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 3: WE WILL FOCUS ON WHAT WE KNOW WORKS The global community has vast experience in preventing child deaths. In the past 15 years, more than 48 million young children have been saved through these efforts. The issue is not what we need to deliver, but how we are going to reach the children in need. As a partner in global efforts to eliminate preventable child deaths, Save the Children has prioritised seven sub-thematic areas of work. Each of these sub-thematic areas of work focuses on the delivery of a small set of proven interventions. These interventions represent the most cost-effective and efficient way to achieve our ambitions. Currently, a sizeable proportion of our investment falls outside of these prioritised areas of work. Over the next three years, we will more effectively align our investments with our programme priorities, with the aim of ensuring that no more than 10% of our total health and nutrition investment fall outside our priority areas of work. Within these priority sub-thematic areas of work, some delivery approaches have proven particularly effective in reaching children in need. Community case management of childhood illnesses, for example, has proven highly effective in bringing life-saving health services to children in need. Over the coming three years we will identify a small set of high potential approaches and build capacity across the organisation to deliver these common approaches. Finally, we will identify countries on the tipping point of taking breakthrough approaches to scale, and mobilise resources across the organisation to assist these countries in achieving scale. We refer to these programmes as Signature Programmes RESULTS We will have focused 90% of our expenditure and reach in our priority sub-thematic areas of work We will have identified and built capacity and momentum around common programme approaches in sub-themes in which we aspire to be global leaders We will have mobilised organisation-wide investment in achieving national scale of approved health and nutrition Signature Programmes 23

24 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 3: SPOTLIGHT ON SIGNATURE PROGRAMMES The development and scale-up of Signature Programmes has been identified as a global organisational priority. Signature Programmes focus on a specific approach with potential to effect change at scale. They represent Save the Children s theory of change in action the organisation has contributed significantly to the development and/or refinement of the approach, has produced and published evidence of its potential and effectiveness, has worked with partners to establish a conducive social and policy environment for implementation, and has thus helped to position the approach to be delivered at scale. The Signature Programme designation is reserved for Save the Children programmes at the tipping point where targeted investment will lead to delivery at national or global scale and is intended to catalyse organisation-wide commitment to, and investment in, moving these programmes beyond the tipping point. To date, we have four approved health and nutrition Signature Programmes: Essential Newborn Care in Nepal, Community Case Management in Nicaragua, MAMONI in Bangladesh and the Infant and Young Child Feeding Franchise Model in Vietnam. SAVE THE CHILDREN S THEORY OF CHANGE We will be the innovator develop and prove evidence-based, replicable breakthrough solutions to problems facing children be the voice advocate and campaign for better practices and policies to fulfil children s rights and to ensure that children s voices are heard (particularly those of children most marginalised or living in poverty)... build partnerships collaborate with children, civil society organisations, communities, governments and the private sector to share knowledge, influence others and build capacity to ensure children s rights are met achieve results at scale support effective implementation of best practices, programmes and policies for children, leveraging our knowledge to ensure sustainable impact at scale COMMUNITY CASE MANAGEMENT IN NICARAGUA In 2007, Save the Children introduced a programming approach known as Community Case Management in Nicaragua. The approach builds the capacity of community health workers to diagnose and treat childhood illnesses. The project was piloted in the Department of Leon where, together with the government, Save the Children demonstrated that community members with limited training could effectively treat pneumonia and diarrhoea. Over the course of the project, the number of children dying from these two illnesses was reduced by more than half in pilot communities. The results of this work were used to influence policy makers and politicians in Nicaragua to adopt the approach at national scale. In 2012, the Nicaraguan government introduced a policy mandating provision of services from trained community members in all communities more than two hours walk from a health facility. Save the Children is working with the government to realise this policy ambition. 24

25 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 4: WE WILL BE THE VOICE FOR CHILDREN Policy and advocacy are key components of Save the Children s theory of change. We have a deep history of influencing policy at the domestic, international and country-level, resulting in positive change for children. In 2016, Save the Children will shift its global campaign emphasis from the EveryOne campaign to the more encompassing Every Last Child campaign. Every Last Child will focus on overcoming the discriminatory and financial barriers that prevent children from surviving and learning. Over the next three years we will sustain the momentum generated by the EveryOne campaign, and support country-level priorities within the new campaign. Our engagement on the new campaign will require deeper expertise in areas such as health financing and governance. In addition to our work on the Every Last Child campaign, we will continue to promote evidence-based advocacy change at the country-level, redouble efforts to position for leadership and influence in global and regional policy and norm-setting institutions, and will coordinate more effectively to ensure quality representation in high-level global meetings such as the World Health Assembly RESULTS We will have developed and implemented a global health and nutrition advocacy and policy strategy We will have supported efforts to achieve global policy change around three priority issues: Fairer financing for essential maternal and child health services Equitable access to essential maternal and child health services Improved accountability around meeting children s health and nutrition needs We will have supported country-level campaign efforts in up to 15 countries 25

26 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 5: WE WILL BETTER SERVE CHILDREN IN EMERGENCIES AND CRISES Save the Children is committed to ensuring that children in emergencies and crises have access to essential health services. In 2014, the organisation re-confirmed its commitment to emergency health and nutrition through its merger with MERLIN and the development of Save the Children s first-ever cross-organisation humanitarian health strategy. Moving forward, we will continue to build our capability to respond to the health, nutrition, HIV and WASH needs of emergencyaffected children. Over the next three years, we aim to increase the speed, predictability and impact of our emergency response activities. We will build our rapid deployment capacity, and introduce enhanced mechanisms for managing risk and delivering quality emergency health programming, including the delivery of child mental health services, surgical services and the management of large-scale disease outbreaks RESULTS We will have established six deployable primary health care teams with capacity to provide services to 100,000 people within 72 hours of any emergency event We will have established a fully functional risk management capability,including a strong clinical governance framework for emergency response activities We will have established a robust and operational pharmaceutical network of people, resources, supply chains and processes We will have a minimum of one humanitarian certified staff person in 90% of active health programme countries 26

27 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 6: WE WILL EXPAND OUR CROSS-THEMATIC WORK Save the Children has prioritised five thematic areas of work: health, education, protection, poverty and child rights governance. The success of Save the Children s health investments are intimately related to progress in each of these other thematic priorities. For example: Education: Globally, rates of under-5 mortality are more than three times higher among mothers with no education than among mothers with a secondary education. Child Poverty: Globally, rates of under-5 mortality are twice as high for the poorest 20% of households than for the richest 20%. Child Rights Governance: To achieve our universal coverage ambitions, governments will need to re-affirm their commitment to children s rights to basic child health services, and commit the monies and resources required to ensure that these obligations are fulfilled. Child Protection: Sexual abuse and early marriage are directly associated with negative reproductive outcomes, and the experience of strong, frequent or prolonged exposure to stress can have lasting negative impact on the brain development of young children. Over the next three years, we aim to discover new ways of working to enhance coordination and impact across these thematic areas. We will collaborate with our thematic colleagues on a number of important initiatives, and will document and disseminate lessons resulting from that collaboration RESULTS We will have developed a detailed plan for learning about and documenting mechanisms for more effective programme integration We will have developed guidance on cross-thematic programming and initiated its roll-out We will have expanded our mental health and psychosocial support for children, and established a Mental Health and Psychosocial Support (MHPSS) cross-thematic working group to document our experience in integrated programming 27

28 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 7: WE WILL BROADEN OUR INVESTMENT IN HEALTH To achieve our thematic ambitions, we must increase investment and expand our fundraising efforts into new or largely untapped markets. Of the 14 Save the Children members that invest in international programming, just half currently invest in the health and nutrition thematic area. The performance of our health and nutrition fundraising efforts relative to available resources in these countries varies widely, and there are a number of countries in which there is considerable potential for attracting additional health and nutrition resources. Over the coming three years, we aim to generate more funds within existing markets and develop the fundraising capacity of high potential members not currently resourcing health and nutrition work. Additionally, we will work to increase health and nutrition investment and programme capability in southern countries who are key to reaching the most deprived children, with particular emphasis on portfolio expansion in India RESULTS We will have increased international programme revenue for health and nutrition by 20% We will have increased the number of Save the Children fundraising countries meeting global health and nutrition fundraising targets We will have increased the number of southern countries meeting their domestic health and nutrition fundraising targets 28

29 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 8: WE WILL ENHANCE ACCOUNTABILITY AND KNOWLEDGE SHARING Globally, Save the Children has more than 4,500 staff working in the health and nutrition thematic area. These staff are the foundation to the organisation s success. To fully realise our potential, we must enhance our cross-organisational coordination, accountability and knowledge sharing. Over the next three years, we will continue to grow and solidify the capacity of the health and nutrition global theme to coordinate the organisation s health and nutrition efforts. We will reinvigorate the health and nutrition steering group to provide broader oversight and accountability, and we will establish strategy working groups for each of our sub-thematic areas of work. The health and nutrition steering group and strategy groups will guide our health and nutrition strategic direction and ensure we progress against our established targets. In addition to solidifying our thematic governance architecture, we will place increased emphasis on the management and sharing of knowledge across our members and staff. Over the next three years, this work will focus on the development of a health and nutrition resource library and staff directory, support for communities of practice and the hosting of regular programme learning events RESULTS We will have established a fully functional thematic governance architecture, including a diverse and active Steering Group, a robust core team and movement-wide sub-thematic and cross-thematic Strategy Groups We will have improved cross-organisation knowledge-sharing systems, with particular emphasis on the management of a curated internal resource library, a staff directory and a series of global learning exchanges We will have integrated domestic health programming into our thematic portfolio and governance mechanisms 29

30 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 9: WE WILL BUILD OUR STAFF CAPACITY Development of our staff capacity will be critical to attaining our health and nutrition ambitions. Recruitment of high-calibre staff and the roll-out of learning and development opportunities for staff will improve the quality and efficiency of our programming, enhance our readiness for emergencies, improve thought leadership within the organisation and contribute to the retention of highperforming staff. While we are currently undertaking a number of excellent health and nutrition capacity building projects, we do not yet have a defined capacity building strategy, and there is little coordination around our capacity building efforts. Over the next three years, we will finalise and roll out a capacity development strategy and collaborate with our human resource colleagues to normalise recruitment, hiring and performance appraisal processes RESULTS We will have rolled out a comprehensive learning and development strategy targeting mid to senior level health and nutrition thematic staff around the world We will have standardised hiring processes, performance expectations and orientation processes for health and nutrition thematic staff 30

31 OUR HEALTH AND NUTRITION COMMITMENTS COMMITMENT 10: WE WILL CULTIVATE RESEARCH AND INNOVATION Innovation and development of novel delivery mechanisms will be critical to reaching every last child. While the global community knows which interventions need to be delivered to reduce child deaths, understanding how to deliver interventions to those most in need has been a greater challenge. Over the years, Save the Children has played an important role in the development and testing of novel delivery approaches, and has developed a theory of change to articulate the process of moving from innovation to scale. Over the next three years, Save the Children will continue to explore and test innovative programming approaches. Areas of particular promise include the testing of simplified antibiotic regimens for the treatment of newborn infections, the delivery of sexual and reproductive health services to very young adolescents, and the use of mobile technologies for both programme and monitoring and evaluation purposes. While we will actively monitor and develop innovative ideas at global level, during the next strategy period we aim to get more systematic about identifying, surfacing and documenting innovation at the country or sub-national level. It is widely acknowledged within the private sector that true transformation often occurs at the periphery, from unexpected sources. Our country-level footprint offers unique advantages to identify promising innovations (both internal and external), and become early adopters and advocates RESULTS We will have agreed upon cross-organisational research priorities and will more effectively unify around those priorities We will have achieved incremental growth in the number of Save the Children authored articles published in the global scientific literature We will have identified and forwarded at least one promising innovation emerging from the national or sub-national level 31

32 Statistics are based on latest available figures from Save the Children programmes or recognised international sources. Monetary figures have been converted into US$, using the exchange rate on 31 December We use an agreed-upon methodology to obtain data through our global annual reporting process. Where significant figures have been rounded, they have been rounded to the nearest 10,100 or 1,000. Published by Save the Children USA 501 King's Highway East, Suite 400 Fairfield, CT Contact: Save the Children International St Vincent s House 30 Orange Street London WC2H 7HH United Kingdom +44 (0)