Global Health & Nutrition High-Impact Health Services for Mothers and Children October 2014

Photo credit: Jeff Holt Global Health & Nutrition High-Impact Health Services for Mothers and Children October 2014 2000 L Street NW, Suite 500, Washington, DC 20036 1-800 Save the Children SavetheChildren.org

Global Health & Nutrition High-Impact Health Services for Mothers and Children Save the Children USA s international health and nutrition programs are dedicated to ensuring that the world s most vulnerable mothers and children have a healthy start, with access to and effective use of high impact, evidence-based services and practices now, in times of crisis and in the future. In collaboration with host countries and leading global development organizations, the Department of Health & Nutrition (DHN) addresses the unique and complex causes of maternal, newborn and childhood illness, death and malnutrition, to ensure that children in resource poor and emergency situations not only survive but thrive. Informed by our global on-the-ground presence, we invest in program innovation and learning to strengthen policies, systems and programs that support our commitment to ending preventable maternal, newborn and child deaths and ensure a healthy start for all children. For more than 75 years, Save the Children has worked to improve the health and nutritional status of women and children. Working in partnership with global and national stakeholders, we generate and use evidence to inform and influence global and national policies, and leverage sustained and sustainable change in large health systems Our key health and nutrition priorities and areas of technical expertise include: Newborn Health Child Health Maternal & Reproductive Health Adolescent Sexual & Reproductive Health Nutrition Emergency Health & Nutrition and programs. Through rigorous program monitoring and evaluation, documentation and dissemination of best practices and lessons learned, we effectively advocate in support of critical health and nutrition priorities. Save the Children USA is one of 30 national Save the Children organizations that collectively implement our overseas programs through a single global program delivery unit, Save the Children International. All members share the vision, mission and values of our global movement, and each supports the implementation of programs that are delivered and supported by a SCI central office, regional offices and staff based in the countries where we work. This overview reflects the health and nutrition work that is managed and supported by Save the Children USA to advance our shared commitment to achieving lasting impact for the world s most vulnerable children 5. Global Health & Nutrition by the Numbers Many mothers and their children do not benefit from proven, affordable, lifesaving services and practices that could prevent two-thirds of maternal, newborn and child deaths. Each year, 289,000 women die during pregnancy and childbirth 1. In 2013, 6.3 million children under five died from preventable illnesses 2. Nearly half of all deaths in children under 5 are attributable to malnutrition 4. 2.8 million newborns die from preventable and treatable conditions each year 2. 1/5 of all underfive deaths in 2013 occurred in fragile and conflict-affected countries 2. 1. World Health Organiza on. Maternal Mortality. Geneva, 2014. 2. UN Inter-agency Group for Child Mortality Es ma on. Levels & Trends in Child Mortality: Report 2014. New York, 2014. 3. World Health Organiza on. Every Newborn: an ac on plan to end preventable deaths. Geneva, 2014. 4. UNICEF/WHO/World Bank. Joint Child Malnutri on Es mates. New York, 2014. 5. Save the Children USA is fully responsible and accountable for all technical, administra ve and financial requirements of its overseas programs.

NEWBORN HEALTH A mother holds her newborn, preterm baby boy while in the neonatal unit at Jinja Referral Hospital, Uganda. Photo credit: Ian P. Hur ley. Each year, 44 percent of the estimated 6.3 million children under five that die are newborns 2. While the global newborn mortality rate declined 40 percent since 1990, the proportion of newborn deaths among children under five increased from 37 to 44 percent in 2013 2. Save the Children focuses on addressing the main causes of newborn deaths: complications of prematurity, sepsis, infections and labor and delivery which together account for more than 80 percent of newborn deaths globally 2. To avert the deaths of mothers and newborns and prevent stillbirths, quality care is needed before, during and after delivery. Basic, low-cost care, such as warming, drying, early and exclusive breastfeeding, antibiotics for infection and resuscitation for babies who are not breathing at birth, can save most of these lives. Since 2000, the Bill & Melinda Gates Foundation-supported Saving Newborn Lives (SNL) program has contributed to improved policies and expanded programs that address the major causes of newborn mortality. SNL works with governments and local partners to test and adapt promising technologies and approaches to deliver lifesaving care, mobilizes commitment and resources, and establishes strategic partnerships to ensure effective newborn health programs operating at scale. This work contributes to an understanding of what can be done affordably and sustainably to save newborn lives in low-resource, highmortality settings around the world. The Maternal and Child Survival Program (MCSP) introduces and supports high-impact health interventions in USAID s 24 priority countries with the ultimate goal of contributing to ending preventable maternal and child deaths within a generation. MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. EVERY NEWBORN An action plan to end preventable deaths Save the Children played a critical leadership role in shaping and launching the Every Newborn Action Plan (ENAP) in July 2014, which aims to reduce preventable newborn mortality. This plan identifies targets and goals for quality of care, newborn mortality and stillbirth rates, monitoring, investments and the national plans to support newborn health 3. 3

CHILD HEALTH This five-month-old baby was treated for pneumonia by a community health worker, Bangladesh. Photo credit: Asma Sharmin. The number of under-five deaths has fallen nearly 50 percent in the past two decades, from 12.7 million in 1990 to 6.3 million in 2013. Despite this improvement, millions of children still do not benefit from affordable, lifesaving services that would prevent the deaths of nearly 17,000 children under the age of five who die each day 2. Save the Children s child health programs focus on empowering frontline health workers to deliver preventative and curative care that addresses three of the major killers of children under five: pneumonia, diarrhea and malaria. Trained and supported frontline health workers in communities and countries most in need can often deliver lifesaving care such as immunizations, oral rehydration solution and zinc, antibiotics and malaria drugs. These frontline health workers help increase access to and quality of child health services, and enable families, communities and governments to be active partners in improving the health and survival of their children. Save the Children initiated Integrated Community Case Management (iccm), a broadly endorsed global strategy to reduce child mortality, in which a health system trains, supplies and supervises community health workers (CHWs) to treat sick children who otherwise would not have access to health services. Through iccm programs, CHWs can deliver appropriate, lifesaving treatments closer to where children live. iccm is integrated because it addresses multiple, potentially life-threatening, syndromes. It also brings medicine to where CHWs provide health care. By combining preventive and curative measures, each complementing the other, iccm achieves better results. We also specialize in the design and implementation of mhealth appropriate, health-related mobile technologies to efficiently increase the quality and use of high-impact practices at scale for improved maternal, newborn, child and adolescent health and survival. We are recognized as a credible partner in applying and supporting the development of these technologies. Save the Children s pioneering initiative, Mwayi wa Moyo (MwM) A Chance to Live works in Malawi to improve access to, and availability, quality and demand of health interventions, which includes supporting an enabling environment to increase use of a community-based package of high-impact services, including post-partum family planning services and commodities. Lifesaving child health, maternal and newborn interventions include CCM of childhood illness (malaria, pneumonia and diarrhea), community-based maternal and newborn care, and postpartum family planning. Working with the District Health Management Team, community leadership and other government partners to support Community Action Groups, MwM targets underserved rural and peri-urban communities, with an emphasis on children under five, women of reproductive age and new pregnancies. 4

MATERNAL & REPRODUCTIVE HEALTH Pregnancy and childbirth are the leading causes of death and disability among women of reproductive age in developing countries. Nearly 75 percent of maternal deaths are from complications during and after pregnancy and childbirth 1. Despite the global reduction of maternal deaths since 1990, 800 women still die every day from preventable pregnancy-related complications because they lack access to inexpensive, lifesaving services and practices 1. Save the Children s approach to reducing maternal mortality includes engaging communities in identifying local solutions and building their capacity to make motherhood safer through a Household-to-Hospital Continuum of Care (HHCC). This approach seeks to improve services and practices at each level, and empowers and enables community members and frontline workers to improve practices and bring basic services closer to the community. We recognize that access to safe and effective contraceptive methods is a critical component of this continuum and that healthy spacing of pregnancies is essential for improving the health and survival of mothers and children. Through our groundbreaking Partnership Defined Quality (PDQ) methodology, we engage community members and health workers as partners in planning, implementing and monitoring efforts to improve the quality of care delivered through health facilities. In Bangladesh, Save the Children works with more than 15 local partners and professional bodies to implement MaMoni Health Systems Strengthening (HSS), an integrated maternal, newborn and child health, family planning and nutrition program. MaMoni HSS works with the Ministry of Health and Family Welfare and local NGOs to strengthen health systems, and availability and quality of health services. In Nepal, we work with the Ministry of Health to educate and empower married adolescent girls to delay early pregnancy, and in Vietnam, with the Ministry of Health on efforts to implement the HHCC approach throughout the country. This out-of-school girl participates in Save the Childrensupported sexuality education programs. Photo credit: Berina Kamahoro. Adolescent Sexual & Reproductive Health Our Adolescent Sexual and Reproductive Health (ASRH) programs span the adolescent reproductive health lifecycle, and include comprehensive sexuality education, contraception for youth, girls empowerment, male involvement and gender equality. We focus on the special needs of very young adolescents (ages 10 to 14) and young mothers who typically lack access to appropriate SRH information, support or services. We help empower adolescents to grow up safe and adopt healthy behaviors by ensuring access to information, adolescent-friendly services and peer counseling. We also train health providers and teachers, support parents to be advocates for young people and mobilize communities to support girls. We continually develop and apply innovative social and behavior change communication tools to help boys and girls form positive gender norms and become agents of change, and to help young mothers acquire the services and support needed for improved health outcomes for their children. 5

NUTRITION Malnutrition is an underlying cause of nearly 50 percent of all under-five child mortality globally, accounting for roughly three million deaths each year 4. And stunting a measure of chronic malnutrition can leave a devastating and permanent impact on a child s physical and cognitive capabilities. In 2013, 25 percent of children under five were stunted 4. The first 1,000 days, from the start of a woman s pregnancy through her child s second birthday, is the timeframe Save the Children emphasizes as the window of opportunity for nutrition. This time period is vital, for even if nutrition status improves after the first two years of life, the damage done to physical growth, brain development and the immune system is largely irreversible. We deliver a variety of interventions through community health workers, volunteers and health facility staff. Our programs support efforts to ensure adequate food and nutrient intake, effective feeding and care practices and protection against infectious diseases. Specific interventions include support for exclusive breastfeeding through six months of age, timely and appropriate complementary feeding, feeding during and after bouts of illness, improved hygiene practices and timely health care-seeking. Save the Children leads Suaahara, the $55 million USAIDfunded integrated nutrition program in Nepal that mobilizes communities to adopt positive agriculture, nutrition and hygiene practices and health service promotion. We direct the $50 million USAID-funded Empowering New Generations to Improve Nutrition and Economic Opportunities (ENGINE) integrated nutrition program in Ethiopia, which strengthens capacity to develop and institutionalize national nutrition programs and policies and improves the quality and delivery of nutrition and health care services at facility- and community-based platforms. In Cambodia, the $16 million USAID-funded Integrated Nutrition, Hygiene and Sanitation Program aims to improve the health of mothers and young children through better nutrition and hygiene practices, with a focus on pregnant women and children under two. The Bill & Melinda Gates Foundation and Governments of Canada and Ireland-funded Alive & Thrive initiative, led by FHI 360, works to reduce morbidity, mortality and stunting by addressing sub-optimal infant and young child feeding (IYCF) practices at sc ale. In addition to advocacy activities, programs in Bangladesh, Ethiopia and Vietnam reached millions of caregivers of children under two with interpersonal communication related to IYCF, mass media campaigns and community mobilization activities. Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) is a 5-year USAID flagship nutrition project dedicated to strengthening global and country efforts to advance supportive nutrition policies, and scale up high-impact nutrition interventions. SPRING provides state-of-the-art technical support focused on preventing stunting and maternal and child anemia in the first 1,000 days, promoting social and behavior change and fostering integration of agriculture and nutrition globally. Save the Children also leads the USAID-funded Technical and Operational Performance Support (TOPS) program, a learning mechanism that generates, captures, disseminates and applies the highest quality information, knowledge and best practices in development food assistance programming, to ensure that more communities and households benefit from the U.S. Government s investment in fighting global hunger. A Suaahara counseling session for mothers on healthy timing and spacing of pregnancy. Photo credit: KJ Borja. 6

EMERGENCY HEALTH & NUTRITION We collaborate with global and national partners and actively participate in national and sub-national coordination mechanisms. In cases where local infrastructure and capacity are significantly diminished, we provide direct services as an interim measure until the transition of these services to local authorities is possible. Save the Children engagement in the global humanitarian community through various response coordination and memberships includes the Global Nutrition Cluster Strategic Advisory Group, the Global Health and Nutrition clusters, the Infant Feeding in Emergencies Core Group and the Inter-Agency Working Group on Reproductive Health in Crisis. A Save the Children-supported Syrian mother and baby in Jordan s Za'atari refugee camp. Photo credit: Hedinn Halldorsson. In the immediate aftermath of a disaster or conflict, and throughout the transition from emergency response to recovery and sustainable development, Save the Children s presence in 120 countries facilitates the rapid delivery of evidence-based and innovative health and nutrition interventions that address the major causes of illness and death among the world s most vulnerable populations. Our emergency health and nutrition programs focus on basic lifesaving maternal, newborn and child health services, communicable disease prevention and control, detection and treatment of acute malnutrition, breastfeeding promotion, the Minimum Initial Service Package for reproductive health in crises (MISP), including adolescent sexual and reproductive health, and family planning. In recent years, Save the Children has responded to health and nutrition emergencies in more than 20 countries, including: Ebola virus outbreak in Liberia, Sierra Leone and Guinea, where we are increasing access to care through the establishment of the first-ever Ebola Community Care Centers in Liberia and Ebola Treatment Centers in Sierra Leone and Liberia; restoring health systems through distribution of infection control materials, essential medications and medical equipment to clinics and hospitals; and promoting community-level awareness and transmission prevention through communications, hand washing facilities and tracing of contacts. In response to the conflict in Syria, we have supported refugees in Egypt, Jordan, Lebanon and Turkey with infant and young child feeding, reproductive health, prevention of gender-based violence and mass vaccination campaigns reaching nearly 220,000 children. Conflict in the Central African Republic displaced thousands of children and their families, damaged schools and health facilities and created vast food shortages. Save the Children provided essential medical supplies and health care, training for medical personnel, vaccination support and treatment for malnutrition. 7

INNOVATION & KNOWLEDGE Save the Children staff are actively engaged in ongoing global health and nutrition research and exploring innovations that address the complex causes of maternal, newborn and childhood illness, death and malnutrition. Our Innovations Working Group identifies critical barriers to improved global health and nutrition, and pursues dynamic partners to develop pioneering solutions and technologies. We leverage the expertise of our health and nutrition technical staff, agency leadership and resource development teams to inform our global health and nutrition work, and our capacity to identify and pursue priority innovations. Save the Children works with the private sector and local governments to develop and test new technologies and approaches for improved health outcomes. We advised Philips Design in the development of a durable and inexpensive respiratory rate counter to better identify and manage childhood pneumonia, and supported groundbreaking research on reducing newborn mortality through the use of chlorhexidine for umbilical cord care to prevent newborn sepsis. Through our Saving Newborn Lives program, we manage the Healthy Newborn Network, a state-of-the-art global knowledge platform and online community designed to address critical knowledge gaps in newborn health. Finally, our staff conduct research in each of our technical priority areas, and frequently contribute to various academic journals. Recent examples include authoring several articles for The Lancet Every Newborn Series, and lead guest editor for a special supplement to the American Journal of Tropical Medicine and Hygiene on Community Case Management research. WHERE WE WORK Save the Children USA supports health and nutrition programs in more than 30 countries and emergency response efforts in over 20 countries globally. We currently target 14 priority countries with the greatest need including: Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Mali, Malawi, Mozambique, Myanmar, Nepal, Nigeria, Pakistan, Uganda, Yemen and Zambia. A six-month-old girl is weighed during a growth monitoring and promotion session, Bangladesh. Photo credit: Jeff Holt. Save the Children invests in childhood every day, in times of crisis and for our future. In the United States and around the world, we are dedicated to ensuring every child has the best chance for success. Our pioneering programs give children a healthy start, the opportunity to learn and protection from harm. Our advocacy efforts provide a voice for children who cannot speak for themselves. As the leading expert on children, we inspire and achieve lasting impact for millions of the world s most vulnerable girls and boys. By transforming children s lives now, we change the course of their future and ours. 2000 L Street NW, Suite 500, Washington, DC 20036 1-800 Save the Children SavetheChildren.org 8