Below are some encouraging examples of how the global health community is addressing childhood mortality.
Supporting Community Health Workers
There is a strong evidence base supporting the use of ICCM to reduce childhood mortality and morbidity in countries where health systems are weak. In several low and middle income countries, there are already models of successful ICCM programmes that have been in existence for years, delivering quality healthcare in rural communities. One such example is in Nepal, where the United States Agency for International Development (USAID) provides technical support to the national Female Community Health Volunteer (FCHV) scheme. There are currently about 49,000 FCHVs throughout Nepal, serving as a community based resource, providing health education and services in rural areas, with a special focus on maternal and child health. They play a significant role in the distribution of essential medication for pneumonia and diarrhoea, regular immunisation, and distribution of family planning commodities. To learn more about community health workers in Nepal, please click here.
Health Systems Strengthening
Multilateral support for ICCM has been slow to start, with some funding organisations favouring more measurable health interventions like net distributions or vaccine initiatives. However, funding health interventions in isolation, without reference to health systems and capacity building, risks delivering results that are unsustainable. In 2010, data from the Millennium Development Goal country progress report highlighted this problem. As a result, funding organisations are becoming more concerned with how to build the capacity of health services while at the same time delivering immediate disease interventions. The Global Fund to Fight AIDS, Tuberculosis and Malaria announced at the end of 2010, that for the first time, some of its disbursements would address health systems strengthening. This decision from the single biggest global health donor marks a fundamental shift away from targeted disease funding and is an extremely encouraging indicator of the potential to harness aid money to build the capacity of health systems in a sustainable way. It also potentially opens the door to future disbursements from the Global Fund to cover diarrhoea and pneumonia. To read about the Global Fund's work on health systems strengthening, please click here.
Integrating Child Health Care
With improvements in diagnostics and net coverage, reported malarial illness rates are dropping and it is becoming increasingly clear to the child health community that non-malarial febrile illness caused by diarrhoea and pneumonia accounts for more childhood deaths than any other disease. Currently, bilateral donors invest in preventive measures against respiratory and enteric illness such as immunisation, adequate nutrition and by addressing environmental factors including water and sanitation, however more needs to be done to treat these diseases at community level when they present and, where possible, integrate the treatment of these diseases with existing healthcare mechanisms for malaria and HIV/AIDS, especially among children. The Canadian International Development Agency (CIDA) is funding Malaria Consortium to carry out ICCM in four malaria endemic countries to integrate malaria treatment with the treatment of diarrhoea and pneumonia to maximise existing healthcare mechanisms and improve childhood survival rates. You can read more about this project here.