USAID and UNICEF: A Winning Partnership for Child Survival and Development

As the international community engages in a last push to decrease child deaths annually from 12 million in 1990 to 4 million by 2015, world leaders will meet for the 'Child Survival -- Call to Action' Summit in Washington, D.C. this week to set an even more ambitious goal of 'ending all preventable child deaths' down to 2 million by 2035. This is a fitting moment for reflection and celebration of USAID's 50th anniversary, and 30 years of historic contribution and leadership in what came to be known as a global Child Survival and Development Revolution (CSDR).

The philosophical underpinnings of the CSDR can be traced back to the establishment of the U.S. Agency for International Development (USAID) by President John F. Kennedy in 1961. Kennedy's call to action to end world poverty had inspired a young American named James P. Grant, who had earlier witnessed a public health revolution in China following a 'barefoot doctor' method, and a 'Green Revolution' to increase food production in India, Turkey and elsewhere. While working for USAID and a small think-tank organization called the Overseas Development Council in the 1960s and '70s, Grant was convinced that real human development needed to focus on improving people's health, education and well-being alongside economic success.

Grant was appointed head of UNICEF in 1980, and two years later he articulated a vision of a Child Survival Revolution. It was unconscionable, he argued, that 40,000 children were dying each day, when there were many low-cost, readily available interventions to prevent such deaths. He proposed regular child Growth monitoring, Oral rehydration therapy, Breastfeeding, and Immunization, as the cutting edge interventions, supported by female education, family planning, and food supplements -- known as GOBI-FFF. Of these, immunization and ORT were seen as the 'twin-engines' of the child survival revolution.

Grant persuaded world leaders to raise immunization rates from single digits to 80 percent in less than a decade. To reach all children, UNICEF promoted temporary cease-fires called "Days of tranquility" in conflict zones. Grant persuaded the United Nations to convene the largest gathering of world leaders -- the World Summit for Children in 1990 -- which adopted an ambitious Declaration and Plan of Action for the Survival, Development and Protection of Children, which laid down many time-bound goals and targets, and commitment of world leaders to allocate resources to achieve them.

Due to the rise in childhood immunization and other child survival interventions, lives of some 10,000 children were saved every day by 1990, and another 10,000 deaths were prevented daily two decades later. CSDR also led to improved health and nutrition through measures such as: prolonged breastfeeding; reduction in vitamin A, iodine and iron deficiencies; improved hygiene and sanitation; basic education and women's empowerment. Most importantly, advocacy of CSDR elevated the well-being of children on the world's development and political agenda.

Recognizing that ministries of health in most developing countries lacked resources and political clout for such a grand scale revolution, Grant developed a strategy to persuade top national and local political leaders to invest heavily in life-saving services which yielded political dividends at minimal financial cost. He also motivated religious leaders, the mass media, cultural icons, and non-governmental organizations to promote child survival. In an era before the advent of mobile phones, internet and today's social media, such social mobilization led to large-scale action for child survival.

Initially, Grant faced opposition from many who accused him and UNICEF of pursuing a vertical campaign approach that would be unsustainable. But eventually his critics were convinced that Grant's vision for development, creating success stories with a small number of highly "doable" interventions, helped the overall goal of combating poverty, promoting democracy, slowing down population growth and accelerating economic development.

To overcome the early criticism of CSDR, Grant needed the support of the U.S. government and the public. To secure such support, UNICEF activated a citizen's group called the US Fund for UNICEF which had extensive network of volunteers all over America. Another small NGO called RESULTS helped plant write-ups in local newspapers justifying the feasibility and affordability of the child survival revolution, and urging the US to take a global leadership role. A Task Force for Child Survival was established in 1984, which coordinated action by many partners like the World Health Organization and the World Bank to improve public health and reduce maternal and child deaths. Finally, and most importantly, USAID became a strong and forceful champion of child survival. UNICEF and USAID collaborated closely, with UNICEF taking the lead on immunization, and USAID leading a global effort to popularize oral rehydration therapy (ORT).

Peter McPherson, AID's administrator in the 1980s, tripled USAID's funding support in three years to disseminate ORT in 50 countries. Under McPherson's leadership, USAID supported research, incorporated ORT in all USAID supported primary health care projects, encouraged all USAID country directors to promote and disseminate ORT worldwide, and enlisted US Peace Corps Volunteers to promote ORT at community levels.

As UNICEF Representative in Haiti in the early 1980s, I personally collaborated with USAID in an ambitious national program to promote a local brand of ORS called serum oral. Within just a few years, eighty per cent of mothers in Port au Prince and 30 percent of those in the countryside had heard of serum oral and begun to use it, saving thousands of children annually.

The collaboration between USAID and UNICEF produced great results, saving millions of child lives every year. Besides the intrinsic merits of promoting child survival, the solid US backing encouraged WHO, the World Bank, European and other donors to join ranks, leading to a true global movement for child survival and development.

While we celebrate the great achievements in child survival over the past decades, the continuing loss of 21,000 children daily from preventable causes is unacceptable. In future, we will need to deploy some new approaches that the world community has devised in recent years, including further increases in childhood immunization, nutrition and food security, elimination of pediatric AIDS, malaria control, water and sanitation, greater attention to the link between child and maternal health, and increased focus on the FFF components of the original GOBI-FFF strategy.

To complete the unfinished CSDR agenda, a big priority now should be to focus on equity and make a deliberate effort to reach the most deprived and marginalized children. Such focus on reaching the "bottom quintile" would be very timely and appropriate because the great progress we have made in child survival in recent decades, while encouraging, has been very uneven. Indeed, despite the good progress we are making in achieving the United Nations Millennium Development Goals or MDGs, we are witnessing an alarming widening of disparities between rich and poor countries and within nations.

With the 'Child Survival -- Call to Action' Summit in Washington, D.C, world leaders will embark on an ambitious, but achievable agenda to end preventable child deaths. The world looks to USAID, along with other partners like UNICEF, to play a leading role in a renewed child survival and development campaign. As it celebrates its 50th anniversary, USAID can have no nobler mission than to rededicate itself to the original call to action by its founding father -- President Kennedy -- to lead the way to eradicate world poverty, and help build a world fit for all our children.