Joining Up for Women's and Children's Health

If we are to bring about the drop in mother and child mortality rates that we all wish for, integrated approaches to health and development that cut across artificial institutional barriers are the right way forward.
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Co-authored by Julio Frenk, Dean of the Faculty, Harvard School of Public Health

"Often the women don't have clean water, we find that there are a lot of difficulties, especially with home deliveries. They draw the water from shallow wells, yes, it's quite difficult. And that usually causes a lot of infections. It is very dangerous for the woman and the child when there is poor hygiene. A lot of infections can occur."

Today at a high level meeting, the United Nations Secretary-General, Ban Ki-moon, will review progress made since the launch a year ago of the Global Strategy on Women's and Children's Health.

For Clara Muchimba, the midwife at Chikuni Mission Hospital in Zambia quoted above, the discussions in New York may well seem like a world away -- but if we get this right, the initiative will have a positive impact on the lives of the mothers and children Clara cares for, as well as millions of others around the globe.

As a health professional, Clara knows all too well that there isn't one single simple solution to reducing the number of maternal and child deaths. Poverty, a lack of education and ill health are interrelated in people's lives. Poor sanitation in schools, for example, leads to more sickness, higher drop-out rates and lower educational attainment.

The impact of such knock-on effects means that we need a more joined-up approach -- a way of tackling these problems that deal with both the causes and the symptoms.

Last year at the launch of the global strategy, the U.N. Secretary-General highlighted the importance of "integrating efforts across diseases and sectors such as health, education, water, sanitation and nutrition." In effect, we -- governments, NGOs, civil society organisations, the private sector -- need to work together, better.

However, the vast majority of development programmes continue to be run in isolation. All too often, separate agencies and government ministries run projects that focus on just one area, like health, education or water.

But it doesn't have to be this way, as the report "Join Up, Scale Up" shows. Appropriately written by a group of charities working together, the report highlights aid projects that have succeeded in dealing with a problem by applying more than one solution. Because of this cooperation and communication, they are achieving results far beyond what a narrow approach could generate alone.

A hand washing and oral hygiene programme in elementary schools in the Philippines, for example -- involving the Department for Education, the not-for-profit organisation Fit for School and regional and local government -- cut school absenteeism by 30 percent, while the number of underweight children was reduced by one-fifth in the targeted schools.

In Peru, chronic child malnutrition was cut across the country by nearly 5 percent in under three years by bringing together community groups, politicians, small scale financing, water and sanitation improvements, better child and mother health care, and nutrition education programmes.

Meanwhile in Nepal, through working together, the national government, aid agencies, charities and local government have completed a programme to train all local doctors and nurses on hygiene education. This work is now going a step farther with the setting up of a new nationwide water quality surveillance system, dealing with the causes -- as well as the symptoms -- of the problem.

Making a success of the Global Strategy on Women's and Children's Health is going to be both challenging and complex. But the current system, where one type of health service is often prioritized over another, or where certain services are completely unavailable, simply isn't working.

That's why global leadership on women's and children's health is so critical right now. If we are to bring about the drop in mother and child mortality rates that we all wish for, integrated approaches to health and development that cut across artificial institutional barriers are the right way to move forward. With 4,000 children continuing to die every day, just from diarrhea caused by unsafe water and poor sanitation, we need to meet this crisis head on -- and together.

Julio Frenk is also Board Chair of PMNCH (Partnership for Maternal, Newborn & Child Health) and was Mexico's Secretary of Health

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