Every Woman Every Child

At the start of 2017, our team has taken some time to reflect on the bigger picture – how our objectives align with global movements and initiatives of different kinds and how best a small group like ours can have the impact we aspire to.

We have been especially interested in looking at the Every Woman Every Child (EWEC) movement and seek to understand how best we could engage with it so that we can track its progress, learn from it and think about how we could contribute our experience too.

In this post, we introduce the EWEC strategy and then comment about sections in the strategy that we think link mostly deeply to our work. We are explicit about how we think we can contribute.

Introduction

In September 2010 Ban Ki-moon, UN Secretary General, launched the multi-stakeholder ‘Every Woman Every Child’  to galvanise the global community to do more to save the lives and improve the well being of women and children.

In 2016, EWEC published The Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030. The strategy describes adolescents as “central to everything we want to achieve, and to the overall success of the 2030 Agenda.”

The three overarching objectives of the updated Global Strategy are Survive, Thrive and Transform. The vision is to – end preventable death – that no woman, child or adolescent should face a greater risk of preventable death because of where they live or who they are and to realize their rights to the highest attainable standards of health and well-being…

The strategy document includes nine action areas and in this post we explore the three most pertinent to the work of Children for Health (although most overlap).

Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030: Nine Action Areas:

1. Country leadership
2. Financing for health
3. Health system resilience
4. Individual potential
5. Community engagement
6. Multi-sector action
7. Humanitarian and fragile settings
8. Research and innovation
9. Accountability for results, resources and rights

Under each of the three highlighted sections, we offer commentary (in green font) and insert questions (in red font). We include text from the report in black italic.

Section on the Action Area 4, Individual Potential

The section on ‘individual potential’ begins with this statement…

Women, children and adolescents are potentially the most powerful agents for
improving their own health and achieving prosperous and sustainable societies.

This sentiment is what we know at Children for Health – it’s the fuel in our tank, the engine that drives us. We seek to advocate for the role of children in this mix. In our experience however, although some people hold this idea in their minds, it is rare to find it in their actions or hearts. After all, the ‘Participation Principle’ was a cornerstone of the United Nations Convention on the Rights of the Child – ratified by most governments in 1989…but its still rare to find evidence of ‘good participation’ on the ground where women and children truly are agents of their own destiny.

The report goes on…

… They [the woman, children and adolescents] can also pass this health and social capital on to future generations. But they cannot fulfil this crucial role unless country leaders and societies uphold human rights, ensure access to essential commodities, services and information, and expand opportunities for social, economic and political participation.

Everyone is born with a unique biological potential for health and then acquires potential from education, skills and life experience.

Environmental factors in early development can influence later health.

Individuals at all ages draw on their biological and acquired potential to meet individual, social and environmental demands on their health and well-being. Having the right resources and opportunities can help people make informed choices about their health.

 A child’s brain and other systems develop most rapidly through the first three years of life, so investments in early development are essential to promote the physical, mental and social development that shape each individual’s present and future health.

 Adolescence is a second critical developmental stage…

Many of those we work with would be confused by what could be argued as a jump here between young childhood and ‘adolescence’ (and we were very confused by this for a while) until we discovered that adolescence is defined by many international organisations as 10-19 so children as young as ten are included in this group although most practitioners would think of ten year olds as pre-adolescent and in late childhood. WHO Puts forward the following definition…

The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19. This age range also falls within WHO’s definition of young people, which refers to individuals between ages 10 and 24.

Note that international organisations also define ‘childhood’ – or ‘a child’ as any person under the age of 18!

So to be clear it is our experience that THE richest seam of childhood for effective health education and health promotion activities is between 10 and 14 years. A period of growth and transition that Save the Children USA refers to as the “very young adolescent” (for example – an article on VYA and sexual and reproductive health can be viewed here) . Many educators might not consider the 10-14 year old as adolescence at all but, ‘late childhood’. It is our view that considering the 10-19 year olds as a ‘group’ or ‘stage’ has its problems when planning or developing strategies as the capacities and interests of children vary enormously. We would argue that the mid-to late adolescent stage is a less effective time to be engaging children in outward facing health promotion and health education activities and community engagement activities. It’s important that a powerful strategy that seeks to galvanise government and civil society and influence policies and practice on issues such as how best to develop individual potential and community engagement makes distinctions of this kind. 

Children in young adolescence (10-14) age are like sponges for learning. They have often acquired the basic skills (reading, writing, arithmetic), they are close to their families and they are empathetic, enthusiastic and responsible. All characteristics that weaken and can even drop away in later adolescence. This is not opinion. Important neurological studies show how the brain develops and changes in later adolescence. Empathy is much stronger at 11 years then it is at 15 years. Any parent of a teenage child can confirm this! Children in young adolescence are keen to join clubs and participate in community outreach activities. They have more time and more enthusiasm than most adults, to participate in this way.

Clare Hanbury is the CEO of Children for Health and was part of a narrow cohort of teachers trained in the early 1980’s (at the University of Cambridge) to teach children attending ‘middle school’  i.e. children aged 9-14 years. She then went on to spend five years in the classroom working with this young adolescent age group. In most of her time working in international development, it has been with the teachers (and teacher trainers) of this age group that has been her focus. Clare has lived and worked in numerous developing countries and has observed first hand that is it this also this age group that bears the brunt of much of the child care in the family. She knows the needs and development characteristics of this age group in theory and in practice!

In many countries this cohort of children (literally) carry a lot of responsibility for the well being of younger children for whom they are at least partial caregivers. They are also at an age where they can be reached effectively as there are far more 10-14 years olds in primary schools across the developing world than there are older adolescents in secondary school.

Most children in young adolescence are developing abstract thinking (vs the concrete operational thinking of younger children); they are usually close to their families and can have a subtle but powerful influence on family habits and practices. Family members may be interested and accepting of ideas and questions that children in this age group come back with – especially if their ideas and questions originate with a teacher or someone whom the family member respects.

We have witnessed children in this middle childhood have been successful in:

• Persuading their fathers to give up smoking (Kenya)
• Persuading male family members to stop stop chewing ‘gat/’khat’ (Yemen)
• Persuading their fathers to store their guns safely (Yemen)
• Adopting the consistent and ongoing use of insecticide treated bed nets and getting others to do the same (Mali)
• Taking their younger siblings to clinics to be immunised or urging their parents to do the same (Vietnam)
• Adopting the SAFE the strategy to prevent trachoma (Ethiopia)
• Influencing parents to buy and use ORS and zinc when their young siblings have diarrhoea (Nigeria, Uganda)
• Helping relatives to calculate their BMI index to identity obesity (Sri Lanka)
• Insisting that a young child with rapid breathing gets to a health centre of urgent attention (India)
• Influencing mothers to adopt exclusive breast feeding (Mozambique)
• Addressing stigma linked to HIV and encouraging adults to go for testing (Uganda)

“Before, the children were breast fed for a shorter period of time, but after PCAAN many women already feed their babies for longer. Now mothers are really fighting hard to be able to breast feed.” (Parent, Tsangano district Mozambique)

• Make and monitor handwashing stations outside family latrines. (Mozambique); and lastly and although this sounds unlikely…
• Changing the staple ingredient from a popular but less nutritious version of maize flour (chima) to one that is richer in nutrients. One strategy that children came up with was to call the white flour ‘chima zero’. (Mozambique).
  

The list goes on…and on…. and on… and the potential is unlimited.

…The physical, mental and social potential acquired in childhood can blossom into skills, behaviours and opportunities that contribute to better health and well-being in adolescence and later to a more productive adulthood…

Here the strategy does seem to be acknowledging the potential of young adolescence…

… The right investments and opportunities may consolidate early gains, or offer a second chance to young people who missed out during childhood. Moreover, as possible future parents, adolescents can transfer health potentials and risks to future generations…

… We would argue that unless already married, it is children in young adolescence that have greater contact with and responsibility for younger siblings…and influence over other family members.

… As adults, women contribute to society, politics and the economy in many ways that can promote health and well-being and advance sustainable development.

The adolescent’s contributions are often overlooked, but they include:

• Knowledge;
• Resilience in the face of adversity;
• Leadership for their own and their families’ health;
• Contributions to the workforce;
• Participation in cultural and political life; and
• The ability to mobilize themselves and their communities to prevent and mitigate crises, rebuild communities and achieve transformative social change and peace…

… We agree and all this can be best attributed to young adolescence.

 … Many of the barriers individuals face in realizing their potential are related to violations of their human rights, including violence, abuse and discrimination. An experience of violence can disrupt development and cause immediate and long-term physical, mental. Emotional and social harms.

ACTIONS

1. Invest In Child And Adolescent Health And Development.

Develop and finance integrated health and development programmes for early childhood and adolescence that combine efforts across sectors (including health, nutrition, responsive care-giving, social and mental stimulation, education, environment, water, sanitation and hygiene, employment and economic development programmes) and by a range of partners (including government, civil society, the private sector and communities)…

 Again there is a jump here – early childhood and then adolescence (our highlights) … we need to be clear what is meant by adolescence and that the young adolescent stage is not being overlooked. At Children for Health we have developed our own content and activities to target this age group and we are more comfortable referring to this age group as ‘children’ from now on!

We have also developed or adapted this content and these activities alongside our partners in Nigeria, India, Mozambique and Sierra Leone.

We also lightly support others in other countries that are interested in our approaches and materials. Our health messages for children have been recognised by and are posted on the Orb platform.

Some questions for EWEC:

• Would our 100 messages for children to learn and share be of use to the EWEC movement? Could they be adapted? Adopted?
• Could our stories for children and posters for teachers and children help resource any of this work?
• Would our suite of activities to empower children and their carers and teachers be of use?
• Would it be useful to share experiences and case studies on the work we are doing in ‘Children’s Participation in Nutrition Education’ in Mozambique? Or ’Children’s Participation in Diarrhoea Prevention and Control’ in Nigeria and India?
• How can we link to those who might be interested to adopt or adapt our content and activities?

… Support people caring for young children (and these are often children in the 10-14 year old age group) to provide nurturing care with stimulation and opportunities for learning in the first years of life…

See our ten messages for children to learn and share on the topic of, ‘Caring for Babies and Young Children’ Would these be of help?

… Ensure that young people achieve literacy and numeracy and have relevant technical and vocational skills for employment and entrepreneurship…

We believe that health and life skills learning are inextricably linked. Our sister organisation, Lifeskills Handbooks, has resources that thousands of individuals and organisations view and download every year.

The FRESH framework proves a context for the effective implementation of skills based health education programmes. Our CEO, Clare Hanbury contributed to the M & E Guidance and the Eight Core Indicators for School Health Programs.

2. Support Women, Children And Adolescents As Agents For Change.

Identify context-specific needs — including barriers to realizing rights — and promote access to essential goods, services and information. Expand age appropriate opportunities for socio-economic and political participation. Ensure that these activities are funded in country plans and budgets…

This complex ‘programme optimization’ work is precisely what Children for Health has been doing since its inception in 2013, alongside government programmes and INGO’s and so far as part of specific programmes in Mozambique, Pakistan, Nigeria and India.

A range of technical skills are required to scope the opportunities and challenges and to develop strategies to best position, support and develop capacity building interventions plus curriculum and materials development.

Please note that although young as an organisation, Children for Health draws upon thirty four years of field experience in numerous countries, each with very different systems and approaches.

3. Remove Barriers To Realizing Individual Potential And Protect From Violence And Discrimination.

Identify the root causes of exclusion, discrimination and deprivation, including inadequate civil registration and vital statistics systems. Strengthen legal frameworks to register and address human rights violations, promote human rights literacy and provide age- and gender-appropriate protection services and safe spaces for women, children and adolescents, including in humanitarian and fragile settings. Expand civil registration and vital statistics systems to increase access to services and entitlements in order for women and children to realize their rights to proper health care, education and basic social benefits, including housing and social protection…

Our work on child centred health education in districts and communities is also protective of children. Its work to help children make the invisible – visible. The work they are highlighted by the activities they do and that ‘light’ made more powerful. Parents and friends of children in some of the districts in Mozambique where primary school aged children are working as nutrition activities, describe the children as “heroes.”

Section on Action Area 4 | Community Engagement

“Community” is a broad term that includes local, national or international groups of people who may or may not be spatially connected, but who share interests, concerns or identities. Several countries offer strong evidence of the effectiveness of community engagement. Examples include women’s groups supporting those who are pregnant or new mothers, involvement of men and boys in health programmes, and involvement of patients in quality-improvement activities within urban health services.

Ideally, the whole community, including adolescents, should be engaged in the process of deciding on health priorities and shaping health services for people of all ages…

This is a great idea but is rarely found in practice – although it is very straightforward and does not take long to orchestrate rich exchanges between children and community mobilisers, community health workers or teachers.

In our experience, adults involved in these exchanges (that often take place initially within a workshop setting) are amazed and delighted at the extent of the knowledge, attitudes, skills and sensitivities shown by children. In a recent workshop in India (November 2016), some colleagues described the fieldwork with children on the topic of diarrhoea prevention and control as a highlight of their professional careers. Working with the children opened their eyes to the potential and possibility of involving children in campaigning. They were excited by how little it would take to harness their enthusiasm and local knowledge to promote the objectives of their programmers.

Schools and community programmes can embed opportunities to engage children ( or – young adolescents!) using participatory techniques. This takes training but. in our experience not very much training – its more a mind shift and finding ways to create that ‘light bulb’ moment that opens the eyes of those adults who have had a role in working with children.

… For instance, community health workers are trusted community members in many countries, yet are under-recognized and remain peripheral in many national health systems. Civil society organizations, faith-based organization sand local, faith and traditional leaders also play important roles in addressing sociocultural barriers to the promotion of healthy behaviours…

We agree that all existing structures that bolster and strengthen communities can and should get involved in designing, supporting and even monitoring children’s activities.

ACTIONS

1. Promote Laws, Policies And Social Norms That Advance Women’s, Children’s And Adolescents’ Health.

Create legal and policy frameworks to promote positive social norms, for example to prohibit violence against women and girls and promote the full inclusion in society of individuals living with disabilities. Remove legal and policy barriers to adolescents’ access to services. Improve community engagement through improved health literacy, dialogue, learning and action and community engagement strategies.

… And children themselves can play a part in designing these frameworks. The strategies could include the part children can play in positive change. They can even be equipped to be at the front line of protecting themselves and others against violence and abuse. Children for Health staff developed two modules for the Keeping Children Safe Toolkit on Children’s Participation in Child Protection – designing activities for educators to use with children; and a Training Guide to prepare teachers to work with children using participatory techniques in this sensitive area.

… Tailor mass-media campaigns to different social contexts, resources and needs to promote health literacy and positive behaviours in areas such as:

• Comprehensive sexuality education for adolescents and adults;
• Breastfeeding and good nutrition;
• Water, sanitation and hygiene practices; and decision-making related to health…

Children for Health have developed 100 messages for children to learn, collect and share in 10 health topics. Each message is between 120 and 200 characters (so very short).

The aim of our suite of health messages for children is to provide parents, teachers, other educators and schools with a set of very simple yet well researched health messages that can be adapted and translated (in situ). More on how we create our messages can be found here. One of our key ideas is that every child would learn, collect and share 100 locally relevant health messages before leaving primary school.

 But a health message is only the starting point. These health messages are like a doorway! Behind each message are sets of activities and discussions and in particular questions to ask in the family. Even if a child knows that they should be using soap to wash their hands as critical times – they will not have the purchasing or other power to make this happen. What they can bring to the family are questions – What do we need to help us wash our hands properly at critical times? – or Why is it hard for us to wash our hands properly and at critical times?  Ideally it is then the adults themselves who join with the children to come up with solutions together and this process stated or at least influenced by the children’s enquiry.

 Here are links to our messages:

1. Early Childhood Development
   
2. Coughs, Colds & Other Serious Illnesses
   
3. Immunization
   
4. Malaria
   
5. Diarrhoea
   
6. Water, Sanitation & Hygiene
   
7. Nutrition & Growth
   
8. Intestinal Worms
   
9. Injury Prevention
   
10. HIV & AIDS
    

As well as creating our own collection of  messages, we have worked with partners to create and integrate messages and activities to their own programmes for example:

• We have developed a curriculum for ‘School Health Clubs’ structured around eight nutrition messages for the provincial Government of Tete in Mozambique;

• We have developed a curriculum for the Save the Children’s Diarrhoea Prevention and Control programme in Nigeria structured around 12 messages. We have repurposed these materials and using a similar approach in the signature programme in India. The health messages are part of a comprehensive pack of materials for trainers and educators and include story books and this Speaking Book.

All these materials have at their heart the promotion of children’s participation and empowerment.

2. Strengthen Inclusive Community Action That Recognizes The Roles Of Different Groups.

Involve community and political leaders and planners alongside other community members. Develop a more integrative and holistic approach to the continuum of health care by involving civil society organizations, including humanitarian actors, community and faith-based leaders and traditional birth attendants in dialogue and participatory learning and action.

Formalize the contribution of community leaders and health workers within national health systems, with appropriate devolution of responsibility, support, supervision and remuneration.

 Encourage communities to participate in defining their health needs. Reorient health and development services in response…

Part of the Children for Health ‘Toolbox’ is a collection of activities that ensure enjoyment by children in the identification and prioritization of health issues that affect then.  Our activities include role plays, games, quizzes  and a variety of discussion starter tools.   One of these is our ‘Opportunities Chart’ discussion tool. This tool is sometimes used to get a broad idea of ‘what matters’ to children (and their educators too) but very often the agenda is set – either by government or by local priorities or funding is pegged to achieving certain health goals. 

Most of the activities we design require little or no resources to make them work and once a tool or method is grasped by the educators and the children it can be adapted for other health topics.  It is having the correct knowledge, an understanding of specific activities and the skills to facilitate them and facilitate meaningful discussions that really makes the difference between an encounter between children and adults being fully participatory or not.

3. Ensure women and girls can fully participate and engage men and boys in health programmes.
   

Involve women, children and adolescents and the organizations that support them in decision-making for health policies and programmes that affect their health and well-being. Include age and context-specific mechanisms in health programmes to ensure their participation…

Teacher Training Curricula and Programmes, School Health Clubs and School Curricula are surely the easiest pre-existing ‘mechanisms’ through which children can be engaged or can participate. What is usually missing (among the policy makers, project managers as well as college and school based staff is an understanding of what participation really IS, how it differs form what is already happening and how best to harness the ideas and enthusiasm of children and their champions to meet health goals.

This is unsurprising as few adults experience participatory approaches at either a school or training college. Even at the University of London’s Institute of Education, students receive lectures in participatory methods! It takes a cohort of experienced master trainers and/or teachers, some innovative approaches to deliver this training and some basic ‘standards’ if we really want to achieve fully participatory engagement.

As has already been described, the Children for Health Toolbox contains fun and engaging methods to help educators and other understanding the distinctions between traditional health education and participatory approaches.

A notable and recent addition to this is the Rainbow Flower, a tool that teachers learn, discuss and then craft to take home and remember.

… Promote supportive attitudes and behaviour from health workers for engaging men and boys and provide space for male partners in health clinics.

Section on Action Area 8 | Research and Innovation

The full spectrum of research is required to understand and overcome the barriers to health for women, children and adolescents. Policy, implementation and operational research can lead to stronger systems and to improved service quality, efficiency and effectiveness.

 Clinical research and systematic reviews of the evidence are essential to develop and update effective interventions (see Annex 2) and combat emerging challenges. These challenges include: Antimicrobial resistance, as well as neglected tropical diseases, particularly as

They relate to women’s, children and adolescents’ health. More and better data are needed from monitoring and evaluation to increase the timeliness and accuracy of accountability tools and information. Research is needed to understand the determinants and barriers that continue to restrict the access of many women, children and adolescents to health services.

Likewise, evidence is needed on the most effective approaches to reduce these inequities, across a range of contexts.

Social, behavioural, anthropological and community research helps to increase understanding of how to promote positive behaviour for health—such as breastfeeding and hand washing with soap—and how to prevent harmful practices such as child marriage and female genital mutilation. Political and social sciences are also suited to capture evidence related to important health-related human rights and social goals, such as health equity, empowerment and eliminating discrimination…

Since its inception in July 2013, Children for Health has been advocating for research in the area of children’s participation in nutrition and health programming. We have developed two concept notes with colleagues at the London School of Hygiene and Tropical Medicine: one linked to a programme to prevent trachoma (eye infections) and the other linked to Save the Children’s Diarrhoea Prevention and Control programmes.

We have authored a Rapid Sift of current evidence

… And, with DANIDA funding and as part of our work in Mozambique, developed a case study out of an evaluation of a pilot intervention in 12 schools in Tete Province.

The evaluation suggested that the involvement of children in nutrition education has led to an increase in breastfeeding; an improvement in hand washing practices and (most strikingly) a change in the way a staple food is prepared in order to preserve more nutrients. We consider it urgent for robust research in this area, and in particular as ‘individual potential’ and ‘community engagement’ are two of the nine key strategies highlighted by the EWEC movement. Children for Health have considerable experience in designing innovative interventions that fit with the local context and we have a strong understanding of the factors that promote and inhibit effective health education with children.

• How can we help to prioritise such research?
• When can we access a research grant
• Who might be interested to partner with us?

… Evidence shows that knowledge and technological advances can be at least as important as economic resources in improving health and well-being.

Innovation is the starting point of a process that translates powerful new ideas and scientific evidence into effective, widely used interventions and commodities. To identify and take them to scale, the Every Woman Every Child movement has adopted the concept of integrated innovation. This states that scientific and technological, social, business and financial innovations are all needed and can often be combined to achieve transformative effects.

Innovations in low-income countries are a vital source of progress and should be supported by global partnerships and south-south cooperation. Community-based organizations have a critical role to play, particularly for innovations that go beyond health service delivery to address harmful social norms, build institutional capacity and reduce inequities.

 Actions

1. Invest In A Wide Range Of Research, Prioritizing Local Needs And Capacities

Build country capacity to generate and use robust and relevant research evidence for the development of more effective policies, practices and advocacy for women’s, children’s and adolescents’ health…

… Children for Health is ready to help

2. Link Evidence To Policy And Practice. Invest In And Nurture The Cycle Of Research, Evidence, Knowledge, Policy And Programming.

Develop “knowledge brokering” and knowledge translation mechanisms to ensure the latest evidence is available to all stakeholders at country, regional and global levels. Invest in global and national research networks, knowledge platforms and data hubs to provide accurate, timely and transparent evidence, knowledge, data analysis and synthesis…

… Children for Health is ready to help

3. Test And Take Innovations To Scale.

Actively engage governments, the public and private sectors, academia, civil society, foundations, donors, socially-minded investors and other relevant stakeholders to develop and bring successful innovations to scale…

Children for Health is currently supporting the planning to scale the innovation, Children’s Participation in Learning and Action for Nutrition (PCAAN – in Portuguese), in Mozambique. We have been involved in this initiative since November 2011 and have taken every effort to ensure that the interventions were scalable and sustainable from the start. We have been the technical lead and have a good sense of what it takes to make a participatory programme work and how to make it sustainable.

Create a positive business environment that recognizes the value of innovation to society.

Prioritise innovations that have the greatest potential to reduce inequities in health, and to ensure that progress on women’s, children’s and adolescents’ health benefits disadvantaged populations at least as much as more affluent ones.

It is our view that a hugely overlooked resource in our health programmes are the children themselves who have knowledge attitudes and skills to offer and who, by using participatory approaches will gain not just knowledge about health but become empowered citizens.

Encourage the sharing of expertise and experiences.

Through our website Children for Health aims to share its resources, expertise and programmes to all those interested in children’s participation in health.

Final Note – the role of Children for Health in the EWEC Movement…

At Children for Health we think the EWEC movement have correctly highlighted the urgent need to improve the health of millions of women, children and adolescence across the globe. We know that one of the ways of doing this is to mobilise children aged between ten and fourteen using the schools together with school and community health clubs.

We hope that this post has highlighted the potential for children to be mobilised as health activists!

At Children for Health we can provide technical expertise in health education programme optimization and we specialize in child participation and empowerment and particularly focus on reaching children in young adolescence (‘Upper Primary’ in most countries).

We are experienced and ready to develop or strengthen programmes that already recognise this extraordinary untapped potential. We have content, we have activities and we know how to help organise these programmes  – the factors that can help and hinder. We develop materials, we design and conduct training, teacher training and master training. We are experienced in evaluation and we are ready to contribute to the design of research and work alongside research teams.

Contact us to find out more, clare@childrenforhealth.org