"Children who are poor, hungry and living in remote areas are most likely to be visited by these 'forgotten killers' and the burden placed by pneumonia and diarrhoea on families and health systems aggravates existing inequalities."—GAPPD 2013

Tremendous achievements have been made in decreasing mortality among children under the age of 5 years, with a 41% drop from 87 to 51 deaths per 1,000 live births between 1990 and 2011.¹ However, the reduction rate is not the same everywhere: still in 2010, 7.6 million children died before they reached the age of five.² Disparities among regions are growing with the highest mortality rates in Sub-Saharan Africa, where 1 in 9 children die before their fifth birthday—more than 16 times the average for developed regions (1 in 152 ). Southern Asia is the second highest child mortality region, with 1 in 16³ children dying before the age of five. Most of these child deaths occur at home and without access to essential health services and basic lifesaving commodities.⁴ The three primary killers of children under 5 years of age (pneumonia, diarrhea and malaria) are both preventable and treatable with simple and cost-effective interventions. 

The past five years have shown a marked increase in global collaborations committed to ending preventable child death. The 2012 Child Survival Call to Action and A Promise Renewed, jointly led by USAID and UNICEF with the Governments of Ethiopia and India, brought together over 700 public, private and civil society sector partners. In 2013, the WHO led development of the Global Action Plan for Pneumonia and Diarrhea (GAPPD), which is an integrated effort to protect children from pneumonia and diarrhea. The Every Woman Every Child campaign was launched in 2010 and includes the Global Strategy for Women’s and Children’s Health—a roadmap to strengthened financing, policy and programming. Several coordination groups have also been formed, including the UN Commission on Lifesaving Commodities for Women and Children and the Diarrhea and Pneumonia Working Group.

Strategic Approach
MCHIP has been a vital contributor to increased global momentum towards ending preventable child deaths through participation in key global forums such as the 2012 Child Survival Call to Action and A Promise Renewed and the Diarrhea and Pneumonia Working Group, as well as by providing technical assistance in the development of the 2013 integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD). While there has been increasing—although  still inadequate—attention and funding for malaria programs, MCHIP is committed to increasing access to services for all three of the major killers of children: diarrhea, pneumonia and malaria. As a traditionally neglected childhood illness, diarrheal disease is at the core of MCHIP advocacy and awareness-raising efforts. MCHIP is building on the current momentum of A Promise Renewed and the GAPPD report to support joint diarrhea and pneumonia programming. MCHIP actively advocates for better strategic integration of diarrheal disease programs with malaria, nutrition and newborn interventions.

MCHIP recognizes that efforts to end preventable child deaths will only be successful when these integrated packages of interventions are available to the populations most at risk. While most countries have adopted Integrated Management of Newborn and Childhood Illness (IMNCI), many communities still do not have access to the health facilities that provide these case management services. MCHIP supports integrated Community Case Management (iCCM) as a “strategy to deliver lifesaving curative interventions for common childhood illnesses… where there is little access to facility-based services."⁵ At the heart of this approach is the recognition that community health workers (CHWs) are a strong potential workforce in hard-to-reach areas. CHWs are available almost everywhere and, with proper training and support, they can provide lifesaving treatment to children in remote villages. MCHIP supports the introduction and expansion of iCCM at the country level by working hand-in-hand with counterparts at the Ministry of Health. To support countries implementing iCCM programs, MCHIP acts as the Secretariat of the CCM Task Force, helping to strengthen global momentum and coordinate iCCM resources available in support of country level programs.

Key Contributions to Child Health

• Through global advocacy, MCHIP has contributed substantially to increased interest in, and refocused priorities on, the “forgotten” killers of children- diarrhea and pneumonia. When MCHIP started in 2008, diarrheal disease programs were suffering from low visibility, low interest from global partners, insufficient funding and weak country programs. Over several decades, very little progress had been made to advance diarrheal disease programs despite the enthusiasm sparked first by the introduction of oral rehydration therapy in the 1970s then renewed in 2004 through the WHO/UNICEF technical recommendation for combined low-osmolarity ORS and zinc treatment. Over the past few years, MCHIP has worked with USAID, UNICEF, WHO and other global partners, as well as with Ministries of Health at the country level, to call increased attention to the state of child health. The GAPPD report and the Diarrhea and Pneumonia Working Group are two examples of how this increased momentum has resulted in tangible actions that can inform and support child health programs in target countries.
• MCHIP has been at the heart of efforts to introduce and expand iCCM. As the Secretariat of the CCM Task Force, MCHIP provides technical leadership and strategic management to facilitate enhanced partner coordination and to centralize and disseminate key global learning through CCMCentral.com. For iCCM at the country level, MCHIP has: advocated (6 countries); introduced (4 countries); expanded (4 countries); and evaluated (4 countries) the strategy. (For more on our work with the CCM TF, please refer to the CCM section.)
• In country, MCHIP works at the national level helping to establish and update supportive policies, at district or provincial levels ensuring that health teams are empowered to manage child health interventions, and with health providers to ensure that clinicians are properly trained in the most up-to-date case management of childhood illness. For example, in Kenya, MCHIP has worked hand-in-hand with national ministries to advocate for openness to task shifting and the introduction of iCCM to reach communities without access to health facilities. MCHIP has helped establish a national iCCM implementation plan, iCCM monitoring and evaluation framework and to reclassify zinc as an over-the-counter medicine. The iCCM Implementation Plan, also referred to as the CCM Roadmap, coordinates efforts by all partners involved in iCCM in Kenya and will help to ensure that scale up is done in a successful manner. By advocating for zinc to be available without a prescription, MCHIP has helped to ensure that this essential life-saving commodity can be accessible at the community level. In health facilities, MCHIP has worked with partners to strengthen oral rehydration therapy (ORT) corners including supply provision and management, health provider training and job aides. In one district, MCHIP is conducting implementation research to evaluate initial introduction of an iCCM program.

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¹ CHERG (2012), Levels & Trends in Child Mortality
² UNICEF (2012) Countdown to 2015: Building a Future for Women and Children: The 2012 Report.
³ CHERG (2012), Levels & Trends in Child Mortality
⁴ Loaizo E et al. (2008), Child mortality 30 years after the Alma‐Ata Declaration. The Lancet. 2008;372:874‐6.
⁵ CCM Essentials book