Investing in 5th Birthdays

Photo By: Mike Carey (CC)

Fifth birthday celebrations in the USA are one of many during early childhood, but five years also means a child is ready to begin formal education and a new phase of life.  But a fifth birthday celebration is a major accomplishment in many parts of the world, and this was especially true in 1984 when 1 in 4 children died before age 5.    In response to this tragic situation, a partnership was launched that has resulted in saving hundreds of thousands of lives and improving the health of millions of women and children in the past 30 years.   In 1984, with bipartisan action in both Houses of Congress, the Child Survival Act was added to the Foreign Assistance Act.  

Congress instructed the administration to “undertake activities designed to deal directly with the special health needs of children and mothers. Such activities should utilize simple, available technologies which can significantly reduce childhood mortality, such as improved and expanded immunization programs, oral rehydration to combat diarrheal diseases, and education programs aimed at improving nutrition and sanitation and at promoting child spacing.”

The Senate added that the funds should be channeled to developing countries “with such assistance to be provided through private and voluntary organizations and international organizations whenever appropriate.” 

With a portion of these allocated funds, the United States Agency for International Development (USAID) created the Child Survival and Health Grants Program (CSHGP) which built a partnership among American private charities, their citizen supporters and USAID to work in the hardest to reach communities where basic health services were non-existent or lacking.   The CSHGP used affordable and effective interventions, such as immunization, Vitamin A distribution and oral rehydration therapy, many of which had been proven effective under USAID-funded research.  Seventy-five PVOs worked with government counterparts to build local capacity to deliver life-protecting and life-saving care to children and families in 180 countries over the past 28 years.  

Because PVOs were already working in these forgotten corners of developing countries, the initial investment in infrastructure was lower than it might have been otherwise.  PVOs were also required to match every $3 that the USG provided with $1 from the public or other private sources.   Training local public and private sector health providers was another way that the limited dollars were used to strengthen services and ensure that local programs would be sustained after projects ended.  

The CSHGP provided a learning laboratory for innovations in maternal and child health, thus advancing the state of the art for public health globally.   Two significant examples of these innovations are testing the addition of zinc to oral rehydration treatment of diarrhea and testing the ability of community health workers to assess and treat malaria and pneumonia.  These scientifically proven interventions are now standard treatment to prevent children from dying of common diseases.  The effectiveness of CSHGP programs has been monitored and a recent analysis estimated that annual rates of child mortality decline (for a group of projects implemented from 2001 to 2007) were twice as fast in areas where PVOs were implementing health programs compared to surrounding regions (5.8 percent vs. 2.5 percent), according to a 2014 article by Jim Ricca, published in  Health Policy and Planning.

When the program began in 1985, global child deaths were a shocking 13 million per year.  Now, that number has dropped to 6.5 million (even though many more children are born annually) and the rate of improvement is accelerating.   The PVOs have changed as well – the tools and techniques promoted by the program emphasized rigor in data collection for monitoring and evaluation. This has strengthened the documentation of results and reporting to organizations’ donors and partners. This change has been facilitated by the CORE Group, which was originally formed through the CSHGP grantees.  CORE Group has grown to be a network of 75 PVOs committed to ending preventable maternal and child deaths and improving health in communities.  It provides a neutral forum to foster strategic partnerships for global and in-country collaboration and the creation of evidence-based tools and guidance for maternal and child health to accelerate the effectiveness of community health efforts.

American citizens recognized the work of this valuable program.  Public supporters of Save the Children, Project Hope, World Vision and CARE among others have spent time on Capitol Hill letting Congress members know about the effectiveness of these programs.   While the PVOs were only required to make a 25 percent match, their support was much higher.  In all, 45 percent of the funds flowing into the effort were raised by the implementing PVOs to complement the competitively-awarded grants. 

As USAID pauses to reflect on the progress being made toward Ending Preventable Maternal and Child Deaths this week in Washington, and the work remaining to be done, it is our hope that they take the time to recognize the results of the CSHGP.   It can be described as one of the bright spots in American international development assistance in terms of the partnership with engaged US citizens, and the enhanced capabilities of both private voluntary organizations and local Ministry of Health staff in priority countries. Most of all, the partnership saved the lives of women, children and improved the health of their families around the world.   There is no doubt that the CSHGP has contributed to the celebration of many more fifth birthdays in at-risk communities.   


Judy Lewis is the Board Chair of the CORE Group Board and the Professor Emeritus at the University of Connecticut School of Medicine.