APPROACH AND METHODOLOGY
Using a participatory approach aimed at building community ownership and capacity, the project will work in partnership with local health and social services department cadres providing child health and development services, as well as with nongovernmental and community-based organizations.
The project has the following objectives:
1. Strengthen local health and development systems and community structures to provide inter-sectorial services responsive to the actual needs of the community. The project will strengthen the capacity of local health and social services systems, health care providers and social workers, and communities to capture and analyze data to manage and plan integrated child health and development programs.
2. Improve the quality and range of clinical and community-based services addressing the health and development needs of children aged 0-2. Working directly with service providers, the project will provide competency-based training to ensure workers have the right skills; strengthen supply systems and equipment infrastructure management to ensure health workers can provide the right services at the right time; foster peer-based learning and mentoring to support continued improvements in service quality; and strengthen monitoring and supervision and referral mechanisms.
3. Increase behaviors among caregivers that positively impact the health and development of children aged 0-2 in beneficiary communities. The project will identify local barriers to service utilization and build on existing and emerging community organizations to develop and expand community-based behavior change communication strategies, ranging from individual counseling sessions to use of community-based theater and local media.
4. Expand the knowledge base and foster the widespread adoption of project lessons. The project will develop a robust operations research and cost-effectiveness agenda to capture the relationships between the targeted packages of interventions, the local context, and the health and development outcomes generated by the project; and implement coordinated knowledge dissemination activities based on the project's evidence base.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
The project will be implemented over five years in South Africa and four years in Mozambique. The initial six-month design and planning phase will include detailed assessment of health and development needs of target populations, as well as widespread community engagement and participatory planning activities with community stakeholders. To ensure rapid project mobilization and impact, the project will build upon existing structures, interventions, community-based organizations, and relationships at national and provincial levels.
The project will begin implementing in two districts during the last 6 months of year 1 and will begin operations in the remaining two South African districts at the beginning of year 2. Assessments will begin in Mozambique in early year 2, and implementation will begin toward the midpoint of year 2.
Deliverables will include:
1. Improved quality of planning for health and development services.
2. Reductions in vertical transmission of HIV and resulting child mortality.
3. Reduction in diarrhea incidence, morbidity, and mortality.
4. Increases in breastfeeding and infant nutrition.
5. Improvements in care-seeking and child development practices.
6. Reductions in perinatal and infant mortality.
Although the number of child deaths in developing countries has declined in recent decades because of better immunization coverage, improved nutrition, and other factors, large numbers of children continue to die. Deaths are often attributable to preventable causes such as malnutrition, diarrhea, pneumonia, malaria, HIV, and tuberculosis.
Early childhood, especially the period from birth to age two years, represents a critical window of opportunity to shape the health and development of children and to influence the onset of chronic diseases later in life. Meeting the health and development needs of children during their first two years requires strengthening provision of health and social services and enhancing community use of those services, as well as improving preventive health behaviors and parenting practices in the home.
In South Africa, an estimated 104 of every 1,000 children die before the age of five years, including 53 who die during the first year of life (UNDP, 2010). These death rates, which are higher than those in many other countries, will make it almost impossible for South Africa to meet its commitment under MDG 4 to reduce its under-five mortality by two-thirds by 2015.
In Mozambique, child health outcomes are also poor, despite progress toward reaching MDG targets. Mozambique's estimated under-five and infant mortality rates of 145 and 96 per 1,000 live births are largely a result of preventable and treatable diseases such as malaria, syphilis, acute lower respiratory infections, diarrhea, and HIV (UNDP, 2010).
Women in both countries suffer from poor maternal health, which gives their children a poor start in life and makes it difficult for these countries to achieve targets for MDG 5. The chance of a woman dying during childbirth is 1 in 100 in South Africa and 1 in 37 in Mozambique, and progress toward achieving the MDGs in both countries has been hampered by weak and fragmented health and social services that fail to meet the needs of women and children.