Marking Three Decades of Child Survival and Development Revolution

Marking Three Decades of Child Survival and Development Revolution

And 30 Years of RESULTS’ Contribution to Shaping Global Development Agenda

RESULTS International Conference

By Kul Chandra Gautam

Washington, DC, 21 June 2010

I feel immensely honoured to be asked to address this Plenary Session on Global Health issues. I am especially delighted to join my good friend, and my most favourite Minister of Health in the world, Dr. Tedros Adhanom Ghebreyesus of Ethiopia, with whom I have had the pleasure to work closely in a number of Boards of global health partnerships.

2010 marks 30 years since the beginning of what was billed as a “child survival and development revolution” (CSDR), launched by the late legendary leader and former Executive Director of UNICEF, James P Grant. It also coincides with a parallel effort by RESULTS, a small Washington, DC based advocacy agency, initially led by its young and dynamic leader, Sam Daley Harris.

Grant had the vision to articulate a set of ambitious goals that put the survival and development of children at the heart of the world’s humanitarian and development agenda. Harris had the acumen to ensure that the American public and politicians, especially US Senators and Congressmen, heard about this visionary initiative from editorials and op-ed pieces published in their local, hometown newspapers.

In retrospect, the Grant-Harris joint effort was a great winning combination that generated strong bipartisan US Congressional support for child survival. Eventually this bold initiative blossomed into a global movement which saved the lives of tens of millions of children in the world and paved the ground for putting child survival and development squarely at the centre of the world’s development agenda, as currently reflected in the Millennium Development Goals.

Jim Grant died 15 years ago, but his example and vision continue to inspire many of us involved in pursuing some of the most ambitious and audacious global health initiatives like the Global Fund, GAVI, Rollback Malaria, and the Education for All Fast Track Initiative.

Perhaps some of you heard Secretary of State Hillary Clinton recently recalling very fondly Jim Grant’s extraordinary leadership in promoting child survival, as she outlined the US Government’s plans to put a spotlight on child malnutrition at the forthcoming MDG review Summit at the UN in September 2010.

To better understand the importance and historic significance of RESULTS’ very productive partnership with UNICEF and the global child survival movement, let me remind you the context of the early 1980s when CSDR was born.

Jim Grant was appointed as head of UNICEF in 1980. He came to UNICEF bubbling with grand ideas, and bouncing with extraordinary energy and enthusiasm. It was as if all his life he had been preparing to come to lead UNICEF, which would provide the perfect bully pulpit for him to espouse his ideas and vision.

Before coming to UNICEF, Grant had been a champion of the school of thought which we now call human development. Development, he argued, had to be measured not by the gross national product of a nation but by the physical quality of life of its citizens.

Infant mortality, life expectancy, literacy and other social indicators were far more important measurements of a nation’s development than its economic wealth or military might, he argued.

Jim Grant assembled a team of high caliber thinkers, doers and managers to advise and assist him in his revolutionary mission. Beyond UNICEF staff, he reached out to the media and academia, the development think tanks of the world, and young activists like Sam Harris of RESULTS, to help him craft a new action plan for UNICEF’s work, building on its considerable inherited strengths.

He articulated a bold vision of unleashing a Child Survival Revolution. It was unconscionable, he argued, that 40,000 children a day, or 15 million annually, were dying at that time, when there were many low-cost, readily available interventions to prevent such deaths.

Like the Green Revolution that multiplied agricultural production and prevented famine in Asia, he argued that a child survival revolution could drastically cut down child deaths and unleash a virtuous cycle of child well-being and human development.

Growth monitoring, Oral rehydration therapy, Breastfeeding, and Immunization, were proposed as the cutting edge interventions, supported by female education, family planning, and food supplements – known as GOBI-FFF.

Of these, immunization and ORT were seen as the most promising twin-engines of the child survival revolution.

Grant promoted CSDR with an infectious passion. He visited over a hundred countries and met their leaders – some of them multiple times. He initiated the publication of an annual State of the World’s Children report which ranked countries according to their child mortality rate. Arguing that morality must march in tandem with capacity, he persuaded leaders of the world to raise immunization rates from single digits to 80 percent in their political lifetime.

To demystify the low-cost, high impact child survival and development interventions and to make these readily accessible to every family, UNICEF published a “Facts for Life” primer. Nearly 20 million copies of this book are in use worldwide, in 215 languages. Only the Holy Bible is known to have been translated in more languages!

To reach children in situations of conflict, UNICEF promoted the concepts of “Days of tranquility”, “corridors of peace” and “bubbles of child protection” in conflict zones ranging from El Salvador to Sudan, from Iraq to Sri Lanka, and elsewhere.

Jim Grant gave the decisive push to the long languishing negotiations on the Convention on the Rights of the Child, and saw it come to completion and into effect in 1989. He then pushed hard for its ratification, making it the world’s most universally embraced human rights treaty (alas, with the singular significant exception of the United States of America).

Grant’s crowning achievement was the convening of the World Summit for Children in 1990. It was the first ever world Summit, attended by the largest gathering of world leaders in history until that time.

I personally had the great privilege to work closely with Jim Grant, including serving as his point man to draft the outcome document of the Summit for Children which laid down many time-bound and measurable development goals. Most of today’s Millennium Development Goals were inspired by the goals of the Child Summit.

What was the net result of all this effort?

Perhaps the best way to sum it up would be to quote Nicholas Kristof, a columnist of the New York Times who said: “…the late James P. Grant, a little-known American aid worker who headed UNICEF from 1980 to 1995 and launched the child survival revolution with vaccinations and diarrhea treatments, probably saved more lives than were destroyed by Hitler, Mao and Stalin combined”.

How many leaders of the world would merit such credit?

And how did RESULTS help in this great effort?

At the beginning, some of Jim Grant’s ideas were considered very outlandish, idealistic and even naïve. Some Europeans even accused him of being a Mad American with a missionary zeal and over-blown ambition. It was therefore very important that at the very least his ideas had the solid backing and support of the US government.

This is where, RESULTS came in.

With Sam Harris’ skillful penmanship, clear and convincing write-ups were prepared justifying why a child survival revolution was needed, and how it was feasible and affordable, and urging the US to take a global leadership role.

With the help of hundreds of RESULTS volunteers and activists -like yourselves- in local communities, draft editorials and op-ed pieces were presented to editors of newspapers in small towns and cities all across America. Suddenly hundreds of such articles appeared in local newspapers, and the subject of child survival became a topic of discussion in local town-hall meetings. Senators and Congressmen could not ignore this groundswell of grassroots interest and support for child survival.

So when Jim Grant and other high profile advocates went before Congress to testify in support of child survival, Senators and Congressmen already had press clippings in front of them from their home-town newspapers sent by their constituents. Thanks to RESULTS community level work, UNICEF’s advocacy became so much easier to sell.

As a result, year after year, there was consistent bi-partisan support for UNICEF and its child survival mission. Even when the White House tried to cut budget for child survival and UNICEF, in the larger context of budget cuts and deficit reduction during the Reagan and Bush (Sr) administrations, the Congress consistently restored such cuts and even increased allocations – always with bipartisan support.

Besides the intrinsic merits of promoting child survival, the solid US backing, encouraged European and other donors to join ranks, leading to a true global movement for child survival and development.

I recall vividly a most touching moment on the 29th of September 1990. That evening, on the eve of the historic World Summit for Children, RESULTS organized Candlelight Vigils to publicize the plight of children and the opportunity for world leaders to take bold action. More than one million people participated in over 500 U.S. locations and in 74 other countries.

As Jim Grant recounted to world leaders gathered at the UN the next day, the Candlelight Vigils served as a catalyst, the trigger point, for the start of an unprecedented media coverage that no leader or people of goodwill could possibly ignore.

I recall RESULTS Canada played a crucial role in getting Prime Minister Brian Mulroney to play a leadership role at the Summit for Children. And several other country affiliates of RESULTS also played a motivating role to encourage their national leaders to attend the Summit and to support the child survival and development agenda.

RESULTS and the RESULTS Education Fund have used similar advocacy and communications strategies to promote many other worthy goals, such as ensuring and enlarging funding support for Head Start, the WIC nutrition programme, and support for a variety of anti-poverty legislations domestically in the US.

In terms of international programmes, RESULTS has been a passionate advocate of micro-credit and its revolutionary potential to transform the lives of millions of poor people, especially women. More recently it has championed the cause of Global Fund to fight AIDS, Malaria and TB.

Backed up by good research and evidence that is presented in a very simple, understandable manner, RESULTS has been a premier advocacy and lobbying organization much respected and admired in the Capitol Hill.

Now let us fast forward to 2010. RESULTS and the RESULTS Education Fund have now become well-established, much respected and effective organizations. They work closely with affiliate organizations in six other countries – AustraliaCanadaGermanyJapanMexico, and the United Kingdom – to encourage their governments to create policies and funding to empower people to end hunger and extreme poverty.

Domestically, RESULTS has more than 800 grassroots volunteers and working groups in more than 100 communities across the U.S. They are ordinary people from many walks of life who cause extraordinary changes in public policy through phone calls, letters, and face-to-face meetings with public officials.

They are people, just like you, committed to take action to educate the public and their elected officials about ending hunger and poverty, and making these issues a national and international priority.

Many changes have taken place in UNICEF as well. People often ask me what would Jim Grant’s vision and priorities be today if he were still alive and at the helm of UNICEF. This question was actually addressed by Peter Adamson, a close collaborator of Jim Grant who was editor of the State of the World’s Children Reports throughout Grant’s tenure at UNICEF.

Speaking at Grant’s memorial service in February 1995, Adamson opined that while securing large-scale coverage of basic services for children had been Grant’s priority in the second half of the 20th century, his priority for the 21st century would be to focus on equity – to ensure that no child was left behind, that in further expanding basic services deliberate effort would be made to reach the most deprived and marginalized children.

Interestingly, the recently appointed Executive Director of UNICEF, Tony Lake, has made equity and reaching the “bottom quintile” of children his highest priority, thus picking up where Jim Grant had left off.

We are thus witnessing in 2010 a rekindling of the spirit of Jim Grant in UNICEF, with renewed focus on the unfinished business of the original child survival revolution, adapted, of course, to new developments and new realities of the 21st century.

Why this focus on equity and reaching the “bottom quintile”? As Tony Lake explains it, we can all be very proud of the great progress made for children overall, but this progress has been very uneven at best.

As we measure progress towards meeting the MDGs, data show widening rifts between rich and poor countries and glaring disparities within nations – injustices that should make us all very concerned, and ashamed.

Children from the bottom quintile in developing countries are two or three times more likely to die before reaching the age of five than those from the richest quintile. The same applies to children who are malnourished or children who are out of school, or women who die during child birth.

When you add the special discrimination facing girls, indigenous people, children with disabilities, and children living in conflict zones or in emergency situations – the picture becomes even more grim.

Tony Lake argues that the time has come, as we move towards the 2015 deadline for the Millennium Development Goals, that a very special, targeted attention be given to these forgotten children who are marginalized simply because of the economic and social inequities in their societies, left behind simply because they were born female, or poor, or in the wrong place.

Two weeks ago I visited one such “wrong” place: Mugu district of my home country Nepal. Out of Nepal’s 75 districts, Mugu ranks number 75 at the bottom in terms of the human development index. A district in the remote Himalayan mountains not yet connected by any motorable roads, where the only mode of transport is on foot up and down steep hills.

The majority of births there take place at home, unattended by any skilled birth attendants. When there is a complicated pregnancy, expectant mothers in labour have to walk or be carried on someone’s back for 6 to 8 hours to reach the nearest health facility. Most women in Mugu have never seen a doctor or even a nurse in their whole life. Many suffer from severe anemia and debilitating uterine prolapse.

Child malnutrition rates reach up to 79 per cent and acute malnutrition requiring therapeutic intervention reaches as high as 17 percent.

While Nepal is one of the few Least Developed Countries on track to achieve MDG 4 and 5 – of which we are all very proud – the people of Mugu district will certainly be left behind.

A chronically food-deficit area, it is now suffering visibly from the impact of climate change and global warming. Trails historically covered with snow are now covered with dust. Even well-intentioned efforts by the government and donors to help are often having counter-productive impact.

The World Food Programme offers some food aid in this district. Because of the remoteness of the area, all foodstuff has to be airdropped by helicopter. The cost of airfreight alone is often 5 times the price of the foodstuff. The white rice that is airlifted, which everybody likes, is poor in vital nutrients compared to traditionally locally produced millet, maize and legumes.

But the people have become so dependent on imported food that they prefer to walk and wait for sacks of rice to fall from the sky rather than to labour hard to produce more nutritious local foods. Some businessmen fly in relatively cheap, easy to cook, commercially mass-produced packets of instant noodles that are very tasty but nutritionally junk food.

Statistical average of national progress never captures the realities of places like Mugu, and much less the plight of the most deprived communities in such localities. It is such forgotten places and people at the bottom of the pyramid that Tony Lake’s “equity” focus seeks to lift up to the top of UNICEF’s and the world’s programme priorities.

An increased focus on the bottom quintile is not only the morally right thing to do; it can also produce practical results in the most sustainable manner. Efforts to reach the bottom quintile will involve approaches that are bound to benefit the upper quintiles as well, just as making schools child-friendly, and especially girl-friendly, actually helps enhance the enrolment and quality of schooling of boys as well as girls.

Popularizing an equity-focused approach to development requires a massive education and communication campaign with simple, clear messages. RESULTS has a track record of crafting and conveying such messages effectively. In the coming months and years, we look to RESULTS to make such an “equity-focused” development approach its signature campaign, as part of your broader advocacy campaign to combat, hunger, disease and poverty in the world.

I know you have done this before, and we can count on you to do it again. As President Obama is fond of saying, and as your banner here says: “Yes We Can” – we have the power to end poverty – if we focus on the bottom quintile.

Dear friends, all of you – grass roots leaders and volunteers for RESULTS – and your predecessors – can be truly proud of how you have managed to influence and shape the world’s development agenda.

Many of you may not be fully aware of what a huge impact your work and activism can make on the well-being of children, women and other vulnerable groups around the world. But take it from me – as someone who has witnessed first-hand the life-saving and life-enriching impact of RESULTS’ advocacy in the far corners of the world – that you are among the great unsung heroes of the child survival and development revolution.

Your advocacy on global health, specifically on child survival and development – and more recently on micro-credit, education for all, and poverty eradication – touches and transforms the lives of millions of people, including in my country – Nepal, and Minister Tedros’ country – Ethiopia.

Most Nepalis and Ethiopians, or for that matter, Nigerians and Haitians, Cambodians and Zambians will never know that you cared so much about them and mobilized such great support. And most of you will never meet the millions of people you have helped, and will not hear too many “thank yous”.

A good job in support of a noble cause does not always earn a medal of honour or a certificate of recognition. But I hope you all feel in your heart that you are serving humanity in the most meaningful and self-less manner.

And believe me, you are the anonymous recipients of the blessings and gratitude of millions of people whom you have helped to uplift from poverty, if not from death itself.

Minister Tedros and I are here – from two of the world’s poorest countries – but both representing great ancient civilizations – very rich in culture and human values. We thank you on behalf of our peoples and the people of many other developing countries, for all your noble efforts and dedication.

And I know, there is someone else – the father of the child survival revolution – Jim Grant, who is looking at you with a big smile from up above with pride and gratitude and offering you his blessings for your continuing success.

Keep up the great work. Your efforts really produce great results and make a real difference.

Thank you.