This flyer discusses the legal protection of a child. This includes assurance that they have access to birth registration, an official recording of the child’s birth by government, and, upon death of their parents, access to assets and appointment of a legal guardian. Birth registration provides state recognition of a child’s existence and establishes their identity, nationality, kinship and age, key for one’s legal protection and access to essential services, including health, education, grants, and legal employment when older. Registering for a birth certificate is not so simple in many parts of the world. For children left orphaned or vulnerable because of poverty, displacement, or other risk factors such as HIV and AIDS, the weak registration systems result in children with restricted access to basic services and protection and increases the children’s susceptibility to abuse, violence and exposure to HIV. For example, a child orphaned by AIDS who is not registered and does not have a birth certificate to prove their identity is extremely vulnerable to having property rights violated and left to live a life of poverty and survival by whatever means possible, including child labor, transactional sex, or early marriage.

The USAID-sponsored Community Health Worker (CHW) Regional Meeting held in Addis Ababa, Ethiopia from June 19 to 21, 2012, was attended by over 60 government and nongovernmental (NGO) representatives from six African countries (Ethiopia, Kenya, Mali, Rwanda, Uganda, and Zambia) as well as participants from international NGOs and organizations. The meeting was planned by Initiatives Inc. under the USAID Health Care Improvement Project (HCI) and designed to share new tools and strategies to strengthen the functionality of government and NGO CHW programs; facilitate dialogue about challenges and best practices among participating countries and identify and support evidence-based strategies for scale-up. This report details proceedings from the meeting.  

A follow-up report describing actions taken by participants following the meeting is now available at:http://www.hciproject.org/publications/chw-regional-meeting-country-follow-plans-and-actions

This report describes the implementation of a children and youth workshop held in Nairobi in April 2010, to gather and understand the perspectives of vulnerable children and youth with regard to services provided for them.  The report was developed by the national Orphans and Vulnerable Children Technical Working Group, with support from HCI.

Several quality gaps have been documented across the continuum of maternal, newborn, and child health (MNCH) services.   For antenatal care (ANC), despite the progress in increasing its coverage, quality gaps persist. Several studies show that ANC services often miss the opportunity to provide essential services such as counseling clients on danger signs of pregnancy, delivery plans, nutrition, and postpartum family planning. Similarly, services around childbirth are often provided with compromised quality. Common quality gaps include the inadequate or incorrect use of the partograph to prevent the complications of prolonged labor for the mother and the newborn, neglecting to apply active management of third stage of labor to prevent postpartum hemorrhage, poor quality of emergency obstetric care, and failure to promptly detect newborn asphyxia and apply immediate resuscitation.

Quality improvement (QI) offers a powerful a means to increase the effectiveness of MNCH programs in resource-limited countries. QI is based on the understanding that a system is designed to produce the results it produces; in order to obtain better results, the system must change. Hence, in applying QI, teams in health facilities or communities analyze the systems and processes of delivering services, test changes to obtain better results, and measure the effect of the tested changes on pre-determined indicators. Teamwork and shared learning between QI teams allow for rapid spread of best practices.

This paper discusses the role modern QI approaches can play in improving MNCH outcomes and describes specific applications of across the continuum of MNCH care, including ANC, essential obstetric and newborn care, infant and child care, and post-partum family planning.  Drawing on examples from the work of the USAID Health Care Improvement Project (HCI) in Africa, Asia, and Latin America, the paper shows how quality gaps in the services addressing the antenatal, intra partum, postnatal, neonatal, and child periods can be closed through modern QI approaches.

This case study describes the experience of piloting quality service standards to improve the quality of care for orphans and vulnerable children in Kenya, where there are roughly 2.5 million vulnerable children. When the President’s Emergency Plan for AIDS Relief (PEPFAR) was launched in 2003, interventions to meet the needs of orphans and vulnerable children were designed with a sense of urgency to help address the devastating effect of the epidemic on children. While much progress has been made since then, the “emergency response approach” is no longer adequate.