The views expressed in this book are those of the authors and do not necessarily reflect the views and policies of the Asian Development Bank or its Board of Governors or the governments they represent. ADB does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use. Use of the term “country” does not imply any judgment by the authors or ADB as to the legal or other status of any territorial entity. Case studies have been edited from their original version. Copyright This publication has no copyright. Translation, adaptation, and copying of materials used for non-commercial use is encouraged, provided that the original credits to Development Finance International, Inc. (DFI) and the event’s facilitators (Asian Development Bank, GlaxoSmithKline and Save the Children) are maintained. Drafted and compiled by Ann Ewasechko Edited by Jennifer Petrela Designed by Creative 2.0, Inc. Photos from the workshop were taken by Chris Peregrino. Photos from the field credited to Ann Ewasechko unless otherwise indicated. Published 2009 by Development Finance International, Inc. Asia Representative Office Manila, Philippines ISBN 978-971-93216-2-0 Printed in the Philippines C TABLE OF Contents Abbreviations iv Acknowledgments v Executive Summary vii INTRODUCTION 1 MATERNAL, NEWBORN AND CHILD HEALTH INTERVENTIONS 5 The State of Mothers and Children in Asia 6 The Investment Case for MNCH in Asia 8 Barriers and Bottlenecks: What Prevents Interventions From Working and What We Can Do 10 Broadening NGO Involvement in the Delivery of MNCH Services Through Contracting 12 Tackling Four Challenges Related to MNCH Interventions 14 Challenge 1: Mobilizing Resources 14 Challenge 2: Generating Political Will 16 Challenge 3: Delivering MNCH Programs 17 iii Challenge 4: Communicating Messages for MNCH Interventions 18 IMMUNIZATION 21 Access, Partnerships and Latest Developments in Vaccines for the Developing World 22 Innovative NGO Approaches to Immunization 24 NGO Solutions to Immunization Obstacles 29 Scenario 1: Low-Income Country, Weak Coverage 29 Scenario 2: Middle-Income Country Graduating From GAVI 31 Scenario 3: Making the Case for More Funds 33 Scenario 4: Innovation Pile-Up 35 MOVING FORWARD: WHAT’S NEXT? 37 APPENDICES 41 Appendix 1: Workshop Description and Agenda 42 Appendix 2: Participant Directory 46 Appendix 3: NGO Participants by Country of Affiliation 56 Appendix 4: Speaker / Panelist Bios 57 CAppendix 5: Workshop Evaluation 60 ABBREVIATIONS ADB Asian Development Bank ADRA Adventist Development and Relief Agency (ADRA) Basic Education for Awareness Reforms and Empowerment/ Basic BEFARe Education for Afghan Refugees BRAC Building Resources Across Communities CCF Christian Children’s Fund CIHP Consultation of Investment in Health Promotion CSO Civil society organization EPI Expanded Program on Immunization GAVI Global Alliance for Vaccines and Immunization GSK GlaxoSmithKline HU Health Unlimited IBI Indonesian Midwives Association Japanese Organization for International Cooperation in Family JOICFP Planning MAP Medical Assistance Program International International MDG Millennium Development Goal MIRA Mother And Infant Research Activities iv M&E Monitoring and evaluation MNCH Maternal, newborn and child health NGO Nongovernmental organization NUV New and under-utilized vaccines NORAD Norwegian Agency for Development Cooperation PATH Program for Appropriate Technology in Health Peoples’ Primary Healthcare Initiative/ PPHI/SRSO Sindh Rural Support Organization PFV Philippine Foundation for Vaccination PNGOC Philippine NGO Council on Population Health and Welfare, Inc. Q&A Question and answer RACHA Reproductive And Child Health Alliance RDRS Rangpur Dinajpur Rural Service UNICEF United Nations Children’s Fund WATCH Women Acting Together for Change AWHP World Health Partners C AACKNOWLEDGMENTS This publication would not have been possible without the dedication and enthusiasm of the workshop speakers, the workshop participants and the authors of the case studies featured here. We would like to thank them and the many individuals whose commitment to better health helped these projects to succeed. We would also like to thank Julia Cummins for her invaluable contribution as lead facilitator as well as the co-facilitators, Merla Aquino, Ester Isberto, and Chonchita Ragragio, for their support. C v A C EXECUTIVE SUMMARY ASIA NGO WORKSHOP EEXECUTIVE SUMMARY Introduction Between February 24 and 26 60% of neonatal deaths occur in Asia NGOs are 2009, 27 international and national non- and stressed the invaluable role played governmental organizations (NGOs) by NGOs in the struggle to improve sometimes the only from across Asia convened in Manila, the health status of Asia’s mothers and the Philippines for a regional NGO children. The NGO participants then players to reach workshop on maternal, newborn and brought their collective experience disadvantaged and child health (MNCH). Hosted by the to bear on the questions of how to vii Asian Development Bank (ADB) and strengthen efforts to mobilize resources remote areas where Save the Children (STC) with the support for MNCH programs and interventions, of GlaxoSmithKIine (GSK), this landmark how to generate greater political maternal and child event provided for the first time a will for MNCH financing and creative mortality rates are unique and intimate forum for some of programming, how to play a larger the region’s most experienced NGOs to and more effective role in delivering highest. share their perspectives, experiences and MNCH services, and how to better approaches in implementing MNCH and communicate the importance of MNCH immunization programs in Asia. Official interventions at the community level. development agencies from Australia, There was consensus that each of these Canada, Norway and the United States, four challenges must be elevated as along with representatives from priority for NGOs moving forward. ADB, World Bank, the United Nations Children’s Fund (UNICEF), and the Global The second day discussed a proven Alliance for Vaccines and Immunization MNCH intervention: immunization. (GAVI), also participated in the Millions of Asia’s mothers and children workshop. The dialogue was considered are still not receiving even the most basic particularly timely in light of the current immunization services and healthcare global financial and economic crisis systems are ill-prepared to accommodate and the approaching deadline for the new and improved vaccines. Against the Millennium Development Goals. backdrop of varying immunization rates and different levels of development The first day of the workshop focused between and within Asia’s countries, on MNCH interventions in general. participants shared best practices and MNCH experts underscored that 41% of crafted strategies around how to improve Cglobal deaths of children under five and vaccine availability and uptake for both ASIA NGO WORKSHOP EXECUTIVE SUMMARY Expanded Program on Immunization helping to monitor, report, and forecast stronger incentives that lead to better (EPI) and new and under-utilized demand to reduce the incidence of health outcomes, and by entering into vaccines (NUV) through enhanced vaccine shortages. Capacity building, government health service contracting advocacy, innovative programming, and training, and collaborative efforts would arrangements that would leave creative partnerships. help NGOs make their mark in these governments free to focus on those areas. activities they do best. Substantive Outcomes However, participants recognized that Insofar as international donors are By the end of the two-day event, a for the region’s MNCH indicators to concerned, participants concurred that number of important themes had improve substantially, NGOs could the partnership between NGOs and emerged. These themes related to not tackle the challenges alone. the international donor community NGOs’ unique role in tackling MNCH in To reach their public health goals, could also be optimized for better general and immunization in particular NGOs would have to engage more health results. Of particular concern and to priority areas for future focus and effectively with national governments, is the fact that most donor funding for collaboration. international donors, the private sector, health is funnelled through government and community leaders and groups. entities. In addition, funding tends to be To begin with, workshop participants With regard to governments, workshop minimal, unpredictable and short-term confirmed that NGOs are particularly participants recognized the need to in nature. NGO participants expressed well-placed to both supply and advocate for greater, more effective, and a keen interest in becoming more stimulate demand for MNCH more equitable budget expenditures. engaged in in-country consultative interventions. NGOs are sometimes the This means systematic and strategic mechanisms in order to help inform only players to reach disadvantaged and targeting of ministries of finance and priority-setting processes and to better remote areas where maternal and child planning in order to ensure that MNCH understand donors’ plans. However, mortality rates are highest. They are often interventions including immunization some NGO participants noted NGOs’ singularly adept at mobilizing energies are valued and prioritized in health own responsibility to better demonstrate viii at the community level, at overcoming budgets and systems. program results.