High Five: Building Back Better Children’s Services

by , | Apr 30, 2020

We have previously highlighted the enormous sacrifice the world’s children are being asked to make to help protect the most vulnerable from COVID-19. At the initial peak of closures in mid-April, more than 90% of the world’s learners were out of school and university. Meanwhile, GAVI estimates around 13.5 million children in the world’s poorest countries will not receive vital immunisations as a result of disruption to routine programming.

Global Dashboard’s recent Local Week provided us with plenty of food for thought. Alex Collis and Anna Smith reminded us that even in prosperous cities and countries many children lead disadvantaged lives, pandemic or no pandemic. And Clare Wilks, in her piece on food, open spaces and socialisation, raised the importance of using what we observe during this acute phase to plan, and then to build back better

So here are five actions we should start working on today to ensure children’s services are back up and running as soon as possible, and that they return strengthened and improved. 

1. Design more integrated children’s services

The mid-20th century, especially the period immediately following World War II, was the high-water mark for integrated children’s services. Many governments introduced radical new legislation for children in need of protection.

Across Europe, North America, and elsewhere, schools were seen as an obvious place to provide much needed interventions in nutrition and public health. While the emphasis may have been on the convenience of the location, and much has changed in social policy towards children, their rights and agency, this approach had the major advantage of designing service delivery around the child. 

We would like to see more governments think about the fundamentals – nutrition, education, health, and protection – as the four pillars of social support all children need. Meanwhile, the international community should build on promising integrated approaches like Safe to Learn.

2. Budget for children, not sectors

Getting a clear picture of what governments are investing in children is often almost impossible. The education budget is a given, although we have some questions about the return children are receiving from that investment below. But which parts of health and social services lines benefit children? And has anything been earmarked for young people in the justice or culture budget?

Attempts to review levels of public investment in children systematically are relatively new, but may in some countries already be contributing to stronger youth budgeting. Meanwhile, advocates in some countries suggest public investment in children is stagnating, while those elsewhere point to inequalities between what is invested in the young and the old.

We would like to see more initiatives like the Massachusetts children’s budget to accompany a renewed emphasis on designing and delivering integrated services.

3. Focus on delivering what children need

Public education and health systems are among the most expensive parts of government, especially where teachers and health workers are employed as civil servants.

And yet expenditure does not always translate to better learning or health outcomes for children. In many countries, qualified teachers are not equipped to help children learn to the fullness of their potential, or are chronically absent from the classroom.

Elsewhere, governments and their partners have built clinics that lie empty because they’re located in the wrong place. Or vaccinators may turn children and their parents away because there are not enough of them present to justify opening a fresh multi-dose vial. 

When we design public service delivery systems or incentivise governments through development programmes, we should think at least as carefully about children and their futures as we do about strengthening administrative efficiency or achieving economy with resources.

4. Listen to what children tell us

Every day, doctors think about how to engage children in making decisions about their medical care, supporting them to reach a position where they can give full autonomous consent. Every day, teachers work with children to build their critical thinking and other transferable skills. And yet involving children in public decisions that affect their lives, development and wellbeing remains unusual, and young people who speak and act publicly on issues they care about attract as much opprobrium as praise.

Policymakers can do much to foster children’s participation and visibility in public life. They can ask young people about what matters to them, and feed their ideas into decision making as in New Zealand. They can make sure they address young people directly on the big issues, as the Norwegian and Danish Prime Ministers did recently in their children’s press conferences on COVID-19. And they can ensure that schools give students space to explore issues that matter most to them, and encourage debate.

5. Ensure every child has a legal identity

Achieving universal birth registration by 2030 is an important SDG16 target, and a lot of progress has been made since the turn of the century. But according to UNICEF, a quarter of children aged under 5 – some 166 million – remain unregistered, half of them concentrated in DRC, Ethiopia, India, Nigeria, and Pakistan.

Without a legal identity, accessing children’s services such as immunisation and education becomes much more difficult. Unregistered children become unrecognised adults, with limited or no access to justice or voice in public decision making. If children are expected to give up access to education and healthcare to help protect their societies today, the very least we can do in return is ensure their right to participate fully as citizens tomorrow.


  • Emma Hannay is a public health doctor with a focus on global health strategy and delivery. She works at a global level on organizational strategy across a range of disciplines in global health, and at a country level in implementing health systems reforms in complex operating environments. In her previous role as Head of Health at Acasus, she was part of the team leading the Pakistan Health Reforms Roadmaps, which improved primary care for more than 150 million people, and the DRC’s Mashako Plan to increase immunization coverage for children.

  • specialises in working with governments to help them strengthen delivery of public services, particularly education, in fragile and conflict affected states. She has acted as an adviser to senior officials and politicians in a range of countries, including Pakistan, Nigeria and Lebanon. Victoria is Managing Director of River Path Associates, and collaborates regularly with other consulting firms. She is also a Director of the Acasus Foundation. Since 2015 she has served on the board of the Eden Academy Trust, a multi-academy trust of schools for children with complex educational and health needs in London and the North East of England.

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