High Five: Building Back Better Children’s Services

High Five: Building Back Better Children’s Services

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.

From Peril to Promise: Our Debt to Children

From Peril to Promise: Our Debt to Children

UPDATE: Since we wrote this piece, the UN has quantified the number of children at risk from missing routine measles vaccinations. They’ve identified a horrifying 117 million spread across 37 countries, 24 of which have already suspended their routine immunization coverage.

As our colleague Alex Evans explored here recently, the tail end of the decade with no name featured an increasingly heated intergenerational debate about resources and fairness. While Gen Z’s beef with Boomers may now seem as distant as, say, Brexit or the 10 Year Challenge, it provides us with important lessons we need to take on board as we deal with the long shadow the COVID-19 pandemic will cast.

The Director General of WHO has already described COVID-19 as “the defining public health crisis of our time”. Elsewhere, comparisons with World War II abound. Among the most important features of the global post-war settlement was a strong focus on children, their needs and rights. UNICEF was founded in late 1946, initially to meet emergency needs in nutrition and health but quickly moving into advocating and providing for long range benefits. Organising immunisation was among its first priorities.

A week ago, we touched on the risk the pandemic poses to routine immunisation work, particularly in low and middle income countries. It is already likely that hundreds of thousands of children will not receive the vaccines they need to protect them against a raft of communicable diseases. The poorest and most vulnerable are inevitably most at risk. And yet for these children, a virus like measles may pose a much greater threat than COVID-19.

Overstretched public health systems in many low and middle income countries are already finding it difficult, or impossible, to maintain routine immunisation work as they move to take on the pandemic. Meanwhile, development partners, including UNICEF, have reluctantly taken the decision to suspend work in this area for fear of spreading COVID-19 further. 

Nor is it clear that routine immunisation work will resume smoothly once the acute phase of the crisis has passed. Once a vaccine becomes available, health systems worldwide will begin to grapple with the administrative and logistical complexities of immunising large proportions of their populations against COVID-19. Resources will flow into this area, further increasing the risk that children will die from preventable diseases.

And immunisation is far from being the only essential service children are foregoing as the world tries to slow the spread of COVID-19.

More than 1.5 billion children and young people who were learning at the start of the year are now out of school or university. With unanswered questions about how much this will slow the spread of the epidemic, this is another area where children are sacrificing something deeply important to their future to help protect older people.

We must do more to minimise the health and education burdens being borne by children. Wherever possible, we should maintain preventive health services, while planning for rapid catch-up in affected areas once the immediate shock has receded. We need to continue protecting vaccine supply chains to ensure routine immunisation can continue during a COVID-19 vaccine rollout. 

In education, meanwhile, we need to remove as many barriers to online and other alternative learning content as we can. And we should harness the power of parents the world over to use their own passions and interests as a focus to keep their children learning.

But in the longer run, the world must commit to paying back the debt to children that is mounting up during this global emergency, just as it did after World War II. 

We see three distinct phases to deliver promise from peril:

First, listen to what children are doing for us. We need to quantify the price they are paying in missed immunisations and days at school.

Next, it is time to think. We know what young people worry about when they think of their futures, but before the pandemic we refused to act on their fears. The climate emergency, rising inequality, the chance to do meaningful, properly paid work. This is the currency with which we can pay children back.

Finally, we must act. Listen, think, and then invest in children and in their futures through policies and programmes that are tailored to tomorrow’s realities, not the world before COVID-19. We must be ready to take action as swiftly and decisively as the world did to benefit those other children in 1946.

COVID-19 Immunisation: Preparing for the Perfect Handoff

COVID-19 Immunisation: Preparing for the Perfect Handoff

UPDATE: In the last week, we’ve seen some critical interventions from WHO, GAVI and others on the importance of ensuring development and distribution of a COVID-19 vaccine happens on an equitable basis worldwide.

As the world mobilises to develop a vaccine, some countries will struggle to ensure their citizens are protected against COVID-19 – unless work starts to prepare them now.

Those most at risk of being left behind? The poorest and most fragile countries. And those with weak institutions and poor public health infrastructure.

The great divide of the 2020s could be between the vaccinated and those denied access to immunisation. Beyond the obvious health implications, countries risk finding themselves cut off from the rest of the world, as richer and more stable countries protect themselves from secondary epidemics.

The global race to create a COVID-19 vaccine is well underway. Teams in the USA and China have already reached the first big milestone of Phase 1 clinical trials on humans, with others hard on their heels in Germany, the UK, and Australia. It’s going to take 18 months or so, and likely cost between $200 and $500 million, but the chances of a successful vaccine are high.