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International Health

Institute for International Programs
Advancing Global Health Priorities through Innovative Methods and Evaluations

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Since 2005, the Department’s Institute for International Programs (IIP) has solidified its reputation as a leader in developing new approaches to evaluate global health programs and more accurately assess the causes of maternal and child deaths. The Institute brings together scientists from organizations across the globe and from multiple disciplines, including epidemiology, economics, evaluation, demography, statistics, and health policy analysis. Their research and technical innovations have contributed to fundamental changes in priorities for maternal, child and neonatal health on the global, national and local levels.  

MISSION

In 2008, nearly 9 million children died—most from treatable illnesses. Pneumonia and diarrhea continued to be the top causes of mortality. IIP researchers led the analysis that produced these findings—considered the definitive estimates and used widely by governments and donor agencies across the world. This is just one example of the influential work that IIP researchers produce to fulfill the Institute’s primary mission:

to improve the quality of information to encourage and support evidenced-based public health policies and decision making in maternal and child health 

CHERG
The Child Health Epidemiology Research Group
CHERG was established in 2001 by WHO to provide independent technical expertise on child morbidity and mortality estimates at global and country levels. It has been chaired since its inception by Professor Robert Black. IIP faculty participate in over a dozen committees that have been set up to develop better information and methodologies to enable prioritizing, planning and monitoring of maternal and child health interventions.

Global causes of child mortality
(Source: The Lancet, 2010. Black et al.)

Global Causes of Death

 


 

The main objectives of CHERG are

  • to provide global technical leadership in the development and improvement of epidemiological estimates for children under five, particularly regarding cause-specific morbidity and mortality
  • to address general methodological issues 
  • to assess the potential contribution and impact of interventions to reduce under-5 mortality.

The Lives Saved Tool (LiST)

Institute for International Programs
Investigators 

Robert Black, MD, MPH, Director

Agbessi Amouzou, PhD
Abdullah Baqui, MD, DrPH
Linda Bartlett, MD
Sara Bennett, PhD
Jennifer Bryce, EdD
Christa Fischer Walker, PhD
Ingrid Friberg, PhD
Kate Gilroy, PhD
Elizabeth Hazel, MHS
Kenneth  Hill, PhD
Hope Johnson, PhD
Gareth Jones, PhD
Li Liu, PhD
Marjorie Opuni-Akuamoa, PhD
Jamie Perin, PhD
David Peters, MD, DrPH
Jennifer Harris Requejo, PhD
Ina Santos, MD, PhD
Cesar Victora, MD, PhD
Neff Walker, PhD

Earlier this year, the Bill & Melinda Gates Foundation cited LiST in its pledge of $10 billion to vaccine development and delivery over the next 10 years.1 LiST, which is led by Senior Scientist Neff Walker and Assistant Scientist Ingrid Friberg, is a software tool that estimates the impact (in lives saved) and cost of scaling up various interventions. Many IIP experts collaborate with the LiST project through their work with CHERG. CHERG research provides estimates for many of the key parameters used by the tool, such as the effects of interventions and country estimates for distribution of causes of under-5 deaths.  
 

This year, the International Journal of Epidemiology published a special issue on the development of LiST detailing the technical background and design of the tool, as well as its performance based on actual national case studies. The tool is designed so that a user can load in country-specific information on coverage of interventions and the causes of deaths by age for the country. The user can then build scenarios of different packages of expanded health coverage. For each of these packages the model produces estimates of deaths averted and costs of achieving the coverage targets.

In addition to the Gates Foundation, LiST is being used by many donor agencies, ministries of health, and NGOs across the globe for planning purposes. Trainings have been conducted for program staff at a host of influential organizations, including UNICEF, WHO, Gates Foundation, Save the Children and USAID. Over 400 health professionals have already signed up to receive notices of LiST updates.  

In Niger, use of LiST helped officials reintroduce maternal care at birth into national plans. Ethiopia’s Ministry of Health recently requested a special training for their staff. Last month, Dr. Friberg visited Nigeria to train a DfID-funded project in Northern Nigeria. DfID officials requested this special training to help their staff in evidence-based decision making. LiST is available at no cost at www.cherg.org.

COUNTDOWN to 2015

According the Global Health Council, “The Millennium Development Goals (MDGs) are the most broadly supported, comprehensive and specific development goals the world has ever agreed upon.”2 The Countdown to 2015 is a global coalition of academics, governments, donors, NGOs, and health care professionals who use country-level data to advocate for and support progress towards the health-related MDGs. Senior Scientist Jennifer Bryce co-coordinates (with UNICEF) the research arm of the coalition that focuses on intervention coverage. Her team collects and analyzes data on coverage of effective interventions for maternal, newborn and child health. Their efforts span 68 countries where 95% of all maternal and child deaths occur. Other Countdown groups analyze the factors that contribute to coverage gains, including health systems, policies and finances. Furthermore, Visiting Professor Cesar Victor is leading the efforts to track equity of coverage within countries. While some progress has been made on this front, there are still vast inequalities between poor and rich families in many countries.

Median coverage for effective maternal, newborn, and child interventions in 68 Countdown countries (Source: The Lancet, 2010. Bhutta et al.)

 
Coverage of programs in Countdown countries

The Countdown group’s findings are trusted and widely used by governments and in-country programs for planning purposes. Moreover, international donor agencies and health organizations rely on Countdown publications to support their global advocacy activities.  

"The Countdown process represents an extraordinary vision and effort, initially by a small group of individuals, but one that now embraces hundreds of health workers, investigators, and policy makers across the world."3 --Richard Horton Editor, The Lancet

After the most recent Countdown numbers were released, Canadian Prime Minister Steven Harper announced that his top priority during the G-8 summit would be MDGs 4 and 5. As a challenge to the other leaders, his government committed another $1 billion to the effort, which led to a total G-8 pledge of an additional $5 billion for global maternal, neonatal and child health.  

During the 15th annual African Union Summit, a coalition of global health organizations, represented by UNICEF Goodwill Ambassador and African singing sensation, Yvonne Chaka, called on governments and donors to take immediate action to meet MDG 4 and 5.(5) The impetus for this call to action was the Countdown finding that 11 million African lives could be saved over the next five years if key interventions were scaled up. And, at the recent Women Deliver Conference, advocates called for greater access to trained birth attendants based on the Countdown’s finding that 2 million stillbirths, maternal and newborn deaths annually are a result of poor access to skilled care.6 

In September, the United Nations will host the Millennium Development Goals Summit in New York. The findings of the Countdown will feature prominently there and will continue to support UN Secretary-General Ban Ki-Moon’s challenge to public health professionals everywhere:  

"We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world."7  Ban Ki-Moon UN Secretary-General

While these examples receive attention from the media and policymakers, they rely on the behind the scenes, cutting-edge research of the IIP researchers whose portfolio is impressive in scope. This issue of The Globe highlights some recent IIP projects and their contributions to improved programs and policies for saving maternal and child lives. 
 

—Brandon Howard, September 2010