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International Health

From the Chair
Robert Black, MD MPH 

Robert BlackThe Institute for International Programs (IIP) is now in its 25th year, having been established by the School’s Advisory Board in 1985—the year I came to the school as chair of the Department. Envisioned as an institutional commitment “to provide support, research, technology and manpower to reduce mortality and improve health,” Dean D.A. Henderson said at its launching that it would enable the school to “act boldly in collaboration with developing countries.” As Director of IIP, I have tried to fulfill this mandate by building an exceptional multi-disciplinary team of professionals at the School and developing robust collaborations with institutions and governments in low- and middle-income countries.

The current activities of IIP reflect the historical expertise of the Department and School both in maternal and child health programs to reduce mortality and in rigorous program evaluations. The initial funding for IIP was from USAID at the beginning of the “child survival and development revolution” that was spurred in exceptional ways by James Grant, then the Executive Director of UNICEF. It is fitting that IIP continues to work with USAID on applied research in the area of maternal and child health through a current $17 million cooperative agreement that has evolved from the original $1 million grant in 1985, being successfully re-competed several times over the years. And as illustrated in this issue of The Globe, we work closely with UNICEF and other agencies and funders, such as the World Health Organization, the Bill & Melinda Gates Foundation, and the Canadian International Development Agency to promote, implement and evaluate programs to reduce maternal and child mortality.

Recent years have seen a resurgence of interest and new technologies and delivery strategies to achieve the targets set out at the United Nations in the Millennium Development Goals (MDGs) 4 and 5 to reduce global child and maternal deaths. With this interest and substantial additional funding have come greater expectations for accountability and results. The Countdown to 2015 (to achieve the MDGs) was initiated by the 2003 Lancet Child Survival Series that was led by IIP faculty. It has expanded to be a critical source of accountability for countries, UN agencies and donors in regard to achievement of equitable coverage and quality of maternal, newborn and child health services.

The enhanced demand for measured results has allowed IIP to build a portfolio of program evaluations that are providing objective and independent evidence, thereby shaping programs for greater success. This work also provides an opportunity for the development and testing of novel methods of use for evaluation, such as those for assessment of the quality of care provided by community health workers and the monitoring of child deaths that may permit annual assessment of progress in reducing mortality. IIP is also assisting the Department to develop more course offerings on evaluation methods and providing opportunities for master’s and doctoral students to get field experience and develop skills in program evaluations. In these ways the faculty, students and staff of IIP address what Jim Grant called the “global silent emergency” of enormous numbers of maternal and child deaths from almost entirely preventable causes.