Having led our response to the food crisis in 2010, the memories are still fresh in my mind. I know the earlier we respond, the more lives we can save.

I’ve worked on emergency responses for over a decade — from the earthquake in Haiti, to civil war in Sierra Leone and the Democratic Republic of Congo.

After years living and working in conflict zones, I’m currently based in our head office in London and advise our teams in West Africa. In times of emergency, I fly out to lead the response — as I’m doing now in Niger.

Never a quiet moment

As Team Leader my days are always busy — often ten hours a day, seven days a week — it’s a demanding role.

The first step is for teams on the ground to meet with communities and assess the situation, asking questions such as ‘How many meals are you eating?’, ‘Are you having to work longer hours to meet your survival needs?’.

Once we have that information, I set about planning our response and securing funding.

I have regular meetings with high-level donors where I explain our plans and ability to respond to the crisis. I assess how many staff we’ll need and when, make sure we have a good supply of vital medicines and food, and ensure our staff are always safe. There are a lot of moving parts to get right!

This year our advocacy department published a new report – A Dangerous Delay – calling for early funding to stave off food crises before they peak. This has already been mentioned by some key donors and is helping us to raise the money desperately needed to help save lives.

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Already a crisis

Over the years I have seen first-hand how vulnerable communities are in Niger. Families often depend on their crops for survival and their limited diet means many children grow up malnourished — stunting their development and making them vulnerable to disease.

Now that the rains have failed, insects have destroyed some of the crops and prices are rising — over five million people are facing hunger.

Parents are being forced to migrate in search of food and work, leaving children alone and vulnerable.

There are reports of children withdrawing from school to help their parents earn money or farm the land and our health workers are expecting to see an increase in children suffering from severe malnutrition.

I hope that now we have raised the alarm, the international community will respond with early action to stave off this crisis before it’s too late.

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This blog was written by Michelle Brown, Team Leader, Niger Emergency Response.

Wednesday 18 January 2012 was a little different. I went to Downing Street.

I was one of six Save the Children campaigners who went to hand in a petition calling on David Cameron to sign up to the Charter to End Extreme Hunger.

Each of us was representing one of the cities in the 66 Cities campaign — so I got a natty wee T-shirt with ‘St Albans Champion’ emblazoned across the front — but we were also representing the incredible 18,000 people who had signed up to the petition online.

DorkyDad took the day off work (thank you!), and I took a train into London. It was a true role reversal — he stayed at home with DorkySon while I headed to Save the Children’s office in Farringdon, where I was due to meet up with the other campaigners.

The day got off to a great start when I picked up a copy of The Guardian at the station, and a story about Save the Children and Oxfam’s newly released report – A Dangerous Delay – was on the front cover.

The report details the cost of late response to early warnings in the 2011 drought in the Horn of Africa. More than 30 million people are still affected by the crisis, and A Dangerous Delay outlines some of the steps that can be taken to avoid a similar situation happening again.

At the Save the Children headquarters, as I sat in reception waiting to be met, there was further coverage of the report on BBC News — it looked like it was going to be dominating the morning news, which was brilliant.

After everyone had arrived, there was a short breakfast meeting with some of the brilliant campaign staff, the other campaigners attending the hand-in (including Charlie Is So Cool Like, and his lovely vlogging Mum Lindsay), and Save the Children CEO Justin Forsyth who was just back in the office after an appearance on the Today Show.

We had a chat about the campaign, and posed for some photos with the GIANT petition, before hopping into a cab to Downing Street.

We had been due to do the hand-in at 1pm, but due to a visit from the Italian Prime Minister, we’d been bumped forward to 12pm.

The members of the Italian media gathered outside 10 Downing Street looked somewhat bemused by our group, walking up and down the street and posing for photos in our matching t-shirts! But they were full of questions about what we were doing, and it was great having the opportunity to talk about the 66 Cities campaign.

We had only planned on handing in a small version of the petition, but the policeman on the gate said we couldn’t take in the large version — which was supposed to just be a photo prop — unless it was handed in too.

So now lucky old David Cameron has a giant petition about ending extreme hunger sitting in his front hallway. (It really was big — I had to stand on tip-toes to see over the top!)

I’m hoping it acts as a constant reminder to him of the need for action.

We came out of the hand-in to two pieces of very exciting news.

The first was that Save the Children’s Twitter takeover had been a huge success. Hundreds of people had taken over the PMQs hashtag thread with messages about the Hunger Charter.

In terms of raising awareness and demonstrating the breadth and depth of support for action from the Government, that was absolutely fantastic.

So far, so riveting, hey? Stick with me.

Imagine if you wanted to introduce a brand new shiny high-speed train to the network that would alleviate over-crowding and shorten journey times.

This is a train so great that it would laugh in the face of leaves on the line, plough through snowdrifts like a hot knife through butter and could essentially revolutionise the face of rail travel. Sounds good.

The challenge

What if you have this amazing new train but the tracks weren’t strong enough, the source of fuel was unreliable and there weren’t enough train drivers or guards that knew how to operate it?

What if it there were only a few stations in major cities so that only those in the places that already had good rail links were able to use it?

It’s starting to appear less like a magic solution.

This is the challenge that faces immunisation. We have these amazing new vaccines that can save the lives of millions of children, but the health services through which they are delivered are poorly resourced and rely on weak infrastructure.

They are also massively understaffed — there’s a global shortage of at least 3.5 million health workers who are needed to put the jab in the child’s arm.

The solution

The solution is to strengthen the health systems and make sure that immunisation is an integral part of the health service, rather than operating through one-off campaigns. This is the fourth target outcome of the Decade of Vaccines Action Plan.

In discussions around this target there were many questions on what ‘integration’ means. Should vaccination programmes run alongside existing health services? Should they be joined together or should they merge?

If immunisation and the health service are both 20-seater buses, do we send two buses, do we tie one to the other or do we create a new 40-seater vehicle? (Thanks to Raj Kumar at GAVI for another transport analogy).

One size doesn’t fit all

There can be disadvantages in integration (lack of focus, dilution of funding, etc) so the route to integration is not one size fits all.

To combat this lack of coherence and clarity, the Decade of Vaccines should commission a report as a guide, bringing together best practice on integration and disseminate it to practitioners.

To create incentives for innovations, the Decade of Vaccines could launch a scholarship for individuals or a research grant for institutions that is specifically designed to spur innovation in this area. 2020 seems like a realistic deadline for this to deliver results.

Universities, research institutes, pharmaceuticals and others who have the potential to come up with a game-changing idea on vaccines could be contacted straight away and after one year the first Decade of Vaccine Scholars could already be at work.

Closing the health worker gap

A strong integrated health system also depends on having sufficient human resources, so one of the areas where the Decade of Vaccines could make a difference is on health workers. You can’t train an army of health workers overnight, but a decade seems like about the right time scale.

The Decade of Vaccines should seriously consider how it can work with training institutions and ministries of health to help close the health worker gap.

What an amazing legacy that would be.

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It would be a missed opportunity if the plan is adopted only to later flounder because people don’t know how to get started.
 I decided to use this blog to do a little ‘blue-sky thinking’, if you’ll excuse the business speak, and think in terms of actions for the action plan targets.

Target 1: Countries commit to immunisation as a priority

The term ‘political commitment’ is much used, but poorly defined. It boils down to three things: time, money, and people — the government must dedicate time to discussing the issue in ministries and in public; they must dedicate financial resources and assign people to work on it.

Getting a government to make a public pledge to improve immunisation will not guarantee action, but it would indicate the amount of time, money and people they intend to dedicate.

It could also have two immediate beneficial effects: media coverage of a pledge could help counter some of the negative press about vaccines and it would give civil society something to hold governments to account with. Another benefit may be peer pressure — a public pledge from one country could prompt one from a neighbour.

Making it happen

Many governments have already outlined their objectives in their national health plans or immunisation strategies. So step one would be to find those targets, write them up, and write a letter to the right person in government asking for them to be read out at a public event.

The response, and the country context, will dictate the next step and how easy it will be to use this for influencing.

A survey of attitudes towards immunisation in government departments could help measure progress on this target. A survey that asked officials to rate whether they agree with  statements  like  ‘Children in this country do not get enough vaccines’ — would reveal changing attitudes.

Target 2: Individuals and communities understand and demand immunisation

As my background is in PR, I think there is a role for the media here. I’ve seen a number of glossy advertorials in outlets like the Financial Times, the sole purpose of which is to say ‘Hey, rich people, invest in Cameroon!’. So why not a four-page Decade of Vaccines advertorial in media read by decision makers in developing countries? The sole purpose being to say ‘Hey, Cameroon, invest in vaccines!’.

On day one you write a list of the key publications. A month later the  quotes are in and a slot secured, three months later the supplement is published.

Increasing demand

Effective feedback that shows communities their place in the immunisation ‘league table’ could encourage people to demand better coverage. Much like the passenger information boards in train stations that reveal the number of trains that were on time each period, could we not do something similar for vaccination?

Imagine if every clinic had a board outside showing how many children had been vaccinated that month against a target or against a national average.

Imagine if your district was falling behind the next district over — a little bit of healthy competition might go a long way. (Obviously there would be issues around literacy, cost, data, etc. but we have eradicated smallpox, so this seems relatively easy in comparison.)

That’s the first two targets covered, I will look at the more technical issue of health system strengthening and integration in my next blog.

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This land has been hit by ongoing drought for over a year now. It’s also home to thousands of pastoralist families, who are surviving drought and harsh weather.

Water is extremely scarce here; so people need to move according to water availability.

I was keen to find out how the weather has affected children’s experiences and their access to education.

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Schooling against many challenges

I visited a school and spoke to children of all ages, their teacher and community members.

The school has three grades and caters for children from as young as three, as well as their older siblings up to the age of 21.

This used to be one of our project areas under Bridges, a DFID-funded programme involving a system of ‘networked’ and mobile schools that cater for children’s pastoralist lifestyles, ensuring that school moves with them.

Bedria is the eldest of her siblings. In this photo she carries the youngest one. Bedria’s only experience of education was a month in school, many years ago. Now she looks after her family and often takes care of the cattle. She wishes she could go to school, but then, who would feed her family? Bedria doesn’t want to marry and told us she will resist any attempt.

School drop-outs

The only teacher in this school has been teaching for many years, often teaching under trees until the local government built the existing school.

The teacher said that once children have gone away for a few days to fetch water, the likelihood of them ever going back to school is reduced. Some would come back, some would get involved in other activities, while girls over 14 years old might get married.

He was very clear that the drop-out rate is about to increase and that Babile has not yet seen the worst effects of migration to other areas with more water.

Children’s education in this very dry region tests parents’ willingness to prioritise education when children are needed to support the family with essential house chores or cattle rearing.

All the children I spoke to want to stay in school and they want their friends who have dropped out to return to school.

They want a well or other source of water to reach them soon, so that they don’t have to keep moving and can stay in this school.

Speak up for education

While the ongoing crisis in East Africa means that other life-saving work has more prominence than education, it is still essential that we hear more about what education means for the region’s children.

Missing out on education will have a big impact on their lives, as well as on their resilience and development, so we need to speak up.

It was difficult to say how old she was; my guess was that she was no more than 8 or 9. She had a very serious and solemn expression on her face, almost a reflection of her mother’s.

I ventured out into what remains of the crops after the devastating rains to talk to the young cotton picker and her mother. As I walked closer, I could see that she was even younger than I had first thought.

Buying books and school uniform

They looked at me, straightened their backs and let their hands fall to their side and waited for me to speak.

I greeted them with salaam and asked the name of the village she belonged to. She answered me in Urdu, which made me curious. Urdu could only be learnt if you went to school.

She told me that she was working with her mother in the landlord’s fields and whatever she earned she spent on books and school clothes.

Never known childhood

A few days earlier, another six-year-old girl I met told me she knows that she will never be able to attend school because as the eldest daughter, she has to look after her younger siblings and help her mother with household chores.

These girls have never known a true childhood; they have all had to grow up very quickly. They know that their parents don’t have enough money to send them to schools, buy them new clothes or even feed them three meals a day.

Every misery, from hunger, poverty, lack of shelter, child abuse, child labour, illiteracy and disease takes its toll on their young lives.

Too busy trying to survive

Thousands of children in the flood-affected areas of Sindh don’t have enough time to be kids; they’re too busy trying to survive. They grow up malnourished and uneducated as they work on the land of the feudal landlords and serve them throughout their lives.

They get married at a young age, in most cases while they are still in their early teens. They have on average between six and eight children before they themselves reach the age of 25.

The cycle then continues the way it has for centuries.

Hope for change

I can only hope that good quality care and education can be made available to them soon.

This is the only way to protect their childhood and their future.

Save the Children has reached over 9,000 children with our education response, including setting up temporary school structures and temporary learning spaces to enable children to begin or continue their education.

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This blog was written by Huzan Waqar, Media and Communications Officer, Sindh.

So it was something a little different for me to be invited to an immunisation conference aimed predominantly at two regions that rarely come onto my radar — the Middle East and North Africa, and Central and Eastern Europe. This part of the world faces its own unique set of health challenges.

Despite a 93% reduction in measles mortality and immunisation rates that are often in the high 80-90% bracket, there are still 250,000 unimmunised children in Central and Eastern Europe. These children are mainly in Russia, Turkey, the Ukraine and Azerbaijan.

The Middle East and North Africa region includes several middle-income countries that contain pockets of unimmunised, hard-to-reach children, making the task of universal immunisation very difficult. Egypt and Morocco fall into this category.

The issues these countries face are not unique, but they take on different dimensions in the context of this region.

Security
In the latter half of the 20th century, conflict in several African countries, such as Ivory Coast and Democratic Republic of Congo, led to the destruction of many health facilities and the infrastructure is still struggling to recover. But conflict, insecurity and political instability have hampered immunisation efforts in the Middle East and North Africa even as recently as last year.

Equity
Equity is an issue in many countries. National coverage rates often conceal huge disparities in terms of wealth, geographical location, gender and the urban/rural divide. This region is no different; but here the groups missing out tend to be immigrant communities or particular cultural groups, such as Roma children or certain tribal groupings.

In Bosnia, less than half of the districts in the country have reached 90% coverage and in Georgia that figure is 57%. According to regional targets, not one single district should be below 90% coverage.

Reverse Equity

Three Eastern European countries demonstrate an unusual trend whereby the poorest children are more likely to be immunised against measles than the richest.

Further investigation is required to uncover the exact reasons why Armenia, Turkmenistan and Belarus are displaying this phenomenon, dubbed ‘reverse inequity’, but one suggestion may be that measles campaigns are targeting the most vulnerable children but at the expense of the richer children, or alternatively that these children are obtaining vaccines outside of the public sector.

Private Sector
In some countries private sector healthcare providers are delivering immunisation services, particularly to the richer sections of society, thus creating a two-tier system. This is more salient in light of the expensive new vaccines coming to the market that can only be afforded by the few.

A parallel service provided by the private sector can create inaccuracies in data and coverage levels as private monitoring systems are not always co-ordinated with central government records.

A global challenge

So the challenge for the Decade of Vaccines is not just on the plains of Africa and in the slums surrounding Asia’s megacities; much work also needs to be done closer to home and in middle-income countries.

If the Decade of Vaccines initiative is to be the game changer it desires to be, every child in every country — rich or poor — must receive the benefits of immunisation.

Sincere thanks go to Dr Mahendra Sheth, from the Unicef Middle East and North Africa Regional office (but formally of Save the Children UK in Ethiopia), for his excellent presentation, upon which much of this blog is based.

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Our first test was the January edition of Children Now, our supporter magazine. We used an augmented reality tool to make an image come to life.

Augmented reality tools allows smart phone users to take advantage of the apps and tools on their handsets to make static images come to life.

The possibilities are limitless – you can use animation, 3D graphics, audio, video and more to make a one dimensional image merge with interactive content.

Children Now is published three times annually and sent to 240,000 Save the Children supporters. The magazine was a great platform for our first test because it covers such a wide range of topics, but it is a traditional printed magazine with a limited interaction between audience and writer. It’s very difficult to drive readers to online content!

Our goal with this test was to engage supporters through exciting film content without using email or SMS as a delivery channel. Crucially, we needed to find a low-cost way of getting film content into people’s homes to demonstrate the impact of their support.

We used a free tool called Aurasma to make an image from our East Africa appeal come to life with a film we created a few months ago called Fill A Truck. Getting this test off the ground had its challenges. We definitely didn’t do everything right! Adding digital content to a printed leaflet isn’t straightforward.

Getting it right

The content on the page didn’t end up looking the way we expected so next time we’ll be sure to leave enough time to play around with the layout and wording of the print materials.

We got a lot of help from the team at Aurasma. They created a transition for us (the shift you see from the static image to the film) and worked late into the night to get our Aura live on deadline and gave our film a few small nips and tucks.

If you haven’t tried the Aura yourself, you can watch the film below to see how it works.

Save the Children – How to use Aurasma

This was one of the first of many tests you’ll be seeing over the next few months. As we test new technology, we’ll continue developing our learning so please bear with us and let us know what you liked or disliked by leaving a message below.

It was the story of how Tanzanian president Jakaya Mrisho Kikwete was able to help one woman give birth safely.

She’d been in labour for three days and her family were trying to take her 28 miles to the nearest hospital – on a bicycle.

Hope and opportunity

It was great to read President Kikwete’s update in The Citizen, giving his very personal reasons for addressing the health-worker shortage in Africa.

“When I came into office in 2005, healthcare was the sixth largest budget expenditure,” he says. “Now it is the third largest after infrastructure and education, which indirectly have a relationship with health.”

Ending the unnecessary pain

“Women and children are still dying needlessly” the president says, explaining his commitment to the Global Strategy for Women’s and Children’s Health.

This is a strategy we’ve worked to promote for years now, especially since the launch of our No Child Born to Die campaign a year ago. Unflagging belief and commitment will bring us nearer to achieving Millennium Development Goal 4.

It’s great to read such a determined backing of the global work to save mothers’ and babies’ lives.

Read President Kikwete’s full update.

Today, the Decade of Vaccines Collaboration – a project that is bringing leading global health professionals and organisations together behind the shared goal of saving millions of lives through expanding immunisation – began a regional consultation on its Global Vaccine Action Plan.

Now, that may sound like a big meeting to discuss a document (and ok, that is essentially what it is) but after day one, I believe this event has the potential to make a huge difference, and that it is, genuinely, exciting. And here’s why…

Great potential

Take a conference centre in Rabat, Morocco, and fill it with some of the world’s leading experts on immunisation including, most importantly, those from countries that are home to the highest numbers of unimmunised children.

Add in a few NGOs, a few representatives from pharmaceuticals and a couple of translators, and give them all a shared objective to contribute to a global action plan that will guide our joint efforts towards the ultimate goal of ensuring that in the next decade all people, no matter where they are born, receive the full benefits of immunisation. Achieving that would save millions of lives.

If you have a big problem – and the fact that 24 million children miss out on routine immunisation every year is a very big problem – getting as many people with expertise as you can squeeze into a room to think collaboratively about solutions and bounce ideas off each other has great potential. Today I saw new alliances forming and watched participants challenge each other and share information and experiences.

Different perspectives

Three issues stick in my head that are the result of an exchange with someone from a different perspective to my own.

1. The concept of ‘not for profit’ is not as straightforward as it may first appear. Say a vaccine manufacturer develops a product and agrees to sell it at cost price without profit, job done. But what happens a week later when the price of a key component fluctuates or when the manufacturing plant discovers how to make an efficiency saving.  With complex supply and procurement mechanisms, reflecting these changes will not be as simple as changing a price on supermarket shelf.

2. Whoever is in charge of a country’s health budget is responsible for providing both preventative treatments (eg vaccines) and curative treatments (eg hospital care and drugs). Switching money from the second category to the first may save money in the long term, but would create a gap while the health service waits for the preventative treatment to take effect and for demand for curative treatment to fall.

3. Promoting one vaccine can have the result of reducing demand for other vaccines. An unforeseen and unintended consequence of fiercely marketing one vaccine can lead communities to think that they are completely covered after receiving the well-publicised one and demand for other routine vaccines drops.

First steps

The sceptics among us are likely to think that all these discussions will amount to nothing more than a really well-written action plan that will go on to clutter the desks of health ministers the world over for years to come.

And of course there is a risk of that, which is why I was pleased that throughout the day we were asked to think about specific actions– what can we do to turn these grand ambitions into reality; what resources will we need; who do we need on board; how will we make them deliver; how will we know when we’ve reached our goal.

But, ever the optimist, I’m inclined to think that today we took one of the initial steps towards something that could really be a game changer in immunisation. And if we get it right at the start, we are more likely to keep getting it right.

Let’s hope we have the luck of the dragon on our side.