On March 8, in celebration of International Women’s Day, Marion Bunch, Chief Executive Officer, Rotarians for Family Health & AIDS Prevention and founder of family health days, will participate in a World Bank event about inspiring women who made a difference in the world through innovative programs in the areas of education and health.
In my volunteer work with Rotary International over the years, I’ve been inspired by the impact that family health days make in developing countries, as well as by Marion’s leadership in women’s health. Many of my fellow development practitioners may not have had the chance to see family health days in action. So, what are family health days? Do they make sense from a policy point of view? This post addresses these questions.
What are family health days?
Imagine hundreds of thousands of families and individuals getting free health care for a few days. Family health days make this feasible. Individuals and families can be tested for HIV/AIDS as well as receive counselling. Testing and/or screening for tuberculosis, diabetes, high blood pressure, and other conditions such as cervical and breast cancer is provided. Children receive immunizations as well as Vitamin A supplements. Some sites also include dental clinic and hygiene education as well as eye examinations. Health counseling is provided.
The program was launched in 2011 and is now active in a half dozen countries in sub-Saharan Africa and South Asia, most of which hold 2-3 family health days per year. The program is led by Rotary in partnership with the Coca-Cola Africa Foundation, the U.S. government – including the Centers for Disease Control, USAID and the health service delivery expertise of their Implementing partners – and Ministries of Health, which provide services and supplies at the sites. Media partners promote the days in each of the countries. Thousands of volunteers in each country, including many Rotarians, help in various ways.
Do family or child health days make sense from a policy point of view?
A search of the literature around family or child health days reveals that, for purposes such as screening for illnesses and child immunization, holding such days appears to make a lot of sense. The programs appear to be highly beneficial and cost-effective if implemented well.
For example, Fiedler and Chuko looked at the reach and cost of child health days in Ethiopia in 2008. They found that the program reached more than 10 million children at an average cost of half a dollar per child (one dollar when including measles). This made the program cost-effective, with potential additional benefits to be reaped through economies of scope in increasing coverage at delivery sites.
Palmer and others note in a 2010 article that child health days are becoming increasingly popular, implemented in more than 50 countries at the time of the study. They conclude that the days are helping countries achieve high and equitable coverage of essential health and nutrition services. Child health days were also recognized as beneficial in a 2013 World Health Organization report on essential nutrition actions for improving maternal, newborn, infant, and young child health and nutrition.
Improvements could be made, however. In a 2012 review of experiences integrating the delivery of maternal and child health services with childhood immunization programs, Wallace, Ryman, and Dietz emphasize the importance of proper planning and awareness when implementing these interventions, among other actions to reduce the risks of logistical difficulties, time-intensive interventions ill-suited for campaign delivery, concerns about harming existing services, and overlap of target age groups with other service delivery mechanisms. The review also revealed gaps in information about costs and impacts.
On costs, a 2014 paper by Fiedler and Semakula suggests that part of the reason why costs may appear so low in some countries (US$0.22 per child in their analysis for Uganda) is because of underpayment for Ministry of Health staff and volunteer allowances. Still, the authors find that child health days are successful in saving lives, making them highly cost-effective. Vijayaraghavan and others in a case study for Somalia also find child health days to be cost-effective in addressing leading causes of child mortality in a conflict settings. They rate child health days as one of health sector’s best buys in sub-Saharan Africa.
So, what can be learned from family or child health days? The first lesson is that we can expand access to health care for children and families, and we should invest in the expansion of these programs. The second and perhaps more important lesson is that beyond the important role of the state, which we often emphasize in development work, committed individuals such as Marion can truly make a difference in the life of those in need.
Watch the Inspiring Women of Action World Bank Live webcast from 2:00 to 3:00 pm EST on March 8, or the recording afterwards.
Follow the World Bank health team on Twitter: @WBG_Health