Rotary’s Family Health Days Featured at the World Bank

Today, in celebration of International Women’s Day, Marion Bunch, the founder of Family Health Days, participated in a well-attended event at the World Bank about inspiring women who made a difference in the world through innovative programs in the areas of education and health. The event was streamed online through World Bank Live, and a recording will soon be available if you missed it. What are family health days? Do these days make sense from a policy point of view? And who is Marion Bunch? This blog post answers these three questions.

Family Health days

What are family health days?

Imagine hundreds of thousands of families and individuals getting free health care for two or three days. Family Health Days makes this feasible. Individuals and families can be tested for HIV/AIDs as well as receive counseling. 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 also provided.

The program was launched in 2011 and is now active in a half dozen countries in sub-Saharan Africa and South Asia. The program is led by Rotary in partnership with the Coca-Cola Africa Foundation, the U.S. Mission – including the Centers for Disease Control, USAID and the health service delivery expertise of their implementing partners – and Ministries of Health that 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?

Intrigued by the concept of family health days, I conducted a rapid search of the literature and found that for purposes such as screening for illnesses and child immunization, holding such days appears to make a lot of sense. This type of programs appear to be 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.

Who is Marion Bunch?

What is also interesting – especially as we celebrate International Women’s Day and the power of women to make a difference in the life of the less fortunate, is the personal story of Marion Bunch. Marion is the Chief Executive Officer of the Rotarian Action Group Rotarians for Family Health & AIDS Prevention. She has received numerous awards on behalf of her work for AIDS. But first and foremost, she simply considers herself a mother who helps in representing the human face of AIDS. She started her work after losing her son to the disease in 1994. As she explained it in an interview. “I never thought I’d do anything about it until one day, three years after his death, I felt a tap on the shoulder, and a voice in my ear said, ‘Mom, get up and get going; you haven’t done anything, and it’s been three years.’” Since then, the reach of Family Health days has expanded every year, in close partnership with Ministries of Health in the countries where the program is running. Marion’s story has been told in a documentary film that won two 2015 Telly Awards.

What can be learned from Marion’s project?

On the occasion of International Women’s Day, at least two important lessons emerge her project. The first lesson is that we can expand access to health care for children and families through Child and Family health Days, and we should invest in the expansion of these programs. But the second and most important lesson is that beyond the important role of the state that we often emphasize in development work, committed individuals can truly make a difference in the life of the less fortunate. The theme of the event at the World Bank was “Inspiring Women of Action”. There is no doubt that Marion is such a woman.

If you were not able to watch the event live, a recording will soon be made available here.

This post is adapted from a post published today on the World Bank’s Investing in Health blog.

World AIDS Day: The Role of Civil Society and Rotary

by Quentin Wodon

Today is World AIDS Day. Over the last three decades, the pandemic has taken the lives of 36 million people. According to the WHO, 35.3 million people live today with HIV (human immunodeficiency virus), but only about a third (11.7 million) receives antiretroviral therapy in low- and middle-income countries. The theme for the day this year is “Focus, Partner, Achieve: An AIDS-free generation”, calling for governments, NGOs, and individuals to contribute to AIDS prevention and treatment. This post is about the role of civil society and Rotary in fighting the AIDS epidemic.

Rotary's Family Health Days in Action
Rotary’s Family Health Days in Action

Role of Civil Society

Governments and donors play a key role in the fight against AIDS, but civil society and individuals also play an important role and that role is being increasingly recognized and supported. Last year I published with World Bank colleagues a book entitled Funding Mechanisms for Civil Society: The Experience of the AIDS Response (the book is available online without charge here). We noted that in the past decade, international funding for the HIV and AIDS response provided by governments rose dramatically.

In addition donors have increasingly shifted their financial support toward funding community responses to the epidemic. Yet little is known about the global magnitude of these resource flows to civil society, especially at the local level, and how funding is allocated among HIV and AIDS activities and services by community organizations.

Part of the study focused on the mechanisms used to fund civil society and community-based organizations (CBOs) by four large AIDS donors: the U.S. President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank’s HIV/AIDS Program, and the UK Department for International Development. On average, these four donors provided at least US$690 million in funding per year for civil society organizations (CSOs) during the 2003–09 period.

Much of this funding went to large national CSOs. While part of the funding also went to smaller NGOs and CBOs, including through partnerships with the larger CSOs, in many cases only a small share of international resources trickles down to local communities. More needs to be done to support local-based organizations that are actively contributing on the ground to the fight against AIDS, often relying on volunteer work.

Role of Rotary

Rotary is active in the fight against AIDS in part through the Rotarians for Family Health & AIDS Prevention (RFHA) Rotarian Action Group. Rotarian Action Groups (RAGs) are groups are led by Rotarians in their field of expertise in order to help clubs implement projects and exchange ideas and experiences. There are close to 20 RAGs operating, and RFHA is one of them.

The signature program of RFHA is Rotary Family Health Days (the information provided here is from the RFHA website). The program promotes healthy living and disease prevention through annual campaigns in four African countries: Ghana, Nigeria, South Africa, and Uganda. Family Health Days provide comprehensive, free health care services to underprivileged communities. The services include lifelong immunizations to children, such as polio and measles vaccines, and comprehensive life-saving annual screens such as HIV, TB, Malaria, Diabetes, Hypertension and more, including information about HIV-AIDS.

The program was initiated in 2011 when Past District Governor (PDG) Stephen Mwanje from Uganda asked Marion Bunch, the founder of RFHA, for partnership support in obtaining funding and other resources for this program. PDG Mwanje’s vision was to have all Rotary clubs in his district work together towards a common cause, focusing on HIV/AIDS but also including other disease prevention measures.

Family Health Days is a Rotary-led program, but it leverages partnerships with others including the Coca-Cola Africa Foundation, the U.S. Mission – including the Centers for Disease Control, USAID and the health service delivery expertise of their Implementing Partners – as well as each of the four countries’ Ministries of Health that provide services and supplies at the sites.

Equally important in each country are the primary media partners that include the SABC and Caxton in South Africa, and other media centers in each of the other countries. The Family Health Days program has grown from serving 38,000 citizens in one day in 2011 to serving 343,622 citizens in 2014 in 402 sites with the help of more than 8,000 Rotary volunteers. RFHA hopes to expand the program in more African countries in 2015 and is planning a pilot in India. Importantly, it is also thinking about the measurement and evaluation of the impact and sustainability of the program.

Conclusion

In the fight against AIDS, community-based organizations play an important role because of their proximity to the population, their knowledge of the issues on the ground, and the trust that the population has in them. Rotary could be considered as a large NGO given the amounts of funding managed by The Rotary Foundation of Rotary International. But it can also be considered as a small local-based quasi-community group given that many Rotary clubs are indeed small and working at the local level collaboratively with other NGOs.

A key question for Rotary is how to leverage effectively the resources provided by its network of clubs and members around the world. The Family Health Days, the signature program of the RFHA Rotarian Action Group, is a very interesting case of a successful mechanism to leverage the energy of many local Rotary clubs into programs that reach at least some level of scale and make a difference in the fight against AIDS and the improvement of broader health indicators.