What would you invest in to help children thrive?

Imagine you’re the health minister of a large country in sub-Saharan Africa. You have a child under 5 mortality rate of 88/1000.

You also have data that rates of malnutrition (stunting, wasting) are high and that many children are doing poorly at school compared to neighbouring countries.

A charitable foundation wants to invest $100 million over 5 years to improve child health in your country. You can choose how best to spend that money.

Who would you target?

• Any age groups in particular?
• Boys? Girls? Both?
• Any specific subgroups?

Which condition(s) would you focus on?

• A single health problem or a larger number of related problems?
• Why does this matter to your population?

What intervention(s) would you spend this money on?

• Would you focus on innovative tools and technologies or strengthening the implementation of current tools?
• How solid is the evidence-base for your chosen interventions?
• What makes you believe that the project will be scalable and sustainable after the initial 5 year funding is spent?

How would you know whether your programme has been a success?

• Which outcomes would you measure and why?
• How would you measure them? Which methods and approaches would you use?

Pros and cons

To help with your discussions, consider the pros and cons of:

• A highly targeted approach treating those already with a particular condition vs a broader approach focusing on those who are at-risk but not currently affected
• ‘Vertical programmes’ — very focused on one particular problem and often using dedicated programme staff and infrastructure vs ‘Horizontal programmes’ — using and building on the existing health system, often with a secondary aim of better supporting that health system
• Tech-heavy interventions (e.g. photo-diagnosis of malnutrition using a smartphone) vs low-tech approaches (e.g. use of paper strips, to identify malnutrition)