A REVOLUTION FOR CHILDREN

Item

Title: A REVOLUTION
FOR CHILDREN
extracted text: A REVOLUTION
FOR CHILDREN

. UNICEMOOPERATION WITH FICCl

“The ‘Child Survival and Development Revolution’ is not a
UNICEF programme. We can articulate its potential to those
who will listen, and we can help translate ideas into action with
the very limited resources which governments and concerned
individuals entrust to our administration. But in the last
analysis, we can only claim to be one of the many forces
which must join together to make this ‘revolution’ real, and give
children the chance which they would otherwise not have.
Our greatest hope is that these forces will together constitute
such a vast multitude that the UNICEF contingent in their
midst will be indistinguishable.”
JAMES P. GRANT
Executive Director
United Nations
Children’s Fund (UNICEF)

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CH
It is elementary that children are future citizens and represent
human potential which needs to be carefully nursed and
developed in order to ensure a better tomorrow. Whether or not
mankind can live in peace and harmony depends largely on the
conditions in which children are brought up today. Gandhiji,
therefore, wanted children to be allowed to “grow up in their
natural innocence”. International agencies like UNICEF,
government, voluntary agencies, etc. are already engaged in
activities designed to promote child development. But this is not
enough. Industry, both large and small as well as public and
private sectors can play an effective role in promoting these
efforts. In most of the large industries, health-care for workers
and their families is now available. These facilities can be
extended by industries to the people in their surrounding
regions. If we can involve all voluntary and professional
agencies as well as industry in these efforts, we can certainly
prevent the present child-deaths and suffering due to
malnutrition and hunger by the end of the century.
RAM KRISHNA BAJAJ
President
Federation of Indian Chambers of

Commerce and Industry (FICCI)
New Delhi, INDIA

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Advocacy and Action for Children
A Manifesto for UNICEF Cooperation with
FICCI
United Nations Children’s Fund and Federation of Indian
Chambers of Commerce and Industry are no strangers to each
other; they share a long history of common interests and
aspirations, exchanges of information and ideas, and the
potential for cooperation in joint activities for the well-being of
children.

It is in this context that UNICEF can appeal to FICCI for
renewed cooperation in the cause of the child. Despite the dark
economic prospects for so much of the world, the message is
one of hope and optimism-the possibility of a virtual revolution
in child health and development which could save the lives of
half of the 40,000 small children who now die each day. The
appeal is two-fold. It urges each of you to become leaders in
transforming this potential for revolutionary improvement in
the well-being of children into reality, and thereby provide
those wno are most precious to the world’s future—our
children—the chance which many otherwise would not have. It
also encourages FICCI to consider supporting, with an
unprecedented intensity of effort, this potential that is as
momentous for children in the decade ahead as the Green
Revolution was for increasing grain production in many Asian
countries in the decade from the late 1960s.
What is this potential for a child survival revolution?

Is there hope of reducing the unconscionable daily toll of
40,000 small children dying and another 40,000 crippled? Are
many of the world’s poor children doomed in the 1980s to ever
decreasing chances for a life worth living? Are we helpless to
reverse these trends?
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No, not at all. As has happened so often in human history,
the deepening of the present crisis is now being matched by the
arising of new opportunities on an equal if not greater scale.
It is clear that for a majority of countries particularly in the
developing world, the next five to ten years are not going to
bring back the rapid economic growth rates of the 1960s or
1970s. It is also clear that we can no longer count on the levels of
official governmental assistance from donor countries which
strengthened poorer country resources for development in the
past decades. It is therefore clear that if human progress is to
continue, we are going to have to find ways in both the
industrial and the developing countries to accomplish much
more out of the limited resources now available, or, at best, with
just a little bit more.

But are there possibilities? Yes’ And they need not cost
millions.
For example, consider a point made in 1983 by the
Director of the Centres for Disease Control in Atlanta that the
average American male, aged 50, can expect to live six years
longer than his predecessor of the year 1900 as a result of the
medical advances that have occurred in these past eight decades.
The cost of achieving that extended lifespan exceeds $100
billion annually. But there are four simple measures that an
average American male can follow at no additional cost that
would add eleven years to his life.
First: Eliminate smoking. (Smoking takes 1,000 lives
prematurely each day in the United States.). Second: moderate
alcohol consumption . Third: exercise. And fourth: follow a
moderate diet. Four simple, largely cost-less steps.
This same kind of thinking on how we can progress
through far more effective use of what we already know and
have can be applied elsewhere as well. Indeed, it is now
apparent that parallel social and scientific breakthroughs of
recent years have come together to put into our hands the
sudden means of bringing such major breakthroughs in child
health at low financial and political cost that they could result in
revolutionary improvement in child survival in virtually any
country. Put together, these social and scientific advances now
offer vital new opportunities for improving the nutrition and

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health of the world’s children. Within a decade,, low-cost
advances could be saving the lives of20,000 children each day
and preventing the crippling of another 20,000 each day. It is
not the possibility of this kind of progress that is now in
question. It is its priority: among Governments, among
international assistance sources and networks, and, particularly
in developing countries, within social organizations and
movements, and, of course, in local communities themselves.

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New Hope in Dark Times
An invisible malnutrition today touches the lives of
approximately one-quarter of the developing world’s young
children. It quietly steals away their energy, it gently restrains
their growth, it gradually lowers their resistance. And in both
cause and consequence it is inextricably interlocked with the
illnesses and infections which both sharpen, and are sharpened
by, malnutrition itself. Perhaps as many as half of all cases of
severe child malnutrition, for example, are precipitated not
primarily by the lack of food but by intestinal parasites, fever
and infection—especially diarrhoeal infection—which depress
the appetite, burn the energy, and drain away the body weight
of the child.

Because of this relationship between malnutrition and
infection, illness is frequent, recovery times are inadequate, and
assaults on a child’s growth therefore become cumulative. By
the same token, a relatively small number of interventions can
break this cycle, allow fuller recovery, reduce frequency of
infections and therefore have a disproportionately beneficial
effect on child health.
For the last two years, through its annual report on the
State of the World's Children, UNICEF has, with the help of the
mass media, drawn world-wide attention to the fact that just
four relatively simple and inexpensive methods could now
enable parents themselves to halve the rate of child deaths and
thus save the lives of upto 20,000 children each day.
A serious commitment to achieving that revolutionary
improvement by national and community leaders—including
the business community—and by Government could yet re
accelerate progress to historically unprecedented levels for the
world’s children—slow the rate of population growth, reduce

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child malnutrition sharply and cut child deaths and disabilities
by at least half before the end of the 1990s. In short, there is new
hope in dark times.
Oral Rehydration : The most important and dramatic of
the low-cost scientific breakthroughs described in UNICEF’s
annual message on the State of the World’s Children is a simple
oral rehydration home treatment for the world’s largest killer of
children—the loss of body fluids from the diarrhoea associated
with cholera and other diseases—which takes a toll each day of
2500 Indian children from largely poor families and contributes
to the malnutrition of millions of others. Described in 1978 as
“potentially the most important medical advance of this
centuiy” by Britain’s world-renowned Lancet, oral
rehydration—a remedy costing only pennies—remains virtually
unknown in hundreds of millions of households which need it
most. It is not yet used or promoted in i he majority of the world’s
hospitals and clinics, including those in the industrial countries,
which still rely on relatively expensive intravenous treatment
requiring the use of health facilities not readily accessible to the
majority of families in need. Oral Rchydration Salts (ORS)
consisting essentially of glucose (sugar) and salt, when mixed
with water, replenish fluids that a child needs to stay alive long
enough lor his body to fight the diarrhoea-causing organism.
The lives of thousands of children could be saved each year, and
the health of many millions more improved significantly, if
nations were to effectively promote oral rehydration therapy
through health systems, mass media, educational channels,
industry, labour, religious and other community groups, and
with active support by national leaders.
Immunization : The second element of the children’s health
revolution is the increasing feasibility of immunizing all
children against measles,diphtheria,tetanus,whooping cough,
poliomyelitis, and tuberculosis, which take the lives of
thousands of Indian children annually. The need to administer
repeated booster immunizations requires a well-organized
delivery system. Social breakthroughs in the organization of
communities and national systems, as well as technological
improvements which have reduced the heat sensitivity of
vaccines, making them more portable, with a longer life and
cheaper, make tremendous advances in universal child

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immunization possible. The eradication of smallpox—that
historic scourge—in the late 1970s, after only a decade-long
campaign and at the cost of less than one B-l bomber, is a
dramatic indication of what is now becoming possible if the
world makes the effort. Business houses can be pioneers in
extending immunization to India’s children, by making this a
major thrust of their programmes of community service.
Breast-feeding : The third low-cost opportunity to
significantly accelerate progress in the nutrition and survival of
infants is the campaign—led principally by UNICEF, WHO, and
many private organizations—to promote breast-feeding, which
is the best nutrition for any baby in any society. Breast feeding is
the one technique available to almost all mothers to avoid infant
health problems. Its advantages include nutrition, hygiene,
immunological qualities, and non-cost. The premature shift
away from breast to bottle feeding in the urban slums of the
Third World—just as the reverse trend back toward breast
feeding is seizing the industrial countries—results in the deaths of
scores of thousands of children in families which have neither
income for, nor the knowledge of, nor access to, the sanitation
required to safely use breast-milk substitutes.
Growth monitoring : The fourth technique is the use of
simple growth charts by parents for nutritional surveillance to
increase their awareness, on a regular basis, ofthe child’s growth
progress, and to offer warning of the child’s all-too-often
invisible malnutrition. Growth charts kept by mothers in their
own homes and used to register monthly village weighings are a
stimulus and guide to the proper feeding of the pre-school child.
Consistent under nutrition, successive infections, and bouts of
diarrhoeal disease can all hold back a child’s growth over weeks
and months in a subtle way that usually passes unnoticed by the
parent until the malnutrition is acute. But it will not pass
unnoticed by the chart. Once a mother is aware that her child is
malnourished, experience shows that in one-third to one-half
the cases the mother can correct the malnutrition herself, by
fighting for more food for the child from the family table or
changing the weaning food mix. But her success depends on
being alerted early to the malnutrition through such means as
growth charts.

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None of these measures—growth surveillance, oral
rehydration therapy, breast ■ feeding and timely supple
mentation and universal immunization—is completely new.
They have for years been integral parts of many health program
mes. In many ways, however, either the technology by which
they are applied is recently enhanced, as with oral rehydration
and more heat-stable vaccines for immunizations, or our
appreciation of their value is newly strengthened, as with
breast-feeding and growth surveillance.

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Micro-nutrient Deficiencies
Micro-nutrients are essential for the development and well
being of the body. They are needed in minute quantities and are
found in foods. Many young lives are stunted or wasted due to
micro nutrient deficiencies. These deficiencies tend to aggravate
susceptibility to various afflictions. Certain simple strategic
interventions can prevent these problems.
Iron helps produce haemoglobin, a component of red
blood cells. Iron, insufficiently ingested or improperly
absorbed, results in iron-deficiency anaemia, which contributes
significantly to premature births, low birth-weight babies and to
perinatal mortality (during first week). Sixty-three per cent of
Indian children below three years and 45 per cent of Indian
children between three to five years suffer from iron-deficiency
anaemia. Sixty per cent of Indian women are estimated to suffer
from it.

Anaemia can be prevented:
— by consuming iron-rich foods, like green leafy vegetables,
cereals, legumes, eggs, meat and fish, and iron-fortified salt,
— by treating hookworm when present.

Vitamin A is needed for the normal functioning of the eye,
including the ability to see in the dark. In India, nearly 30,000
children are becoming blind each year due to Vitamin A
deficiency.
Vitamin A deficiency can be prevented:
— by consuming Vitamin A rich foods like green leafy
vegetables and bright yellow or orange vegetables; oral
administration of Vitamin A.

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Iodine is necessary for the production of thyroxine, a hormone
produced by the thyroid gland and essential for the physical and
mental development of children. Disorders caused by iodine
deficiency include stillbirths, congenital abnormalities, neo
natal deaths, neo-natal hypothyroidism (thyroid deficiency),
cretinism and endemic goitre. Forty million people in India are
affected by iodine-deficiency disorders. Between four and 15
per cent of the children, born to iodine-deficient mothers, have
various degrees of mental impairment ranging from a mild form
to blatant cretinism.

Iodine deficiency can be prevented:
— by consuming iodised salt, iodised oil capsules: through
iodised oil injections.

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COMM'JN;TY HEALTH C tLl.
*7/t. (Firt-i Ice? f- V* 's Plead,

Water Supply and Sanitation
Improved water supply and sanitation can have wideranging health, economic, social and environmental impact on
the lives of people in developing countries.
It is estimated that about 15 million children below the
age of five years die in the developing countries every year. The
absence of safe water and sanitation plays a major part in this
tragedy. If everyone had access to safe drinking water and
sanitation, infant mortality could be cut by as much as 50 per
cent world wide.
According to the World Health Organization (WHO),
approximately 80 per cent of all sickness and disease can be
attributed to inadequate water or sanitation.
The drinking water supply programme hits been accorded
top priority by the Government of India. Nearly 80,000 villages
in India do not have a single source of safe drinking water.
Closely linked up with this is the sanitation problem. The
present status of rural environmental sanitation is deplorably
poor. Activities like construction of sanitary latrines and
disposal of waste water, garbage, cattle dung etc. have to be
stepped up in rural areas. Moreover, programmes to provide
drinking water, immunization and better nutrition can be
effective only if basic sanitation is ensured.

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Table: Impact of Health, Water and Sanitation Strategies

PRIMARY
IMPACTS

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Health
— reduced water-Ixnnc
diseases
- decreased mortality
— improved nutrition
- more surviving. and
healthy, children
— reduced natality
- more energy for
work and learning

2. Social
- less burden, more
convenience for
women and children
by having water source
nearby
- more time for
productive, family.
leisure, community
activities
- greater satisfaction
with rural
life
_______

3 Environmental
— cleaner home and
community
environment
- less stream and
groundwater
pollution
- reduced floodingandsoil loss
— more rational,
conserving water use

6 Cumulative,

re inforcing impacts can include:
reduced medical costs, health services
redeployment
Social:
better use of human resources, improved
community dcvelopment/sclf help prospects
Environmental: better natural resources management;
population/water balance
Economic:
increased production and public revenues;
slowed rural/urban migration and more
productive rural use of government funds,
reduced rural/urban income disparities
Health,

LONG-TERM
IMPACTS

Note : This chan inevitably simplifies the wide range of inter connexions
th'at can and do occur in varying sequence and importance.

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Improved Organization
Quite often breakthroughs in knowledge and technique
are inaccessible to the vast majority of people who need
them most either because they are too expensive or because they
can only be administered through the system of hospitals,
doctors and clinics. But the four basic strategies of the child
survival revolution combined with action to prevent micro
nutrient deficiencies have a unique potential because they are
— simple, so that parents can understand them and act on
them;
— inexpensive, so that any family or any nation can afford
them;
— universal in their relevance, and so fundamental, that
they strike at the root of the child health problem;
— entirely compatible with parents’ own values and
priorities.
There is thus a potential for drastic improvement in child
health and survival if the focus is shifted from health institutions
to the family itself. But to move towards realization of this
potential another difficult breakthrough must be made—how to
put these strategies at the disposal of many millions of families.
To make this breakthrough, a massive, concerted,
organization and planning effort is required.

A large number of organizations are already engaged in this
task. The government is primarily responsible for delivery of
health services. UN organizations including UNICEF, WHO,
UNDP are involved. A number of international development
agencies of various countries are working in the field. Then
there are the non government organizations, the voluntary
bodies.

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While government and various specialized agencies are
engaged in developing and refining the machinery—the
hardware as well as the software for health services delivery—the
child health revolution will really succeed only when people
are empowered to avail of new techniques. They must become
aware “consumers” in the health system, solving their health
problems and assessing their health needs.

And this is where business units can bring to bear a lot of
expertise. FICCI has a membership of around 100,000 business
units, employing millions of people. The potential for
achievement is truly vast.
The distinctive capabilities of the business sector are
several:
’ Management experience and acumen.
• Intimate knowledge of, and out-reach in their markets.
* Understanding of the concept of marketing, thus being in a
position to develop a know-how for marketing these simple
strategies.
’ Experience in use of media and other channels of promotion.
• Funds
• Experience in financial management.

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FICCI in the Vanguard
Business houses can make a major contribution to the child
health and survival revolution by application and promotion of
these simple, low-cost (in some cases no cost) strategies in
three ways:
— Application of these strategies to their own employees and
theirfamilies.
— Application of these strategies to the underprivileged and
deprived sector of population through community and
rural development programmes.
' — Using the business and industry as a resource.
Such action would yield rich dividends to the individual
enterprise and at the same time have positive ramifications for
quality of life in general.

Benefits for the enterprise

— Higher production through increased work time.
— Higher productivity through increased general well-being
of employees.
— Better employer-employee relations.
— Boost to corporate image, as a consequence of taking up
development projects. Increased acceptance of the
enterprise by the surrounding population if such projects
are in the vicinity of the company’s plant or establishment.

Benefits at the national level
— The synergistic effects of concerted action by industry
combining with the efforts of government and various non
government organizations and agencies would set off a
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growth spiral by improving health, social status, the
environment and the economy.
— The possibility of arresting loss of GNP through water and
sanitation schemes would improve. In India water-borne
diseases alone claim 1.800 million person hours every year.
The cost in terms of medical treatment and lossof produ
ction is enormous.
— Interestingly enough, increasing child survival has positive
spin offs for the family planning effort. When parents
become increasingly confident of their power to ensure the
survival of their children and protect their health, they
also acquire the confidence and will to have smaller
families. In most countries it has been observed that falling
birth rates are generally traceable to an even large fall in the
death rate. China, Sri Lanka, the Republic of Korea, Cuba,
Costa Rica, Singapore, and the Indian state of Kerala, which
have already achieved a revolution in child survival, now
have birth rates among the lowest in the developing world.

Action
Here are some suggestions for specific action for
implementation of health strategies in the three ways
mentioned earlier:

Employees and Their Families
• For effective implementation of any health strategy it is
essential to create an atmosphere of acceptance through
health education of the target group. Employees must
therefore be educated in the basics of oral rehydration,
immunization, breast-feeding, growth monitoring, and
essential micro-nutrients.
Health education messages can be conveyed by using
channels which would help establish awareness. These include:
messages on monthly pay packets and in the house magazine,
leaflets and posters, regular talks and demonstrations by the
company doctor, and policy statements by the management.
UNICEF can assist in preparing the health education
materials.

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• Immunization of all the children of employees against six
diseases-tuberculosis, polio, whooping cough, tetanus,
diphtheria and measles and immunization of all expectant
mothers against tetanus.
. Promotion of the use of iodised salt
— through the canteen sen ice. if any;
— by procuring and supplying iodised salt to employees “at
cost price”.
. distribution of low-cost iron tablets.

Community and Rural Development Programmes

Incorporating health, water and sanitation strategies in
existing and future projects will greatly amplify the growth
effects of rural development work.

Members of FICCI could take the lead in initiating and
sustaining community based action, thereby enabling people to
make better use of available services and their own ability to
prevent sickness. All efforts could be made to join hands with
social workers and local voluntary agencies to tackle local
problems with practical action.
Six hundred members of FICCI are already engaged in rural
development work. These and other members could
incorporate the following approaches in existing and future
programmes:

• The Welfare/Medical Officer of the company could have
meetings with the District Health Officer to work out areas
and methods of co-operation.

— Medical officers of companies can train local health
workers, thus enriching their knowledge.
— The first step towards inculcating community awareness
could be taken by promoting a ‘core group’ of community/
opinion leaders in each village, who would function as a via
media for information and services between the community
and various organisations. Village schools are generally a
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good venue for holding meetings with volunteer workers in
the village.
• Women in general arc perhaps more motivated and also
have more time for child welfare activities. Wives of
employees could be encouraged to form groups/mandals
and given training to enable them to create awareness and
attitude changes in various communities. The FICCI Ladies
Organization (FLO) is in an excellent position to initiate this
move.
UNICEF can help in organizing workshops for orientation of
members of FLO.
• Where necessary, companies could engage experts in
nutrition to recommend low-cost, locally available,
, nutritious diets.
• Business concerns can make interventions for provision of
drinking water in the following ways:
— Direct intervention, i.e. providing drinking water facilities
to villages adopted by them. Villages near their factories can
be considered for undertaking such activities.
— Indirect intervention through chambers of commerce,
voluntary and industrial associations. These associations
can set up special cells to undertake activities, initiated by
their member companies.

• Sanitation projects can be taken up where inputs include
sanitary latrines for individual households, drainage of waste
water, disposal of garbage, smokeless chulhas, etc. and also
the education of the target group to improve their hygiene
practices.
UNICEF can assist in the training of village level hand pump
caretakers.

Business and Industry—A Resource
Many of the member companies of FICCI can, through their
business operations, provide considerable support to various
aspects of child survival and development. While for some
companies this might involve some financial commitment, in
other cases this may not be necessary. In this FICCI can play a

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major role by identifying suitable sub-groups of its members and
providing them with opportunities to develop ways and means.

Both advocacy and action are needed — and possible.
• Organizations can undertake public service programmes to
call attention to easily preventable health problems. They
can sponsor and promote media and publicity activities such
as films, radio and TV broadcasts.
• FICCI in collaboration with various non-government
organizations in the field can increase operational and
informational activities related to water, sanitation and
health.

• Manufacture of supply of iodised salt in proper packages
should be promoted. In this regard, salt manufacturers can
take a lead.
• Companies in the food products business could consider
projects for manufacture of fortified foodstuff, and oral
rehydration salts.
• Quality and low-cost water and sanitary equipment can be
manufactured by the business housesandmarketed widely in
the country.

Prepared and produced by UNICEF in consultation with FICCI

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