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A comprehensive evidence-based framework is needed to guide policies and programmes that enable children and adolescents to accrue the human capital required to meet the Sustainable Development Goals (SDGs). This paper proposes a comprehensive, multisectoral, multilevel life-course conceptualisation of human capital development by building on the Nurturing Care Framework (NCF), originally developed for the foundational period of growth and development through the age 3 years. Nurturing care (NC) comprises stable environments that promote children's health and nutrition, protect from threats, and provide opportunities for learning and responsive, emotionally supportive and developmentally enriching relationships. NC is fostered by families, communities, services, national policies and beyond. The principles apply across the life course, endorse equity and human rights, and promote long-term human capital. This paper presents an evidence-based argument for the extension of the NCF from preconception through adolescence (0-20 years), organised into six developmental periods: preconception/prenatal, newborn/birth, infancy/toddlerhood, preschool, middle childhood and adolescence. The proposed framework advances human capital within each developmental period by promoting resilience and adaptive developmental trajectories while mitigating negative consequences of adversities.Attaining the SDGs depends on strengthening human capital formation, extending throughout childhood and adolescence and supported by NC. Embedded in enabling laws, policies and services, the dynamic NCF components can mitigate adversities, enhance resilience and promote the well-being of marginalised groups. The life-course extension of the NCF is strategically positioned to enhance human capital, to attain the SDGs and to ensure that children or adolescents are not left behind in reaching their developmental potential.

The estimated number of forcibly displaced persons around the globe is at a record high--nearly 70.8 million (UNHCR 2019)--75 percent of whom are women and children. This includes 34 million adolescent girls and young women, who are among the groups with the highest risk for health concerns. Indeed, many of the countries with the worst maternal and child health indicators are currently experiencing or have recently experienced a humanitarian crisis. The breakdown of health systems in humanitarian settings can cause a dramatic rise in mortality that would otherwise be easily preventable (Al Gasseer et al. 2004). The concentration of adversities associated with humanitarian settings puts young children at great risk of impaired development. Despite the enormous need for early childhood services in humanitarian settings--some 250 million children are living in countries affected by armed conflict--there is a severe lack of such support. Issues related to the mental health and wellbeing of caregivers are often overlooked, despite evidence that attending to their needs is essential in effective interventions (Casey 2015; Chynoweth et al. 2018). The World Health Organization (WHO) has made it a priority to address health care in humanitarian emergencies, in keeping with the United Nations (UN) Sustainable Development Goals and the Global Strategy for Women's, Children's and Adolescents' Health. Understanding health-care needs in these contexts and developing effective guidance materials has been an increasingly important topic on the WHO's global health agenda over the last few years. In this commentary, the authors argue that while evidence-based programs for maternal mental health do exist, tailoring approaches to include content on nurturing care and acknowledging the link between maternal mental health and child development must be a priority for multiple interventions and platforms.

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

In 2012, the World Health Organization adopted a resolution on maternal, infant and young child nutrition that included a global target to reduce by 40% the number of stunted under-five children by 2025. The target was based on analyses of time series data from 148 countries and national success stories in tackling undernutrition. The global target translates to a 3.9% reduction per year and implies decreasing the number of stunted children from 171 million in 2010 to about 100 million in 2025. However, at current rates of progress, there will be 127 million stunted children by 2025, that is, 27 million more than the target or a reduction of only 26%. The translation of the global target into national targets needs to consider nutrition profiles, risk factor trends, demographic changes, experience with developing and implementing nutrition policies, and health system development. This paper presents a methodology to set individual country targets, without precluding the use of others. Any method applied will be influenced by country-specific population growth rates. A key question is what countries should do to meet the target. Nutrition interventions alone are almost certainly insufficient, hence the importance of ongoing efforts to foster nutrition-sensitive development and encourage development of evidence-based, multisectoral plans to address stunting at national scale, combining direct nutrition interventions with strategies concerning health, family planning, water and sanitation, and other factors that affect the risk of stunting. In addition, an accountability framework needs to be developed and surveillance systems strengthened to monitor the achievement of commitments and targets.

A life-course approach to health encompasses strategies across individuals' lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity. Une approche sanitaire fondee sur le parcours de vie englobe des strategies tout au long de la vie des indivldus qui optimisent leur capacite fonctionnelle (en prenant en compte l'interdependance de facteurs individueis, sociaux, environnementaux, temporels et intergenerationnels), assurant ainsi le bien-etre et l'exerdce des droits. Cette approche s'inscrit parfaitement dans les efforts deployes pour parvenira une couverture sanitaire universelle et atteindre les objectifs de developpement durable (ODD). Lorsqu'elle est correctement appliquee, une approche fondee sur le parcours de vie peut accroitre l'efficacite de la premiere et aider a concretiser l'ambition des seconds, en assurant notamment la sante et le bien-etre pour tous a tous les ages. Sa mise en ceuvre exige une comprehension commune par les individus et les societes de la maniere dont la sante est fagonnee par de multiples facteurs tout au long de la vie et d'une generation a l'autre. La plupart des etudes realisees ont porte sur des maladies non transmissibles et le vieillissement des populations dans les pays a revenu eleve, ainsi que sur des aspects epidemiologiques, theoriques et cliniques. L'objectif de cet article est de montrer que l'approche sanitaire fondee sur le parcours de vie peut etre elargie a toutes les tranches d'age, toutes les questions de sante et tous les pays en s'appuyant sur une synthese des donnees scientifiques existantes, les experiences de differents pays et l'avancement des strategies et programmes en matiere de sante. Un cadre conceptuel de l'approche est presente ainsi que les consequences de sa mise en qeuvre sur: (i) la politique et l'lnvestissement; (ii) les services et systemes de sante; (iii) les actions locales, multisectorielles et multipartites; et (iv) les mesures, la surveillance et la recherche. Les ODD fournissent un contexte unique pour l'application d'une approche globale et multisectorielle en vue d'obtenlr des resultats porteurs de transformation pour les individus, la prosperite et l'environnement. Une approche fondee sur le parcours de vie peut renforcer ees efforts, notamment parce qu'elle met l'accent sur les droits et l'equite. Un enfoque basado en la salud para toda la vida engloba estrategias durante la vida de las personas, que optimizan su capacidad funcional (teniendo en cuenta la interdependencia de los factores individuales, sociales, ambientales, temporales e intergeneracionales), permitiendo asi el bienestar y la realizacion de los derechos. El enfoque encaja perfectamente con los esfuerzos por lograr una cobertura sanitaria universal y cumplir los objetivos de desarrollo sostenible (ODS). SI se aplica correctamente, un enfoque para toda la vida puede aumentar la eficacia del primero y ayudar a alcanzar la vision de este ultimo, especialmente para garantizar la salud y el bienestar en todas las edades. Su aplicacion requiere una comprension compartida entre individuos y sociedades sobre como la salud depende de multiples factores presentes a lo largo de la vida y entre generaciones. La mayoria de los estudios se han centrado en las enfermedades no contagiosas, en el envejecimiento de la poblacion en los paises con ingresos altos y en cuestiones epidemiologicas, teoricas y clinicas. El objetivo de este articulo es mostrar como el enfoque basado en la salud para toda la vida se puede extender a todos los grupos de edades, temas de salud y paises, mediante la creacion de una sintesis de las pruebas cientificas existentes, la experiencia en diferentes paises y los avances en estrategias y programas de salud. Se presenta un marco conceptual del enfoque junto con las implicaciones para la aplicacion en los siguientes campos: (i) politica e inversion; (ii) servicios y sistemas de salud; (iii) accion local, multisectorial y de varias partes Interesadas; y (iv) medicion, supervision e investigacion. Los ODS proporcionan un contexto unico para aplicar un enfoque holistico y multisectorial a fin de alcanzar unos resultados transformadores para las personas, la prosperidad y el medio ambiente. Un enfoque para toda la vida puede intensificar estos esfuerzos, sobre todo por su enfasis en los derechos y la equidad., Introduction The right to the highest attainable standard of health for all people, is enshrined in the World Health Organization's (WHO) constitution and in the United Nations' (UN's) human rights [...]

The Member States of the World Health Organization (WHO) are committed to achieve quality, equity and dignity for women, newborns and children as reflected in the four World Health Assembly [...]

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches In addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector Investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results overtime. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond. La reduction de la mortalite maternelle et infantile est une priorite des objectlfs du Millenaire pour le developpement (OMD) et le restera probablement apres l'echeance de 2015. Il existe des donnees sur les investissements, les interventions et les politiques habilitantes necessaires. On comprend mal pourquoi certains pays ont realise des progres plus rapidement que d'autres pays comparables. Les Facteurs de reussite des etudes sur la sante des femmes et des enfants ont cherche a combler ce manque de connaissances en utilisant les analyses statistiques et econometriques des donnees provenant de 144 pays a faible revenu et a revenu intermediaire et recueillies depuis 20 ans: une analyse comparative qualitative booleenne; une etude bibliographique et des etudes specifiques a chaque pays pour les 10 pays a progression rapide pour les points 4 et 5a des OMD. Il n'existe pas de formule standard--les pays a progression rapide ont deploye des strategles personnalisees et se sont adaptes rapidement auxchangements. Cependant, ces pays ont en commun des approches efficaces visant 3 grands axes afin de reduire la mortalite maternelle et infantile. Premierement, ils impliquent de nombreux secteurs pour traiter les facteurs determinants et cruciaux pour la sante. Pres de la moitie de la reduction de la mortalite infantile dans les pays a faible revenu et a revenu intermediaire depuis 1990 resulte des investissements dans le secteur de la sante, l'autre moitie etant attribuee aux investissements realises dans les secteurs exterieurs a la sante. Deuxiemement, ces pays utilisent des strategies pour mobiliser les partenaires dans la societe, en utilisant des donnees solides et opportunes pour la prise de decisions et la responsabilisation, ainsi qu'une approche de planificaron triple pour prendre en consideration les besoins immediats, la vision a long terme et l'adaptation aux changements. Troisiemement, ces pays etablissent des principes directeurs qui orientent les progres, harmonisent les actions des parties prenantes et generent des resultats dans le temps. Cette synthese de donnees contribue a l'ensemble des connaissances requises pour accelerer les amellorations sur la sante des femmes et des enfants en vue de l'echeance de 2015 et au-dela. La reduccion de la mortalidad materna e infantil es una prioridad en los Objetivos de Desarrollo del Milenio (ODM), y probablemente lo seguira siendo despues de 2015. Existen evidencias sobre las inversiones, las intervenciones y las politicas necesarias, pero se sabe menos acerca de por que algunos paises logran un progreso mas rapido que otros paises comparables. Los estudios relativos a los Factores de Exito en la Salud de las Mujeres y los Ninos han tratado de abordar esta brecha de conocimiento por medio de analisis estadisticos y econometricos de datos de 144 paises de ingresos bajos y medianos (PIBM) a lo largo de mas de 20 anos, analisis comparativos cualitativos booleanos, revision de la literatura y revisiones especificas de cada pais en 10 paises bien encarrilados para los ODM 4 y 5a. No existe una formula estandar, estos paises despliegan estrategias a medida y se adaptan rapidamente a los cambios. Sin embargo, comparten ciertos enfoques eficaces a la hora de abordar tres areas principales para reducir la mortalidad materna e infantil. En primer lugar, involucran a numerosos sectores para hacer frente a los factores sanitarios decisivos. Alrededor de la mitad de la reduccion de la mortalidad infantil en los PIBM desde 1990 es el resultado de Inversiones en el sector de la salud, y la otra mitad se atribuye a las inversiones realizadas en sectores fuera del ambito sanitario. En segundo lugar, estos paises utilizan estrategias para movilizara socios a traves de la sociedad, utilizando evidencias oportunas y solidas para la toma de decisiones y la rendicion de cuentas, asi como un enfoque de planificacion triple para considerar las necesidades inmediatas, la vision a largo plazo y la adaptacion al cambio. En tercer lugar, los paises establecen principios rectores que orientan el progreso, armonizan las acciones de las partes interesadas y logran resultados en el tiempo. Este compendio de evidencias contribuye al aprendizaje global sobre como acelerar las mejoras en la salud de mujeres y ninos hacia el 2015 y mas adelante., Introduction Worldwide, accelerated progress is required to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) as highlighted in the United Nations Secretary-General's Global Strategy [...]

In addition to food, sanitation and access to health facilities children require adequate care at home for survival and optimal development. Responsiveness, a mother's/caregiver's prompt, contingent and appropriate interaction with the child, is a vital parenting tool with wide-ranging benefits for the child, from better cognitive and psychosocial development to protection from disease and mortatity. We examined two facets of responsive parenting--its role in child health and development and the effectiveness of interventions to enhance it--by conducting a systematic review of literature from both developed and developing countries. Our results revealed that interventions are effective in enhancing maternal responsiveness, resulting in better child health and development, especially for the neediest populations. Since these interventions were feasible even in poor settings, they have great potential in helping us achieve the Millennium Development Goals. We suggest that responsiveness interventions be integrated into child survival strategies. Bulletin of the World Health Organization 2006;84:992-999. Resume Sensibiliser davantage les parents ou les personnes qui s'occupent d'enfants aux besoins des enfants qu'ils elevent : interventions et resultats Outre une alimentation adaptee, une bonne hygiene et un acces a des etablissements de sante, les enfants ont besoin, pour que leurs chances de survie et leur developpement soient optimaux, de recevoir des soins appropries dans leur foyer. La reactivite, c'est-a-dire la capacite a reagir rapidement et de maniere adaptee aux interactions avec l'enfant, est une composante essentielle de la sensibilite aux besoins infantiles, qui apporte une grande variete de benefices, allant d'un meilleur developpement cognitif et psychosocial a un renforcement de la protection contre les maladies et la mort. A travers une revue systematique de la litterature provenant de pays developpes et en developpement, nous avons examine deux aspects de la sensibilite des parents aux besoins de l'enfant : son role dans l'etat de sante et le developpement de l'enfant et l'efficacite des interventions visant a la renforcer. Les resultats de cette etude indiquent que ces interventions parviennent a augmenter la reactivite maternelle, d'ou une amelioration de l'etat de sante et du developpement des enfants, notamment parmi les populations dont les besoins sont les plus criants. Ces interventions etant praticables meme dans les pays pauvres, elles presentent un important potentiel de contribution a la realisation des Objectifs du Millenaire pour le developpement. Nous proposons d'integrer les interventions de sensibilisation aux besoins infantiles dans les strategies en faveur de la survie des enfants. Resumen Fierdcio resnonsivo de la parentalidad: intervenciones y resultados Adlemas de alimentos, una buena higiene y acceso a los centros de salud, los ninos han de disfrutar de una atencion adecuada en el hogar si se desea garantizar su supervivencia y un desarrollo optimo. La capacidad de respuesta, esto es, una reaccion rapida, flexible y solicita de la madre o el cuidador a las necesidades del nino, constituye un medio de parentalidad vital que redunda en beneficio del nino por varios motivos, desde un mejor desarrollo cognitivo y psicosocial hasta la proteccion frente a enfermedades y a la muerte. Realizamos una revision sistematica de publicaciones de paises tanto desarrollados como en desarrollo para examinar dos aspectos de la parentalidad responsiva: su funcion en la salud y el desarrollo del nino, y la eficacia de las intervenciones tendentes a mejorarla. Nuestros resultados muestran que las intervenciones mejoran eficazmente la responsividad materna, en beneficio de la salud y el desarrollo del nino, especialmente en las poblaciones mas necesitadas. Dado que esas intervenciones fueron viables incluso en entornos pobres, podrian ser de gran ayuda para alcanzar los Objetivos de Desarrollo del Milenio. Proponemos por tanto que las intervenciones de aumento de la capacidad de respuesta se integren en las estrategias de mejora de la supervivencia infantil., Introduction With only a decade left to achieve the Millennium Development Goals, the status of the world's children remains grim. Every year, 10.6 million children die before reaching their fifth [...]

Abstract Background There is increasing attention, globally and in countries, to monitoring and addressing the health systems and human resources inputs, processes and outputs that impede or facilitate progress towards achieving the Millennium Development Goals for maternal and child health. We reviewed the situation of human resources for health (HRH) in 68 low- and middle-income countries that together account for over 95% of all maternal and child deaths. Methods We collected and analysed cross-nationally comparable data on HRH availability, distribution, roles and functions from new and existing sources, and information from country reviews of HRH interventions that are associated with positive impacts on health services delivery and population health outcomes. Results Findings from 68 countries demonstrate availability of doctors, nurses and midwives is positively correlated with coverage of skilled birth attendance. Most (78%) of the target countries face acute shortages of highly skilled health personnel, and large variations persist within and across countries in workforce distribution, skills mix and skills utilization. Too few countries appropriately plan for, authorize and support nurses, midwives and community health workers to deliver essential maternal, newborn and child health-care interventions that could save lives. Conclusions Despite certain limitations of the data and findings, we identify some key areas where governments, international partners and other stakeholders can target efforts to ensure a sufficient, equitably distributed and efficiently utilized health workforce to achieve MDGs 4 and 5.