UBS Optimus Foundation

Landscape Analysis 2012/2013

ab
Contents
3 CEO letter
5 UBS Optimus Foundation background
Introduction
6 A brief history
6 Past and present focus: areas of interest and
grantmaking approach
6 Identifying opportunity areas: the 2012
UBS Optimus Foundation landscape analysis
7 Focus: child health
8 Focus: child protection
9 Focus: child education
Child health
11 Background
11 Landscape scope and process
11 Key defnitions
13 The state of health for vulnerable children
14 Child health needs: our priorities
15 Defning the problem
16 Approaches
18 Opportunity areas
21 Closing thoughts
Child protection
23 Background
23 Landscape scope and process
23 Key defnitions
24 The state of child protection
26 Defning the problem
27 Approach
28 Child protection needs: our priorities
29 Opportunity areas
31 Closing thoughts
Child education
33 Background
33 Landscape scope and process
34 Key defnitions
36 The state of education for vulnerable children
36 Child education barriers: our priorities
38 Needs: defning the problem
39 Approaches
41 Opportunity areas
43 Closing thoughts
Conclusion
45 A brief summary: how we identifed opportunity areas
45 Complementarity among ubs optimus foundation granting areas
47 Shared opportunities in early childhood care and development
area priority
48 References and footnotes
51 Acknowledgements
Authors: Phyllis Kurlander Costanza, Reinhard Fichtl, Charles A. Gardner, Patricia Lannen, Ann-Marie Sevcsik, Maya Ziswiler.
Layout: UBS AG, Vivianne Gilliron.
3
CEO letter
Dear Colleagues,
More than a decade ago, the
UBS Optimus Foundation was
established to pursue the
development, validation, promo-
tion and dissemination of inno-
vative approaches to improve
education, protection and health
of disadvantaged children
around the globe.
In order to fulfll this obligation,
we must seek evidence, rigor-
ously evaluate strategies, and
constantly rethink how to solve
old problems for children in new
ways.
I joined the foundation in the
summer of 2011 and soon
recognized and appreciated the
thoughtful strategies and reli-
able systems that guided the
work of my new colleagues.
Asa team, however, we under-
stand that many of the worri-
some threats to a childs health
and well-being are the same
now as they were when we
were founded fourteen years
ago. Children are still vulnerable
to preventable diseases, neglect,
violence and the languishing of
their potential that follows
missed days or years in a safe
and proper school.
According to the latest data, in
2011 approximately 3 million
newborns died during their frst
month of life and 6.9 million
children did not live to celebrate
their ffth birthday. In 2009 an
estimated 67 million school-age
children were not attending
school.
However, there is no denying
the hopeful progress being
achieved today in child health
and development a fourishing
of scientifc advances, political
will and global giving, each
shaped by some emerging and
encouraging trends that favor
collaboration among funders,
robust assessment of programs,
and a renewed respect for com-
munity know-how and capacity.
Understanding these trends and
identifying the gaps in knowl-
edge and practice that still leave
children vulnerable is key to the
development of a truly effective
and responsive long-term strat-
egy to defend their lives and
well-being.
Thus, in advance of our fve-year
strategic planning process, we
launched athorough landscape
analysis to deepen our under-
standing of these trends, inform
our planning and refne our
strategy.
As part of this analysis, we
delved into an internally-driven
process that included discussions
with more than 70 global
experts, intensive research and a
comprehensive internal audit of
lessons learned from more than
a decade of grantmaking.
The process helped us identify a
specifc focus for our three prior-
ity areas child health, protec-
tion and education. For exam-
ple, the team determined
based on research which
highlighted a lack of resources
and a high burden that our
childrens health care program
should address the needs of the
youngest children and perinatal
health. The education program
will focus on early childhood
education to give kids the best
start at learning, and our child
protection program will priori-
tize the prevention of sexual
abuse and violence over other
intervention options.
In addition to these promising
new approaches for engage-
ment, our analysis revealed com-
mon themes across our grant
portfolio and complimentary
areas for integrated investments,
as well as emerging global
trends and our own success sto-
ries, from which we have yielded
new insights and best practices.
We are pleased to share more
about these results and other
fndings with this report, which
represent the beginning, not the
end, of a process that will culmi-
nate with a carefully-developed
strategic plan. We plan to keep
our valued peers abreast of our
progress as we begin planning,
and we welcome your ideas and
feedback about what you read
here.
We are also indebted to the
many experts who shared their
insights and experiences, the
synthesis of which is also
refected here.
We hope you fnd the results as
intriguing as we do, and we
look forward to further discus-
sion and collaboration with our
community as we strive together
to help children develop their
full potential.
Sincerely,
Phyllis Kurlander Costanza
CEO, and the UBS Optimus
Foundation Program Team
4
5
UBS Optimus Foundation background
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Vision
The UBS Optimus Foundation is dedicated to the
overall well-being of children. We are committed
to a world in which all children and adolescents
have access to healthcare and education and may
grow up in an environment free from violence and
sexual abuse.
Mission
We support the development, validation, promo-
tion and dissemination of innovative approaches
and ideas to improve the education, protection
and health of disadvantaged children around the
globe, regardless of their political, religious or eth-
nic backgrounds.
As a foundation established by UBS, we promote
the shared philanthropic commitment of clients,
management and employees. We make every
effort to ensure that the funds entrusted to us are
invested for the maximum positive impact on
childrens lives.
Approach
The foundation applies a systematic four-phase
value chain approach to our grantmaking in order
to develop, validate, promote and scale up effec-
tive solutions to improve childrens health, educa-
tion and protection. The process starts with the
innovation phase where we seek to validate
ideas. Successful projects then progress through a
series of stages with increasingly greater fnancial
and time commitments. At each stage of the value
chain, the selection criteria are refned to ensure
we are supporting projects that best ft the foun-
dations long-term strategic vision. The phases of
the value chain are illustrated below.
Grantmaking value chain
To achieve the positive impact that our donors
expect and children deserve, our priority is to
evaluate the gaps in knowledge and practice that
leave children vulnerable and to explore new
and promising solutions.
Jrg Zeltner, Chairman of the Board,
UBS Optimus Foundation
6
A brief history
Established in December 1999 by UBS AG, the
UBS Optimus Foundation is an independent
grantmaking foundation committed to improving
the well-being of children. It is headquartered in
Zurich, Switzerland and led by a team with exten-
sive professional experience in child health, pro-
tection, and education. As of February 2012, we
have 119 active projects, representing an invest-
ment of 87 million Swiss Francs (CHF).
Our funding comes primarily from UBS banking
clients. Because UBS AG covers all of the
foundations administrative costs, 100 percent
of client donations go directly into philanthropic
projects. Furthermore, since many of our projects
involve co-funding with other organizations,
including foundations, local governments and cor-
porations, it is often the case that client donations
leverage signifcantly more than their individual
contributions.
The foundation believes that all children deserve
every opportunity to grow and thrive, free from
debilitating disease, neglect, abuse, or marginal-
ization. Three guiding principles shape our
approach to delivering positive and measurable
improvements in childrens lives. First, we serve the
hardest to reach and most vulnerable children.
Second, we take smart risks. Third, we invest in
lasting outcomes rather than temporary short-
term solutions.
Past and present focus: areas of interest
and grantmaking approach
We are focused on creating a world in which all
children have access to quality education and free-
dom from ill health and abuse. To improve the
general well-being of children, and ensure that
UBS client donations are used as effectively as
possible, the foundation focuses on three distinct
granting areas: child health, child protection, and
education, primarily in low and middle-income
countries.
The Optimus Foundation focuses on solution-
oriented research and innovations across all three
granting areas in order to generate long-term
positive changes that will extend beyond the indi-
vidual projects we fund.
Solution-oriented research aims to:
Validate what works for the feld
Facilitate scaling and replication of evidence-
based innovative approaches
Ensure high-quality projects that beneft children
Identifying opportunity areas: the
2012/2013 UBS Optimus Foundation
Landscape Analysis
The foundations next 5-year strategic plan is
scheduled to begin in 2013/14. In preparation, we
conducted a philanthropic market analysis or
landscaping to provide a context for develop-
ment of the new strategy and ensure we were
poised to have the highest possible impact to
improve childrens lives. We reviewed trends, needs
and opportunities in philanthropy and in the foun-
dations three granting areas. We were mindful of
the foundations size, capabilities, mission and
guiding principles as we sought to identify oppor-
tunities that were both high impact and attainable.
We also developed a set of specifc criteria to help
flter the range of options. Finally, within each
granting area, we mapped approaches against
needs to defne opportunity areas.
The goal of the landscaping was to develop a map
of the most impactful opportunity areas for the
Optimus Foundation to consider, and enable a
strategic discussion around how the foundation
should achieve its goals and assess its impact.
As a starting point for this landscape analysis, the
Board expressed its strong desire to continue its
grantmaking in the areas of childrens health,
protection, and education. For each of these
felds, we defned a focus age group of children,
the dimensions of vulnerability, and a geographic
focus area. The defnition of a child anyone
under the age of 18 as described in the UN Con-
vention on the Rights of the Child is consistent
across all three areas, but our particular emphasis
is on children in the early childhood years between
ages of 0 and 5. The geography and vulnerability
defnitions vary somewhat across the three grant-
ing areas and are described in each chapter.
Introduction
7
For the purpose of the landscaping, we articulated
eight specifc criteria to guide what would be
included and to clarify the characteristics of high
quality opportunity areas. These include:
Social Impact guides us to look for opportunities
that address the needs of vulnerable children in a
manner that is feasible, scalable, and replicable.
Innovation stresses unique opportunities; these
must be distinct from existing interventions and
be capable of catalyzing a paradigm shift that
could change the feld.
Evidence places a high premium on well-estab-
lished programs that can be codifed and repli-
cated and are amenable to ongoing assessment.
Capacity strengthening prioritizes opportunities
that can strengthen human resources and / or
build infrastructure; it also seeks opportunities
to facilitate long-term policy, practice, and fund-
ing improvements.
Our Bridge the gap criterion looks for areas
where we can fll a critical void and ensures that
important ideas receive the attention they de-
serve; it also looks for opportunities that can le-
verage or involve complementary resources.
Leave behind instructs us to focus on oppor-
tunities that will create not only immediate ben-
efts but also lasting positive impacts for vulner-
able children and other stakeholders.
The Easy-to-explain criterion looks for oppor-
tunities that can be easily grasped by and ex-
plained to UBS management and client advisors.
These include development opportunities that
are logical and easy to follow rather than
overly technical, complicated and dense and
are also attractive to our clients and external
partners.
The Optimus / UBS capabilities criterion looks
for opportunities that match the Optimus
Foundations and UBS professional expertise, f-
nancial resources and global reach.
Diverse sources helped us formulate and verify our
observations and hypotheses. We consulted more
than 70 child health, protection, and education
experts from different sectors, including local and
national government; international, national and
local non-proft organizations and NGOs; academia;
thought leaders; and bilateral and multilateral orga-
nizations. We also spoke to our grantees and pro-
spective grantees and consulted critical reports and
publications from UNDP, UNESCO, UNICEF, UNFPA,
UNHCR, the OECD, the World Bank, and the World
Health Organization, among others. Finally, we
looked at the lessons we have learned, mining the
foundations knowledge and harnessing experience
from more than a decade of grantmaking.
Focus: child health
Defning target age: Within child health, our over-
all goal is to support projects that improve the lives
of the most vulnerable children between the ages
of 018, with a particular focus on children under
age 5. Children under fve have the highest mortal-
ity rate of any age group
1
. Indeed, in our ffteen fo-
cus countries (see page 12), there were more than
1 million deaths per year among children between
the ages of 05 compared with more than 60,000
deaths per year among children between the ages
of 614 and more than 210,000 deaths among
people between the ages of 1559. The 0 to 5 age
group presents great need and a high health
burden, but it also shows tremendous potential:
itis here that we fnd the greatest opportunity to
achieve long-term positive health impacts.
Trends in global philanthropy
Though focused on the foundations three granting areas, this land-
scaping exercise also identifed three major trends in global philan-
thropy that infuence all actors, including the Optimus Foundation:
Collaboration is key Funders want to work together. They are in-
creasingly seeking co-funding opportunities, as well as Public Private
Partnerships (PPPs) where diverse sectors public, private, and social
can combine their interests and expertise in order to build econo-
mies of scale, minimize grantee risk and enhance impact.
Assessment matters Social enterprises want to scale-up what
works in order to help the most vulnerable populations. Thus, they are
increasingly focused on creating evidence-based programs that can
demonstrate what works and achieve measurable outcomes.
Leveraging local capacity No one understands the situation on
the ground better than the people who are living there. Local people
are also critical to ensuring the sustainability of programs. Successful
projects engage communities, harness local leadership and recognize
local expertise to solve local problems.
Community knowledge is key to success as this young Nicaraguan girl shows
her peers where to break the mosquito breeding cycle on the green road to
dengue elimination.
8
Introduction
Defning vulnerability and geography: Two multi-
dimensional indices the Bristol Child Deprivation
Index and the Oxford Multidimensional Poverty
Index were used to defne vulnerability and help
us identify 11 sample countries. We then added
four countries with strong UBS operations and
presence.
Other funders: In 2010, foundations, multilateral
and bilateral agencies, corporations, non-profts,
and low- and middle-income country govern-
ments collectively spent about 887 billion US dol-
lars on health in low and middle-income coun-
tries. The majority of this spending (51 percent or
449 billion US dollars) came from middle-income
country governments. Non-proft organizations
and low-income country governments each
accounted for about a quarter of all health spend-
ing (23 percent each and 206 billion US dollars
and 201 billion US dollars respectively). We esti-
mated that 15 percent of all health spending in
2010 about 136 billion US dollars went to
child-specifc health programs.
Collectively, foundations accounted for just one
percent of all 2010 health spending, but three
organizations made signifcant contributions. The
Bill & Melinda Gates Foundation, the Wellcome
Trust, and the Rockefeller Foundation spent 1.5
billion US dollars, 1.2 billion US dollars, and 36
million US dollars on health, respectively. The
Optimus Foundation has comparatively limited
resources, but still ranked as the third highest
philanthropic investor in product-related research
on neglected diseases according to the 2011
G-FINDER report. This contribution to health
research is important, but we need to think strate-
gically to ensure that this investment has a high
impact across all areas of our health portfolio.
Focus: child protection
Defning target age: As children of all ages are
affected by sexual violence and abuse, the UBS
Optimus Foundations focus on child protection
will cover all children between the ages of 018.
This is in contrast to how the Foundation will pur-
sue child health and child education, which both
emphasize early years.
Defning vulnerability and geography: As a rela-
tively new feld which is still developing important
evidence, child protection lacks information about
which groups are most vulnerable to abuse. Cur-
rently, experts believe that all children regardless
of their socioeconomic status and home country
are equally vulnerable.
For this reason, unlike in health and education, we
have not selected specifc countries based on prev-
alence or vulnerability. Our geographic focus will
cover all low- and middle-income countries, plus
Switzerland where the Optimus Foundation is
headquartered.
Other funders: As Overseas Development Assis-
tance (ODA) data are not available for the feld of
child protection, we relied on available data from
the Foundation Center regarding US-based spend-
ing. Based on these data, in 2010 private founda-
tions spent 862 million US dollars on child protec-
tion. The top fve foundations investing in this
area were the W.K. Kellogg Foundation (115 mil-
lion USdollars), the Bill & Melinda Gates Founda-
tion (80 million US dollars), The Annie E. Casey
Sample health project: reducing the risk
of rabies, replicating results from Bohol,
Philippines
Background More than one billion people across Africa and Asia
are vulnerable to rabies infection, which causes the prolonged and
painful death of a child every ffteen minutes. This disease results in
death if left untreated, and the poorest children are disproportionately
affected. Until recently, rabies was a signifcant threat to the 1.3 mil-
lion people living on the Philippine island of Bohol, which led the
region in rabies cases.
Partner organizations the Global Alliance for Rabies Control
(GARC), the US Centers for Disease Control and Prevention, Swiss
Tropical Public Health Institute and the national and local govern-
ments of Chad, Nias, Philippines and Tanzania.
Benefciaries More than 5,000 Bohol community members have
been trained as village rabies watchers. Local health and agriculture
workers were mobilized to vaccinate stray dogs, and to register and
vaccinate pet dogs. School-based rabies education was also estab-
lished so that now, every year more than 185,000 children learn about
bite prevention, rabies treatment and responsible pet ownership.
Objectives and results Our grant to the GARC stimulated and
leveraged signifcant additional funding from the government of the
Philippines in fact, their contribution ultimately exceeding our own.
In just four years, dog vaccination and registration increased from
2.6percent to approximately 70 percent. Within the frst 18 months of
the program, human rabies deaths decreased by half. Today, Bohol
isfree of rabies. In addition, the project also resulted in a signifcant
reduction in the number of road accidents caused by stray dogs.
Scaling We are now supporting GARC to replicate the Bohol cam-
paigns best practices in other affected countries including, Chad, In-
donesia and Tanzania and looking to expand this successful campaign
to other parts of the Philippines
Learn more the project is featured in the 2012 edition of Case
Studies for Global Health (www.casestudiesforglobalhealth.org).
9
Foundation (57 million US dollars), The Robert
Wood Johnson Foundation (35 million US dollars),
and the Ford Foundation (27 million US dollars).
All of these foundations have considerably larger
budgets than the Optimus Foundation. In 2010,
we spent about 5million US dollars on child pro-
tection.
Focus: child education
Defning target age: In child education, we will
have a primary focus on children between the
ages of 0 to 8 and an extended focus on children
up to age 18. The rationale for this age focus is
based on solid evidence that interventions in
younger years represent the greatest opportunity
to achieve positive impact.
Defning vulnerability and geography: We used
four data sources the Bristol Child Development
Index, the Oxford Multidimensional Poverty Index,
UNESCO Statistics from 2011, and the UNDP
International Human Development Index to
assess educational vulnerability, highlighting 14
focus countries with very poor indicators. To this
list of countries, we added two Latin American
countries with strong UBS operations, and a North
African country to ensure regional representation.
Other funders: In 2009, the world spent approxi-
mately 240 billion US dollars on education in low-
and middle-income countries, according to an
OECD report from 2011. The majority of this
money 93 percent or 220 billion US dollars
came from in-country spending by those countries
themselves. Foundations accounted for only one
percent of the total 2 billion US dollars, while
Overseas Development Assistance (ODA)
accounted for six percent (13 billion US dollars), of
which bilateral ODA accounted for 9.5 billion US
dollars and multilateral ODA accounted for
approximately 4.5 billion US dollars.
The top three areas for ODA education spending
in 2010 were higher education, primary educa-
tion, and education policy and administration.
Higher education received almost 4 billion US dol-
lars; primary education received just over 3 billion
US dollars; and education policy and administra-
tion received just under 3 billion US dollars.
Teacher training, basic life skills for youth and
adults, early childhood education, and education
research received less than 165 million US dollars
in ODA funding. The Optimus Foundation believes
these areas are critical to the feld, and among
themost highly leveraged investments for the
7million US dollars we contribute to education
each year.
Sample child protection project: the children
and violence evaluation challenge fund
Background By funding quality evaluations of violence prevention
and child protection projects in low- and middle-income countries, this
ongoing collaboration addresses the insuffcient evidence and knowl-
edge base in these felds.
Partner organizations Bernard Van Leer Foundation, the Oak Foun-
dation, Wellspring Advisors (in 2013)
Objectives Generate and disseminate solid evidence on what
works among violence prevention and child protection interventions,
and to improve policies and programs and ensure that children are
protected from all forms of violence. This project also supports re-
search to develop new strategies to reduce physical, emotional, and
sexual violence affecting children in family settings.
Grantee organizations Applicants include non-profts, universities,
and research institutions. Partnerships are encouraged between re-
searchers and practitioners and between multilateral organizations
and governments.
Learn more www.evaluationchallenge.org
Sample child education project: high-quality
secondary education for girls in Afghanistan
Background There is a strong case to be made for girls education.
In addition to the numerous benefts education provides students,
evidence suggests that well-educated girls will have better educated
and healthier children. But in Afghanistan, 60 percent of girls are not
attending school.
Partner organization The Womanity Foundation
Benefciaries More than 30,000 female students and 700 female
teachers
Objectives This pilot project works to improve access to education
and learning by targeting both students and teachers. Students receive
access to high quality secondary education so they can attend univer-
sity and become active, engaged members of their communities.
Teachers are provided with critical skills to improve their curricula and
pedagogical skills.
Buy-in and dissemination The project is co-funded by the Afghan
Ministry of Education and has strong potential to be replicated and
scaled.
10
11
Background
The UBS Optimus Foundation has been investing
in global health for more than a decade. For the
frst ten years of operations, our grantmaking sup-
ported a wide range of projects in the felds of
neglected tropical diseases and child health. In
2009, we narrowed our strategy, prioritizing the
development of solutions that connect health
knowledge to feld action, combined with rigor-
ous evaluation to identify and understand what
works. Of course, the foundations efforts do not
take place in a vacuum.
We pursue our mission within a complex land-
scape of global health actors, tensions and trends.
Other actors include foundations, aid agencies,
low- and middle-income country governments,
researchers, think tanks, non-governmental orga-
nizations, social enterprises, public-private part-
nerships, and private frms. There may be tensions
some constructive, others not between public
and private actors, rich and poor countries, or the
proponents of technological versus systemic solu-
tions. Current trends in the global health sector
include urbanization, demographic transitions, the
rise of emerging economies, and accelerating
technological innovation.
In addition, there are three trends that are espe-
cially relevant to our health grantmaking. The frst
two are negative and the third positive. First, the
donor communitys current emphasis on techno-
logical solutions and narrow, vertical approaches
(such as a focus on one specifc disease) tends to
weaken local health systems in resource-poor set-
tings where children suffer most. Second, todays
exciting profusion of innovative health solutions
has not been matched by a comparable level of
innovation in the delivery of those solutions to the
people who need them most. Finally, a positive
trend is emerging as public and private actors
embrace new partnerships that harness diverse
skill sets for example, fnancial acumen and
experience with local communities to overcome
global health challenges.
Landscape scope and process
In 2012, we launched a study of the global health
landscape to identify feasible and attractive oppor-
tunity areas for the foundation to consider in
selecting future investment strategies. This paper
summarizes the results of that analysis. It outlines
the most promising ideas and entry points and
the rationale behind them to guide future grant-
making.
Key defnitions
To defne the global health landscape in the con-
text of our broad mission to improve the lives of
vulnerable children around the world, we frst
answered three key questions:
Who do we mean by child?
How do we defne vulnerability?
Where, in what geographies, should we work?
The UN Convention of the Rights of the Child
defnes a child as anyone under the age of 18.
While we remain committed to the health of all
children, we place a special emphasis on children
under the age of 5. Stated simply, children in this
age range suffer the highest burden of death and
disease, and can also beneft the most from early
Child health
Delivering health services, products and knowledge to children can be particu-
larly challenging in peri-urban and rural areas as infrastructure is limited if it
exists at all.
12
health interventions with proven long-term
positive benefts. Also, we are committed to chil-
dren over age fve because in addition to health,
the foundation makes grants in the area of educa-
tion and there are many potential synergies
between health and education for school-age chil-
dren. School-based health interventions, for exam-
ple, can simultaneously improve child health and
academic achievement.
Finally, we extended our defnition of child to
cover the perinatal period, which begins during
the last weeks of pregnancy and extends through
the frst few weeks of life. The perinatal stage is a
critical time for both mother and child
2
. For chil-
dren to be born healthy and stay healthy, they
need healthy mothers who survive childbirth. But
perinatal conditions including premature birth
and low birth weight, birth trauma and asphyxia,
and infections do not attract the global atten-
tion and resources they warrant especially in the
most remote locations.
3
To defne vulnerability, we relied upon two inter-
nationally recognized indices: the Oxford Multidi-
mensional Poverty Index (MPI)
4
and The Bristol
Child Deprivation Index
5
. The MPI covers ten indi-
cators, including lack of education, health, nutri-
tion, electricity, drinking water, sanitation and
housing. The Bristol Index measures a similar
range of factors at the country level, with a spe-
cifc focus on children. Both indices can be disag-
gregated to isolate health-specifc factors.
We also used these indices to defne the geogra-
phy: specifc countries where children are particu-
larly susceptible to poor health. Eleven nations
Bangladesh, China, D. R. Congo, Egypt, Ethiopia,
India, Indonesia, Nigeria, Pakistan, Tanzania and
Uganda had consistently weak MPI and Bristol
indicators. To this list we added Brazil, Mexico, Peru
and South Africa, countries where UBS has
a strong presence and the potential to leverage
its infuence on behalf of vulnerable children. We
confrmed that more than 70 percent of the worlds
vulnerable children live in these 15 countries.
6
With this sample, we explored the distribution of
child vulnerability. Specifc diseases and conditions
e.g. individual species of parasitic worms and
malaria certainly map to specifc regions. How-
ever, overall our analysis reinforced the imperative
to consider the health needs of children in all low-
and middle-income countries rather than just
one or two specifc regions.
15 countries selected
as sample for health
landscape exercise
Child health
13
The state of health for vulnerable children
Children in low- and middle-income countries are
often poor and sick as they lack access to critical
services and provisions including sanitation, clean
water, nutritious food, healthcare and shelter.
Regardless of country or region, these children bear
a much larger health burden than the global popu-
lation. Two well-known measures help to illustrate
this point: childhood death and disabilities.
As shown in the fgure below, 40 percent of all
deaths in low- and middle-income countries were
among children under the age of fve, and more
than one-third of all deaths in low- and middle-
income countries were among children under the
age of 14. In contrast, children in high-income
countries are decidedly less vulnerable. Only one
percent of all deaths in high-income countries
occurs under the age of 5, and there are so few
deaths between the ages of 5 and 14 that the
percentage is effectively zero. In rich countries,
81 percent of all deaths occur over the age of 60.
7

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Source: UN population division; World mortality report 2009, WHO Department of
Measurement and Health Information: Mortality and burden of disease estimates for
WHO member states in 2004, WHO. The global burden of disease: 2004 update.
Geneva, World Health Organization, 2008. (http://www.who.int/evidence/bod).

The mortality rate for children under the age of
fve in low- and middle-income countries is the
most severe in Africa and Southeast Asia. Yet, as
shown in the fgure below, the death rate for all
children under the age of 5 in low- and middle-
income countries is nearly 500 percent higher
than the rate for children between the ages of
6 and 14.
8
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350
1,716
+490%
Source: ibid
Disability-Adjusted Life Years (DALYs) estimate
healthy life years lost, not just to death but also
to sickness and disability. In low- and middle-
income countries, 107 million DALYs are lost each
year among children under the age of fve, com-
pared to 11 million DALYs lost among children
aged 514, and 18 million among young people
aged 1529.
9
In high-income countries, the great-
est burden of DALYs is as we would expect
among older adults.
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Source: ibid
Double burden: communities suffer when
kids get sick
Most people have suffered from the fu or a bad
cold at some point in their life and can attest to
the misery of ill health. But in low- and middle-
income countries, poor health is more than just a
nuisance. It can rob children of their childhoods,
preventing them from attending school, socializ-
ing, and growing into productive adults. And
when kids are sick, their parents often have diff-
culty working and contributing to society during
their peak years of productivity.
The causes of ill health including specifc health
conditions described in the next section are often
preventable and treatable. By defnition, vulnerable
children lack access to essential healthcare, and the
primary goal of the foundations health invest-
ments is to develop and test effective and sustain-
able ways to address this gross inequity.
At the same time, we are also concerned about the
long-term negative socioeconomic consequences of
ill health for communities and nations. Malaria is a
tragic case in point. Spread by mosquitoes, this
debilitating disease has disproportionately afficted
the African continent where, by one estimate, it
has reduced gross domestic product growth over
the past 50 years by 37 percent.
10
An analysis of
malaria in Latin America found that for each year of
childhood infection, adult income drops 2.5 per-
cent.
11
Diseases like malaria create a vicious cycle in
low-resource environments where poverty exacer-
bates ill health, and ill health begets poverty.
14
Child health
Strategic investments in health can help break
such patterns. For example, a recent study found
that boys in Guatemala who received low-cost
nutrition supplements at the age of 3 later had
adult wages 46 percent higher than control
groups.
12
More than 100 years ago, the Rocke-
feller Sanitary Commission launched a campaign
to eradicate hookworm, which, in 1909, afficted
40 percent of children in the American South.
Reducing the disease burden not only made kids
healthier, it also improved school enrollment,
attendance, literacy and, later, adult incomes.
13

Nearly a century later, a Kenyan de-worming
program followed children in 75 schools where
more than 90 percent of kids were infected;
10 years later, treated children earned over 20 per-
cent more than those in the control groups.
14

Child health needs: our priorities
Children in low- and middle-income countries
suffer from myriad diseases and health conditions.
All warrant attention, but we wanted to identify
priority conditions that could help guide our later
analysis (similar to the sample countries chosen
earlier) and where our grantmaking can make the
greatest difference. We began by looking for high-
burden health conditions that receive relatively
little attention from other funders (see graph
below).
As the graph indicates, perinatal conditions, respi-
ratory infections and diarrhea immediately stand
out. Viewed together, these three health condi-
tions are responsible for 50 percent of the health
burden among children under the age of 14 in our
sample countries.
16
These conditions rank as the
top three causes of DALYs lost in all low- and mid-
dle-income countries,
17
and they are the main
causes of death for all children under fve.
18
To identify other important health conditions, we
applied two additional criteria. First, we looked for
health conditions that are tightly linked to perina-
tal conditions, respiratory infections, and diarrhea
through cause, co-infection and comorbidities.
Second, we looked for health conditions that have
potential synergies to our other grantmaking in
education and child protection. As a result, we
selected two additional health conditions: malnu-
trition and parasitic worm infections.
Parasitic worms linked to malnutrition, anemia
and stunting affict more than 80 percent of the
worlds bottom two billion. As one interviewee
said, You will always fnd these diseases wher-
ever you fnd extreme poverty, and that is the
most common determinant. Malnutrition is fre-
quently observed in children suffering from diar-
rhea. It weakens the immune system leaving chil-
dren susceptible to infections like respiratory infec-
Source: The vertical axis, disease burden measured in DALYs, is from data provided by the World Health Organization.
15
The horizontal axis represents donor investment in research
to address specifc diseases and health conditions in low- and middle-income countries. These investment fgures are notoriously diffcult to fnd; relative investments are estimated
here from a variety of sources, and in some cases extrapolated based on assumptions. Despite these drawbacks, our judgment is that the relative position of different health condi-
tions on the horizontal axis is largely accurate.
125
70
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50
40
30
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15
tions, parasitic worms and malaria. Schools are
an ideal entry point for health interventions to
eradicate worms and diarrhea, and the reduction
of these diseases is known to improve school
achievement.
19
We selected these fve priority health conditions
for roughly the same reasons that we had selected
15 sample countries earlier. These sample con-
ditions allowed us to test philanthropic
approaches, explore past success stories from the
feld of global health, visualize possible dream
projects and best illustrate the health needs of
children in resource-poor settings. While these
conditions are likely to be the focus of many
future Optimus Foundation investments, our
investments will not be exclusively restricted to
these fve.
Defning the problem
We identifed almost a dozen barriers that contrib-
ute to the health burden of vulnerable children.
The enormity of some barriers poverty, for exam-
ple require structural, political and economic
changes that clearly exceed the Optimus Founda-
tions infuence and resources. The lack of access
to affordable medicines and vaccines in resource-
poor settings is another formidable challenge that
is, in most cases, better tackled by governments
and donors with deeper pockets.
Rather, our analysis highlighted four barriers that
we can address: (1) health solutions developed for
adults, not kids; (2) health solutions that dont
reach the most remote and vulnerable children; (3)
local capacities that are undervalued and poorly
supported; and (4) global health efforts that are
not suffciently interdisciplinary.
Rx for adults only: Most medicines are devel-
oped for adults. Our knowledge about their safety
and effcacy is based on clinical trials involving
adults and we know little about how they affect
children. The result is a modern armamentarium
of medicines, many of which may be inappropri-
ate for or even dangerous to children.
21
In 2007,
the World Health Assembly passed a resolution
urging member states to take action on this issue.
It noted signifcant risks of high morbidity and
mortality in children, especially those under fve
years of age [because] many manufacturers of
essential medicines have neither developed nor
produced appropriate dosage forms and strengths
of medicines for children.
22
Health needs for all children
Surviving childbirth Perinatal conditions arise during the period
surrounding birth by one defnition, from 28 weeks of gestation to
the second month of life. They include premature birth, low birth
weight, birth trauma, asphyxia (breathing diffculties) and infections.
In addition to having signifcant impact on later physical and cognitive
development, perinatal conditions account for 124 million DALYs and
2.6 million deaths per year in low- and middle-income countries.
Appropriate nutrition Malnutrition is a dietary defciency that im-
pairs immunity and also disrupts physical and cognitive development,
contributes to 30 percent of all deaths for children under the age of 5
and is the direct cause of 27 million DALYs. Malnutrition is the most
important global risk factor for childhood illness and death.
Free from infection Poor children are especially susceptible to in-
fections when they are malnourished, with weakened immune sys-
tems, and when they lack access to adequate health care. Infectious
agents including bacteria, viruses, and parasites result in a wide
variety of childhood diseases such as those below:
Respiratory infections are defned as bacterial, viral and fungal in-
fections of the lung, particularly of the lower respiratory tract. They
are responsible for 1.7 million child deaths per year and 76 million
DALYs lost.
Caused by cholera, salmonella, rotavirus, Giardia, E. coli, and other
bacterial, viral and parasitic organisms, diarrhea is defned by the
World Health Organization as the passage of 3 or more loose or liq-
uid stools per day. Diarrhea accounts for 1.3 million deaths per year
and 65 million DALYs lost.
Parasitic worms, including schistosomiasis, lymphatic flariasis, on-
chocerciasis, hookworm, roundworm, tapeworm, whipworm, stron-
gyloidiasis and other intestinal parasitic worms are worms that live
in, and feed off of, a host organisms large or small intestines. They
account for 47,000 deaths per year and 12 million DALYs lost al-
though recent studies suggest this number is actually much higher.
Other infectious diseases include childhood killers like malaria and den-
gue that are spread by mosquito bites as well as rabies a viral infec-
tion that is invariably fatal if not treated immediately and fesh-eat-
ing conditions such as Buruli ulcer which primarily afficts children
under the age of 15.
Free from preventable injuries and non-communicable diseases
(NCDs) Should a child manage to survive his / her ffth birthday
having overcome the challenges of birth, nutrition, and infection, there
are still signifcant challenges leading into a healthy and productive
adulthood. These include:
Preventable injuries road traffc injuries, drowning, burns, falls
and poisoning take the lives of more than 2000 children and teen-
agers every day, and account for 46 million DALYs lost each year in
low- and middle-income countries.
Non-communicable diseases (NCDs) include cardiovascular disease,
diabetes, autoimmune diseases, asthma and most cancers. The lead-
ing cause of mortality in the world, they are primarily responsible
for death and disability in adults.
16
Child health
Kids are last in line: Even when appropriate health
solutions do exist, they frequently fail to reach the
most isolated and vulnerable children. Access is a
complex issue. Many poor countries and poor par-
ents simply cannot afford medicines and health
services. In addition, delivery systems need signif-
cant innovation; getting products to the people
who need them most remains an elusive chal-
lenge. Children in low-resource settings suffer the
most from a global failure to invest in improved
health service and product delivery methods.
Outside owners: External experts often develop
and implement health solutions in poor countries.
Consultants travel great distances at high cost
to deliver their technical knowledge in the feld.
Projects that give local experts and communities
the lead role in developing solutions are, unfortu-
nately, nearly as rare as the resources needed to
strengthen local capacity.
Dis-integrated health programs: Five of the eight
Millennium Development Goals (MDGs) focus on
health. It is not yet clear whether developing
countries will achieve the MDGs the deadline is
just three years away, and some regions are far
behind but there is growing consensus on the
need for multi-sector collaboration to fast-track
attainment. Too often, solutions are pursued in
isolation. Many strategic challenges impeding
the success of primary health care are rooted in
weak strategic inputs, including lack of intersec-
toral collaboration.
23
Approaches
Once we identifed the key global health barriers
and needs where we believe we can have an
impact, we then defned four approaches that
could best overcome these barriers and improve
the health of vulnerable children. These
approaches refect the priorities of the Optimus
Foundation and the specifc criteria for this land-
scaping as outlined in the report introduction.
Adapt solutions for children
This approach supports efforts to reformulate
medicines and re-tool other health products such
as diagnostics to be safe, effective and age-appro-
priate for children. For example, children under 5
need chewable tablets because they have diffculty
swallowing solid pills. But children under the age
of 2 may choke on chewables so liquid formula-
tions are ideal, but these may require refrigeration
and training to deliver. In tropical environments
and low-resource settings, dispersible powders
(just add water) are often preferred.
24
Similarly,
diagnostics often need to be adapted for children
because samples for example blood or sputum
cannot be obtained in the same way as with
adults.
We have a good idea where to begin in adapting
solutions for children. In Priority Medicines for
Mothers and Children, the World Health Organi-
zation, United Nations Population Fund (UNFPA)
and the UN Childrens Fund (UNICEF) list priority
medicines required for child survival, but for which
further R&D is needed. These include fxed-dose
pediatric tablets for tuberculosis (TB) and fxed-
dose combination medicines against HIV, TB and
pneumonia.
25
Adapting adult solutions is an attractive approach
for the Optimus Foundation because it makes
existing medicines and diagnostics safer, more
effective and more accessible to vulnerable chil-
dren. Compared to the discovery and develop-
ment process for new drugs which can take
1015 years and cost hundreds of millions of US
dollars reformulating adult medicines for chil-
dren is relatively fast, feasible and affordable.
26

Bring solutions to children
This approach focuses on innovative delivery and
implementation methods to bring proven solutions
to remote and vulnerable children. It acknowl-
edges that poor children often have limited mobil-
ity and need to be treated locally, at home or in
their communities. Many developing countries
have limited infrastructure, poor roads and inade-
quate storage facilities, signifcantly complicating
the timely distribution of critical medical supplies. If
supplies do arrive, communities may lack electricity,
refrigeration and special facilities to store them.
They may also lack trained health workers to dis-
tribute them in an appropriate manner for exam-
ple, ensuring that topical medicines are applied to
the skin and not swallowed.
Many conditions that affect childrens development can be hidden from them
and their communities . This girl is from Myanmar, where more than 40% of
children are found to be quietly suffering from parasite infections that directly
result in growth stunting, lingering infections, poor health and poor school
performance.
17
Expert insight
According to Lindsay Mangham-Jefferies and Kara Hanson of the
London School of Hygiene and Tropical Medicine, fve factors must be
considered in scaling up health services: (1) community and house-
hold; (2) health services delivery; (3) health sector policy and strategic
management; (4) public policies cutting across sectors; and (5) envi-
ronmental and contextual characteristics.
Delivering health services and products is particu-
larly challenging for children living in more remote
and rural areas as hospital resources are concen-
trated in urban areas, according to Kahn, Yang,
and Kahn.
27
There are not enough health care
workers and such workers are diffcult to recruit
and retain, especially in rural areas.
28 29
Bringing solutions to children is attractive to the
Optimus Foundation because this approach tar-
gets the most remote and vulnerable populations
both in rural settings and urban slums. We
believe it is feasible because the current wave of
social innovation and social entrepreneurship,
combined with new mobile communication tech-
nologies, can often overturn traditional medical
paradigms, enabling service and product delivery
to the hardest-to-reach children.
Tailor solutions to ft local contexts
Our third approach recognizes and leverages
local knowledge and expertise while also
strengthening the capacities of communities and
local researchers. Recognizing and supporting
local problem-solving capacity is important for
two reasons. First, local people possess critical
inside information about their own context,
including incentives, disincentives, norms and
practices. Second, local leadership and ownership
is a key to lasting impact. UNICEF notes that
community-based care may be the most propi-
tious way to improve environmental health and
combat disease and undernutrition, [and] com-
munity solutions are highly cost-effective and,
most importantly, open to all.
30

Tailoring solutions to ft local contexts is attractive
because the foundation already has signifcant on-
the-ground experience in this area an historical
advantage on which to build. It is also appealing
because we believe that many best practices in
the feld of global health fail to scale up simply
because one-size solutions do not ft all. Mecha-
nisms to deliver health services and products must
be adapted to varied socio-cultural and economic
contexts, and the best way to support such tai-
loring is to work with the people who under-
stand their own context. Thus, to counteract vul-
nerability, we must listen creatively and help to
build resilience in families, communities and local
systems.
Link disciplines to create comprehensive solutions
Prioritizing multidisciplinary solutions is essential
because it is diffcult to make suffcient gains in
child health unless other goals for example,
improving maternal health and providing clean
water and sanitation are addressed at the same
time. This approach involves the creation of new
partnerships across varied disciplines, for example
linking health to engineering, law, agriculture or
education.
It is also important to search for integrated solu-
tions that address a broad set of social determi-
nants of health.
31
Social determinants of health
include the conditions in which people live, such
as where they were born, how they grew up,
whether they were educated, where they work,
and the supporting health systems from which
they are served. These conditions are the result of
resource allocation and access, and as such, are
responsible for signifcant health inequities across
the globe. To address such unfair and avoidable
differences in health status, the UN Secretary-Gen-
eral encourages efforts to work across sectors and
involve multiple stakeholders because synergies
across the goals are clear and indisputable [to]
reduce costs, increase effectiveness and catalyze
local action.
32
Linking disciplines to create comprehensive solu-
tions is attractive because the foundation has sig-
nifcant experience and historical advantage in
projects of this kind. In addition, we believe it is
exactly at the intersection of different disciplines
that fresh ideas often arise to address old prob-
lems.
18
Child health
Opportunity areas
In order to ensure that our chosen approaches
were sound, we frst explored opportunities to
address the fve priority health conditions noted
above (perinatal, respiratory, diarrhea, malnutri-
tion and parasitic worms). For the sake of brevity,
that analysis is not included here. We then
mapped all child health needs (surviving childbirth,
appropriate nutrition, protection from infections,
and remaining free from injury and NCDs) against
our four chosen approaches (adapt, bring, tailor
and create comprehensive solutions). While cogni-
tive stimulation is also an essential health need,
this issue is covered in our Education Landscape as
well as in our discussion of potential synergies
among education, health and child protection.
We then selected three opportunity areas for the
Optimus Foundation (see fgure below). Our selec-
tion process was based on intensive desk research
and our own professional judgment, guided by
testing and feedback from external experts. The
three opportunity areas for health are:
First minutes of life
Child-friendly care
Tailored for kids and communities
Opportunity areas in child health
Needs
Surviving
childbirth
Appropriate
nutrition
Free from
infections
Free from
Injuries & NCDs
A
p
p
r
o
a
c
h
e
s
Adapting solutions for children First minutes
of life
Child-friendly care
Bringing solutions to children
Tailoring solutions to ft local contexts Tailored for kids and communities
Linking disciplines to create
comprehensive solutions
While both injuries and NCDs are a signifcant and
growing cause of child death and disability (espe-
cially among older children and teenagers), we
decided not to include them as focal points for the
foundation, given our limited resources and size,
and the many other signifcant health challenges
facing children under the age of 5. In addition, the
remaining needs including surviving childbirth,
appropriate nutrition and free from infections
had greater synergies with our education portfolio
and we believe there will be more opportunities to
integrate solutions across the disciplines of health
and education by refning our focus.
First minutes of life
Defnition: The period surrounding birth from
the last weeks of gestation through the frst
weeks of life is critical to child development.
Perinatal conditions, including prematurity, low
birth weight, birth trauma, asphyxia, and infec-
tions, are the single largest contributor to child-
hood death and suffering. In resource-poor set-
tings, this is a time of greatly heightened vulnera-
bility. This opportunity area combines all four
approaches.
19
Current grantee spotlight: mobile phones
giving health to moms and kids
Overview The mCare project, recognized as one of the Top 11 Inno-
vations in Mobile Health (mHealth) in 2011 by the Rockefeller Founda-
tion and the mHealth Alliance, aims to validate the implementation
and cost effectiveness of a simple mobile phone technology aimed at
reducing maternal and newborn mortality in rural Bangladesh. Simple
and readily available phones link pregnant women and information
about their pregnancies to a local community health workers and an
emergency neonatal care teams to reduce preterm and intrapartum
deaths.
Partners Johns Hopkins University in partnership with JiVitA, the
Bangladeshi Ministry of Health and Family Welfare, and mPower Health
Benefciaries 25,000 pregnant mothers and newborns
Learn more the project is featured in the 2012 special issue of the
magazine of Johns Hopkins Public Health.
Current grantee spotlight: flms that
entertain and educate
Overview Magic Glasses, is a project that aims to measure the
effcacy of an educational cartoon designed to teach children, in an
entertaining and locally sensitive fashion, how to avoid contracting
intestinal parasitic worms. More than 100 million Chinese children are
currently infected with parasitic worms, affecting not only their health
but their educational attainment as well. To date, mass drug adminis-
tration (MDA) has been the cornerstone of control as treatment is
relatively cheap. However, MDA does not prevent re-infection, which
means that the burden of parasitic worms persists in communities.
This project has developed and adapted a health educational flm,
called Magic Glasses, to augment MDA as a model for lasting and
integrated control of parasitic worms. In early results, Magic Glasses
intervention has shown a 50 percent effcacy in preventing further
parasitic worm infection among school children, a 90 percent increase
in knowledge about parasitic worms, and the proportion of students
washing their hands after using the toilet increased by 200 percent.
Partners Queensland Institute for Medical Research, Australia, in
partnership with Hunan Institute of Parasitic Diseases, China, and local
Ministry of Health and Education departments in Hunan Province
Benefciaries 2,000 children across 38 schools
Learn more the project is featured in the August 2011 issue of the
Optimus World magazine.
Rationale: There are clear entry points for action
to reduce mother and newborn morbidity and
mortality. For example, prematurity and low birth-
weight can be reduced through maternal nutrition
programs, while birth trauma, asphyxia and neo-
natal infections can be decreased by integrating
maternal, obstetric and newborn care. To survive
birth and the frst weeks of life, appropriate health
solutions must be adapted for and reach the most
vulnerable children. In order for such interventions
to be effective and sustainable, they must be tai-
lored to local conditions by local communities and
experts.
Child-friendly care
Defnition: Many health tools including medi-
cines and diagnostics have not been adapted or
re-formulated to be safe and effective for children,
especially those in low-resource settings. There is
also a dearth of innovative delivery systems to
ensure that solutions reach the children who most
need them. Ways to achieve this include adapting
health messages that are age-appropriate and
solicit positive responses from children. This
opportunity area covers two approaches: adapting
solutions for children, and bringing solutions to
the child.
Rationale: There are readily identifable access
points for the Optimus Foundation. For example,
we can work with global partners to support the
development of age-appropriate medicines and
diagnostics. Special attention should be given to
the development and delivery of low-cost point-
of-care diagnostics to distinguish the causes of
fever in order to provide proper treatment. New
mobile health tools, bottom-of-the-pyramid busi-
ness models, micro-franchising, social enterprises,
and other social innovations need to be feld-
tested to identify the most cost-effective ways to
deliver health services and products.
20
Child health
Programs tailored for kids and communities
Defnition: Evidence-based best practices may
fail to thrive when transplanted into new socio-
cultural and economic contexts. Only by working
with local communities and experts who under-
stand their own situation can we begin to develop
and implement interventions that work. Multiple
determinants of health (such as sanitation, educa-
tion and food security) need to be considered to
understand the drivers for a given problem and its
potential solution. This opportunity area focuses
on the need to engage and strengthen local
expertise and leadership to address the complex
determinants of child health.
Rationale: The key stakeholders and participants
are oftentimes easily accessible and eager. Parents,
community health workers, local teachers and
experts from local universities can with the right
support and incentives innovate, adapt and
deliver locally appropriate solutions. Effective and
sustainable solutions will also require attention
across multiple disciplines, refecting the complex-
ity of local determinants of the health of vulnera-
ble children. This opportunity area is especially
conducive to synergies with the Optimus Founda-
tions focus area on education.
Current grantee spotlight: green roads to
dengue control
Background Green Roads, is a project that takes a different ap-
proach to eliminate dengue by involving those most vulnerable to the
disease by teaching them how the disease is spread and in identifying
practical ways to prevent the disease from ever occurring. With an esti-
mated 2.5 billion people at risk of infection, dengue is one of the most
devastating diseases carried by mosquitoes, and the number of infec-
tions have been on the rise worldwide over the past decade. In most
countries, approaches adopted from Ministerial level guidelines, and
those dependent upon pesticides have failed to curb the spread of
dengue. Over the last 5 years, the UBS Optimus Foundation has sup-
ported a community-based intervention project that has shown very
promising results among 23,000 people in Nicaragua, with indirect
benefciaries estimated at 220,000. Key to the project are the brigadis-
tas, local community members who learn from experts about dengue
and the mosquito-living environment and life cycle. The brigadistas
then investigate the dengue infection rate and sources of the mosqui-
toes in their own neighborhoods. Depending on the neighborhood, dif-
ferent interventions have been implemented including school plays,
church events, dances, rap songs, the development of business collec-
tives to sell pupa-eating fsh, clever use of local materials to cover wa-
ter containers (to prevent mosquito breeding), and innovative new uses
for old car tires (a notorious home for mosquito larvae when they fll
with rainwater). Pilot results suggest that the green roads approach
could reduce dengue by 60 percent under the conditions of a random-
ized controlled trial in Mexico and in Nicaragua, currently ongoing with
results expected in 2013. The frst year of peer-to-peer monitoring in
the Camino Verde trial intervention sites in Nicaragua also found that
the percentage of homes with mosquito breeding sites declined from
20 percent to 7 percent. In Nicaragua, the project is scaling up the
community mobilization efforts in collaboration with the Ministry of
Health, and the spill-over effects from dengue control to longer term
economic growth are being measured. This approach is also now being
replicated in Mexico, where dengue fever incidence is on the rise.
Partners CIET in Nicaragua and Mexico, University of California,
Berkeley, United States
Benefciaries More than 100,000 people, including approximately
40,000 children
Health need Free from Infections
Approach Tailor Solutions to Fit Local Contexts; Link Disciplines to
Create Comprehensive Solutions
Opportunity area Tailored for Kids and Communities
Learn more about the project at the Case Studies for Global Health
(http://casestudiesforglobalhealth.org) or visit the Camino Verde
project website (http://caminoverde.ciet.org)
21
Opportunity areas in child heath
First minutes of life Addressing the needs of vulnerable children
during the critical period surrounding birth with the adaptation and
delivery of solutions for children as well as tailored solutions to ft
local socioeconomic contexts.
Child-friendly care Providing appropriate nutrition and care to
prevent and treat infections including redesigning or re-formulating
health solutions to make them age-appropriate, and ensuring that
health services and products can reach children in resource-poor,
remote or inaccessible settings.
Programs tailored for kids and communities Involving local
communities and experts to address the multi-dimensional determi-
nants of health to support the development of effective, sustainable
and locally appropriate solutions addressing the health needs of
vulnerable children.
Closing thoughts
The health feld has made great strides over the
past century. The explosive growth in specialized
knowledge, and the accelerated speed of innova-
tion, have given us powerful new tools to fght
disease. Yet millions of children still suffer and
diefrom preventable conditions. Certainly, more
money, medicines, doctors, nurses and midwives
would help and governments and the private
sector need to support them. We believe that
foundations have a different role. We see ourselves
as strategic investors in social and technological
innovation to develop and test more effective and
sustainable solutions.
We used this landscape analysis as an opportunity
to identify priority health needs and potential
solutions. This led us to three attractive and feasi-
ble opportunity areas that the foundation could
pursue.
Early diagnosis and treatment is key to improving worldwide health and limit-
ing the devastating effects of illness as is known by these Ghanaian children
and mothers, all of whom are former sufferers of Buruli ulcer. They are work-
ing with Stop Buruli, a multidisciplinary research effort to stop Buruli ulcer, a
fesh-eating disease that can lead to signifcant disability and suffering if not
treated early.
Sectiontitle
22
23
Background
The UBS Optimus Foundation has been committed
to child protection since its creation in 1999. In
2003, the Foundation Board decided to focus on
protecting children from violence and sexual
abuse. Today, the foundation supports three kinds
of child protection projects: raising awareness in
countries like Switzerland, Zambia, Malawi,
Mozambique and Germany; delivering services in
sub-Saharan Africa, Georgia, Russia and Belarus;
and grants to generate new evidence, including
the Children and Violence Evaluation Challenge
Fund and the Optimus Study, both of which have a
global focus. The current funding for child protec-
tion is approximately 5 million US dollars per year.
The child protection space is currently shaped by
three trends that signifcantly impact our work
and thinking. We believe all three trends are posi-
tive for the feld. First, donors and practitioners are
moving toward a systemic, holistic framework to
address child safety, shifting away from project-
oriented approaches. The second trend supports
building a global evidence base on child abuse
and its related consequences. The third is towards
active engagement on the important topic of child
sexual abuse, which because it is uncomfortable
and unpopular has remained relatively invisible.
Leaders in the feld agree that abuse cannot be
viewed in isolation it requires systemic and mul-
tidisciplinary solutions. A stronger evidence base is
needed because, unlike health and education
which have been relatively well-studied, the feld
of child protection is new. There is a dearth of
evidence, best practices and codifed approaches.
Without key data, it is diffcult to quantify the
problem globally, inspire action and direct
resources to programs that work. Active engage-
ment is needed, including multiple stakeholders in
advocacy and social marketing, to raise attention
and change laws, increase resources, build aware-
ness and encourage reporting all to improve
child protection.
Landscape scope and process
In 2012 we launched a child protection landscape
to identify feasible and relevant opportunity areas
that the Optimus Foundation should consider
when setting its future strategy and determining
program priorities. We present here promising
ideas and entry points and the rationale behind
them. These opportunity areas will be considered
further as part of our strategic planning process.
Key defnitions
We began our child protection landscape by defn-
ing key terms. The defnition of a child is anyone
under the age of 18, according to the UN Conven-
tion on the Rights of the Child. Because children
of all ages are vulnerable to maltreatment, our
granting focus, and the focus of this landscape
analysis, covers all children aged 018.
Child protection
Community-based child protection is a low-cost way of reaching large numbers
of children such as with these children in India.
24
Since child protection is a comparably new feld,
vulnerability to abuse cannot yet be reliably
assessed. There are no vulnerability indicators as
there are for child health and education. At pres-
ent, experts believe that children are equally sus-
ceptible to maltreatment regardless of their socio-
economic status, home country or culture.
From a geographic perspective, we focused this
landscape analysis on all low- and middle-income
countries, plus Switzerland. Low- and middle-
income countries are the subject of a forthcoming
2013 World Health Organization study assessing
country readiness to implement child protection
interventions. Switzerland is of interest because
UBS AG (the bank) and the UBS Optimus Founda-
tion are both headquartered in that country.
The state of child protection
Whether they live in high-net-worth families in the
global North, or are orphaned by HIV / AIDS in sub-
Saharan Africa, all children are vulnerable to abuse
and neglect. Several statistics illuminate the sever-
ity of the situation:
In 2002, 150 million girls and 73 million boys
under the age of 18 experienced forced sexual
intercourse or other forms of sexual violence.
33
Each year, an estimated 500 million to 1.5 bil-
lion children experience physical violence.
34
Between 133 and 275 million children world-
wide witness domestic violence each year.
35
In low- and middle-income countries, 3 out of 4
children between the ages of 2 and 14 experi-
ence some form of violence physical punish-
ment or psychological aggression at home.
36
Children and communities are affected
when children are abused
Child maltreatment has devastating effects on
children and their communities, producing direct
costs for affected individuals and indirect costs for
the communities in which they live. The annual
global cost of child abuse and neglect is estimated
to be 104 billion dollars or 0.7 percent of the US
GDP.
37
These consequences can be broken down
into fve categories:
(1) Health: Compared to children who are well
cared for, abused and neglected children are less
healthy. The Adverse Childhood Experiences (ACE)
study looked at people who experienced abuse,
neglect, household mental illness, and household
substance abuse.
According to ACE, people who experienced four
or more categories of childhood exposure were
412 times more likely to be at risk of alcoholism,
drug abuse, depression and attempted suicide;
24 times more likely to smoke and have poor
self-rated health; and 1.41.6 times more likely to
be physically inactive and severely obese.
38

They were also more likely to have a high number
of sexual partners, and to suffer from sexually
transmitted diseases.
According to the Australian National Child Protec-
tion Clearinghouse, child abuse and neglect are
correlated with increased prevalence of public
health problems, including community and
domestic violence, delinquency, mental health dis-
orders, alcohol and illicit substance use, obesity,
suicide and teen pregnancy. These outcomes, in
turn, correlate with increased utilization of public
and private health services.
39
(2) Crime: According to a 1992 study by social sci-
ence researcher Cathy Spatz Widom, children who
are abused or neglected have an increased likeli-
hood of being arrested as juveniles (53 percent),
as adults (38 percent), and for a violent crime (38
percent).
40
More recent studies have found that
victims of abuse or neglect are overrepresented
among high-risk male juvenile parolees,
41
and
among both adult male and female offenders in
state prisons.
42

The best available research, according to the
National Institute of Justice, tells us that crime
victimization costs the United States 450 billion
dollars annually. Rape is the most costly of all
crimes to its victims, with total estimated costs at
127 billion dollars a year (excluding the cost of
child sexual abuse).
43
In 2008, researchers esti-
mated that each rape in the US costs society
approximately 151,423 dollars.
44
Child protection
25
(3) Education: It has been well-documented that
child victims of sexual abuse and violence have
greater diffculty learning. They tend to perform
less well on standardized tests and achieve lower
grades, even when socioeconomic status and
other background factors are considered.
45
Pro-
spective studies have consistently shown that mal-
treated children have lower educational achieve-
ment than other children.
46
When children drop out of schools as a direct
consequence of violence, the economic growth of
a country is at stake, according to a 2010 report
by UNICEF, Plan West Africa, Save the Children,
and Action Aid. Studies show that each year
Cameroon, D.R. Congo and Nigeria lose 974 mil-
lion US dollars, 301 million dollars and 1,662 mil-
lion dollars respectively by failing to educate girls
to the same standards as boys.
47
(4) Economics: Adults who were subjected to sex-
ual abuse and violence as children often fail to
succeed economically. Sexual violence survivors
experience reduced income in adulthood as a
result of victimization in adolescence, with a life-
time income loss in the US estimated at 241,600
dollars.
48
According to Watters et al: Child
abuse also reduces the lifetime productivity of its
victims who do not die it is reasonable to
assume that fve percent of lifetime earnings
would be affected.
49
Communities also experi-
ence profound economic consequences. Based on
data drawn from a variety of sources, the esti-
mated annual cost of child abuse and neglect in
the United States is between 104 billion and 124
billion dollars.
50, 51
(5) Well-being: Not surprisingly, children affected
by sexual violence and abuse suffer from tremen-
dous stress and anxiety. According to Hagele, child
maltreatment and the associated disruption of
secure parent-child attachment represents a severe
traumatic exposure comparable to military com-
bat. While there are many exceptions, abused chil-
dren often become abusive parents: Child mal-
treatment independently predicts later dysfunction
in parenting, including the perpetration of severe
physical maltreatment and inappropriate maternal
dependence on children for emotional fulfllment,
(contributing) to the intergenerational transmis-
sion of maltreatment.
52

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1 This breakdown is taken from the Wang 2007 article estimating the cost of child mal-
treatment to be USD 104 billion. More recent reports by Fang et. al. suggest the overall
burden to be USD 124 billion. 2 Direct costs created when the incidence comes to the
attention of offcials. Indirect costs caused by the long-term negative impact of the inci-
dents.
Sources: Total Estimated Cost of Child Abuse and Neglect in the United States (Wang,
Holton); World Bank
The total financial costs of just
one year of confirmed cases
of child maltreatment in the US
are estimated to be 124 billion
dollars, equal to 0.7% of US GDP.
51
26
Child protection
The challenges of child protection
There are multiple reasons why child protection
does not receive the attention and resources it
warrants. Victims of abuse especially when it is
sexual in nature often experience shame that
prevents them from reporting crimes. Child abuse
and neglect make people uncomfortable no one
likes talking about it, and political leaders are
reluctant to be associated with it. The taboo
nature of this problem is unique, impeding our
ability even to assess the full extent of the prob-
lem. An Optimus Foundation study in China found
signifcant underreporting and missing recogni-
tion of the problem.
To complicate matters, societies have different
perceptions of abuse and neglect. Child marriage,
for example, may be condemned by certain cul-
tures, but it is traditional practice in some coun-
tries. These differences in cultural norms make it
challenging to gain universal alignment on some
child protection issues. In addition, child abuse
and neglect often take place behind closed doors,
at home and within families, or in secluded com-
munity spaces. With no public crime, many com-
munities and offcials prefer not to see the abuse
of children.
Low reporting and low evidence of burden results
in limited funding for child protection compared
to other felds such as education and health. Reli-
able data are relatively scarce, according to the
World Health Organization, which also notes,
(There is a) lack of basic knowledge and concepts
such as common defnitions, cross-national com-
parisons, how to measure the problem, context
and risk factors of the problem, costs, context,
policy and legislative data.
53
For example, there
are no clear risk factors for child abuse and
neglect; this makes it diffcult to identify constitu-
ents. Limited evidence on the magnitude of the
problem fuels the cycle of limited attention and
underfunding.
Defning the problem
Children are mistreated in numerous ways.
UNICEF identifes factors relevant to the feld of
child protection including: armed violence; child
labor; child marriage; recruitment by armed
groups; child traffcking; lack of parental care; chil-
dren with disabilities; family separation in emer-
gencies; female genital mutilation / cutting
(FGM / C); gender based violence in emergencies;
landmines and explosive weapons; sexual vio-
lence; and lack of psychosocial support. Though
seldom discussed and infrequently addressed at
community and policy levels, child abuse is,
according to Felitti et al., a silent killer and one of
the leading causes of illness and death.
54
We evaluated each of these categories of child
protection. Some child soldiering, female genital
mutilation, child traffcking and child marriage for
example are concentrated in specifc geographic
regions, which means they dont affect all children
equally. Others including neglect, child labor and
physical abuse are openly discussed and not
shrouded in secrecy. Corporal punishment already
attracts signifcant donor attention and resources.
Young people between the ages of 0 to 18 will
not be safe until all factors relevant to child pro-
tection are addressed adequately, but the Optimus
Foundation sees sexual violence and abuse as one
of the most important challenges where we can
have an impact. Other forms of maltreatment are
often linked to sexual violence and abuse. For
example, a small portion of child traffcking is for
sexual exploitation; whereas, most traffcking is
for labor. The foundation will concentrate on
these forms of maltreatment where they overlap
with sexual violence and abuse. In addition, we
will invest in addressing circumstances known to
be linked to higher risks of being exposed to
sexual violence later in life. All of the issues that
challenge child protection broadly are more pro-
nounced in the area of sexual violence and abuse:
taboo, lack of political action, underfunding,
agap in knowledge and evidence.
What is child sexual abuse?
According to the World Health Organization: Child sexual abuse is
the involvement of a child in sexual activity that he or she does not
fully comprehend, is unable to give informed consent to, for which the
child is not developmentally prepared and cannot give consent, or that
violates the laws or social taboos of society. Child sexual abuse is evi-
denced by this activity between a child and an adult or another child
who, by age or development, is in a relationship of responsibility, trust
or power, the activity being intended to gratify or satisfy the needs of
the other person. This may include but is not limited to: the induce-
ment or coercion of a child to engage in any unlawful sexual activity;
the exploitative use of children in prostitution or other unlawful sexu-
al practices; the exploitative use of children in pornographic perfor-
mances and materials.
55
27
Approaches
We considered several classifcation systems for
approaches to address sexual violence and abuse:
by setting (e.g. home and family, workplace,
community, schools), by intervention type (e.g.
behavior change programs, policy development,
capacity enhancement) or by stage (e.g. seg-
menting the experience before, immediately after,
and long-term impact following an incident of
abuse).
We believe that focusing by stage provides the
greatest opportunity to have a meaningful impact
in this nascent feld. This leads to three types of
intervention: prevention, treatment, and rehabili-
tation and reintegration. Prevention includes both
primary activities anticipating problems before
they arise and seeking to prevent their occurrence,
and secondary activities reducing the impact of
serious risk factors that have already manifested.
Treatment consists of therapeutic activities to
address the physical and psychological trauma of
abuse. Rehabilitation and reintegration emphasize
reconciliation and helping abuse survivors become
empowered members of society.
Considering interventions at these three stages,
we chose to focus on prevention as the best
approach to address sexual violence and abuse for
three main reasons.
1. Due to tremendous underreporting of sexual
abuse and violence 98 percent of cases were
unreported in Hong Kong and 95 percent were
unreported in Switzerland only a small num-
ber of cases are brought to the attention of off-
cials.
56
Thus, only a very small percentage of
cases are amenable to treatment. Prevention ad-
dresses all potential cases.
2. By averting problems before they develop, pre-
vention is a highly cost-effective way to address
child sexual violence and abuse. Investing in pre-
vention especially primary prevention activities
that operate upstream of problems is more
cost-effective and has large and long-lasting
benefts.
57
3. Unfortunately prevention programs and victim
services for all forms of child abuse are severely
underfunded, according to Alexander
Butchart, WHO Coordinator, Violence Preven-
tion.
Focus on prevention to address sexual violence
All children Victim
Prevention
A Addresses all
potential cases
B , 20% of funding
C More cost-effective
than remediation
Detection Treatment Rehabilitation Negative consequences
Repeat victimization
Repeat pattern /
become perpetrator
, 10% reported cases
. 80% of funding
Required system (health and
legal institutions) approach
is complex and expensive
28
Child protection
Child protection needs: our priorities
Because child protection is a relatively new feld,
three basic building blocks are missing: skills,
understanding of cause and effect, and evidence.
Filling these gaps is absolutely critical to ensuring
that children are protected against sexual violence
and abuse.
Many promising child abuse programs designed
by NGOs and other organizations develop out of
grassroots initiatives and involve professionals
without backgrounds or education in research and
evaluation, explained David Finkelhorn, Director
of the Crimes Against Children Research Center at
the University of New Hampshire.
There arent enough trained, qualifed profession-
als who can design and implement appropriate
programs.

This lack of skills holds back efforts to address
child sexual violence and abuse at every level
strategy, program design and program execution.
Because of the absence of skilled specialists and
funding support, we are still not clear what works
and what doesnt when it comes to preventing
child sexual abuse and violence. According to
MacMillan et al., Although a broad range of pro-
grams for prevention of child maltreatment exist,
the effectiveness of most of the programs are
unknown.
58
Without information on the effcacy of prevention
programs, implementers may choose inappropriate
strategies with little utility. For example, in 2009
Davidson, Martellozzo, and Lorenz evaluated the
Child Exploitation and Online Protection (CEOP)
educational training package, ThinkUKnow.
They found that program participants ability to
recall safety messages appeared to fade over time.
A high proportion of young people who had
received the training were not even able to recall
whether they had participated in the program.
59
Expert insight
There should be a clear focus on primary prevention because even
in the best resourced countries, only a fraction of cases three to ten
percent ever come to the attention of the authorities. The vast
majority of victims remain invisible and anonymous.
Chris Mikton, PhD, Violence Prevention, WHO.
It is through the eyes of children that we see the world in its purest form,
andthe environment must be rich in motives which lend interest to activity
and invite the child to conduct his own experiences as noted educator
MariaMontessori observed.
29
Opportunity areas in child protection
Needs
Sexual
violence
Child
soldiering
FGM Corporal
punishment
Emotional
abuse
Child
traffcking
Child labor Child
marriage
Physical
abuse
A
p
p
r
o
a
c
h
e
s
Prevention
Treatment
Rehabilitation
Focus of CP landscape
1. Lack of skills
2. Lack of understanding of cause and effect
3. Lack of evidence of what works
Opportunity areas
To address these gaps in the child protection feld,
we developed three opportunity areas for the
Optimus Foundation. These opportunity areas will
be used to inform the foundations strategic plan-
ning process and are illustrated in the fgure
below.
Strengthen capacity
There is no single profle of a child protection
expert or practitioner, but everyone working in
this feld needs signifcant training. Experts we
interviewed identifed capacity strengthening of
professionals as critical to alleviating child sexual
abuse and violence. Building the knowledge and
skills of funders and implementers through train-
ing and continued learning opportunities will
enable the development of high quality projects
that work. It is also absolutely critical to harness
local knowledge and capacity where it exists and
enhance it where necessary. This will ensure that
local communities help develop interventions and
take the lead to implement them in a sustainable
manner.
Current grantee spotlight: the child safe
organization toolkit
Children can be abused anywhere services are offered: schools, medi-
cal clinics, hospitals, emergency shelters, while participating in extra-
curricular activities, and even while receiving humanitarian aid. To
help ensure that institutions and organizations working with children
uphold child protection principles, ECPAT (End Child Prostitution, Child
Pornography, & Traffcking of Children for Sexual Purposes) created its
Child Safe Organization Toolkit.
With a variety of materials to help organizations develop and improve
policies and procedures on child protection, the kit focuses on six ar-
eas: recruitment, employment and volunteers; education and training;
a professional code of conduct; reporting mechanisms (for concerns
and cases) and referral systems; access by external visitors; and com-
munications and written policy and procedures for institutions and or-
ganizations. In addition to helping organizations create and formalize
their policies, the kit also creates public conversation and critical dia-
logue about sexual violence toward children.
The Toolkit is currently being implemented in The Gambia, Benin,
Ghana, Zambia, Thailand, Vietnam and Indonesia where at least
30 partner agencies in each country are being trained.
30
Child protection
Build a culture of evidence
When implementers pursue strategies based on
anecdotal information and prevailing norms, they
are often met with serious disappointment,
supporting interventions that do not reduce the
burden of child maltreatment.
60
Practitioners and
funders may make erroneous assumptions about
sexual abuse and violence and then allow these
assumptions to guide their work.
Unfortunately, low accountability defnes the child
protection feld. Robust evaluations are the only
way to determine what works and ensure that
what works can be scaled up. This is a particular
challenge in the area where the foundation will
focus. According to a WHO / ISPCAN publication,
little attention in terms of research and policy
has been given to prevention.
61
Building a culture of evidence involves developing
and spreading effective assessment tools, methods
and best practice standards for problem scoping,
solution prototyping, program piloting and scaling
of proven programs. To do this, practitioners must
leverage existing research, build new knowledge
by integrating a research component into inter-
ventions, and build a robust global evidence-base
on child protection by sharing their fndings with
the feld. This requires the involvement of local
community leaders to ensure that assessment and
implementation plans are appropriate for their
own contexts.
Current grantee spotlight: the Optimus Study
a global examination of child sexual abuse
A multi-country initiative, the Optimus Study examines child sexual
victimization in the context of other forms of maltreatment, enumerat-
ing childrens risk and potential protective factors. This study is gather-
ing evidence and conducting research on four continents, with the
ultimate goal of creating an evidence base that can reduce the inci-
dence of, and improve services for victimized children.
Research model The Optimus Study integrates standardized popu-
lation-based survey methods to determine the rates and context of
abuse in a particular population. It also provides clarity on the number
of sexual victimization cases that are brought to the attention of off-
cials and examines the procedures that are used to assist victims and
bring perpetrators to justice. Taken together, the data fulfll four pur-
poses: providing insight into the effectiveness of current offcial re-
sponse systems; helping to advance the feld by providing offcials
with access to information; creating opportunities to reduce the inci-
dence of child sexual abuse; and helping to optimize service response
and delivery.
Project phases The project is broken into three cycles. The frst as-
sesses the problem scope and nature, and evaluates the service sys-
tem structure and processes. In the second cycle, the survey results are
used to inform solutions and build momentum with key stakeholders
who can assist with advocacy efforts and coalition building, and then
implement solutions to address the problems identifed. Finally, the
third cycle assesses changes in the scope of the problem and evalu-
ates improvements in services.
Completed work Successful surveys have already been conducted
in Switzerland and China, drawing attention to the magnitude of the
problem in both countries and highlighting priorities to advance the
child protection feld. Studies in both countries confrmed considerable
levels of child victimization, most of it unreported further evidence
that victimization affects all children regardless of their geographic
location. Research also confrmed the negative consequences of this
exposure, and identifed different risk factors in these two countries.
Next steps In 2012, the project will continue in China and Switzer-
land and also be expanded to Africa and Latin America.
Learn more www.optimusstudy.org
31
Grantee spotlight: Preventing sexual abuse by
improving mothers parenting skills
Problem Domestic violence and sexual abuse are widespread
phenomena in Nepal (documented by the UN study on violence). Be-
ing directly or indirectly a victim of sexual violence can deeply affect
a childs emotional and social behaviors. Parent-child interactions are
essential to prevent violence and sexual abuse.
Solution Prevent sexual abuse by supporting mothers parenting
skills, since mothers have a major role in families dynamics affected
by sexual abuse. Replicate a proven model in Spain based on the theo-
ry that good treatment and supportive family relationships can build
resilience against violence and sexual abuse. Identify and disseminate
the projects impact and effectiveness in Nepal.
Partners BICE (International Catholic Child Bureau), Institute for
Training and Research on Resilience and Violence and its Consequenc-
es (IFIV), Social Service Department University in Nepal, Aawaaj.
Opportunity areas in child protection
Strengthen capacity Develop the skills of funders and implement-
ers through training. Harness and enhance local knowledge and
capacity.
Build a culture of evidence Develop assessment tools, methods
and best practices for the feld. Leverage existing research, integrate a
research component into implementation projects, involve community
leaders and make evidence-informed decision making the norm for
this sector.
Communicate what works Develop, codify and disseminate
knowledge to all stakeholders in order to advance the state of this
sector, improve policy and practice, promote more funding and provide
greater legal protection for children.
Manage knowledge, communicate and advocate
Building a nascent feld like child protection
requires an upfront investment in developing,
spreading and harnessing knowledge. But devel-
oping this culture of evidence isnt suffcient.
There also needs to be a concerted effort to syn-
thesize information, codify and communicate
knowledge in a way that is accessible and credible
for a range of stakeholders. The next step is to
leverage that knowledge and use networks to
reach policymakers and other infuencers. This will
ensure more support for the feld, better and
properly enforced regulations, and a coordinated
system which does not tolerate sexual abuse of
children.
Closing thoughts
We identifed sexual violence and abuse as the
foundations focus within the feld of child protec-
tion. We also identifed prevention as the stage
where we can have the greatest impact since all
potential victims are included. Because child pro-
tection is a relatively new feld, it is inhibited by
the absence of three fundamentals: skills, evi-
dence, and understanding of cause and effect.
We developed three feasible and attractive oppor-
tunity areas to address these gaps, and tested our
hypotheses with experts. These three opportunity
areas exhibit meaningful overlap with our current
child protection portfolio, and offer a starting
point for development of the next UBS Optimus
Foundation strategic plan.
Sectiontitle
32
33
Background
The UBS Optimus Foundation has had a long-
standing interest in global education. Our frst
grants in this feld supported access to education
and vocational training, but we adjusted our focus
in 2009, prioritizing early childhood care and edu-
cation (ECCE). Within the ECCE category, we cur-
rently make grants in three areas which 1) support
programs to improve ECCE quality; 2) link cogni-
tive stimulation and health in early childhood; and
3) link education and child protection in early
childhood. The current annual funding for educa-
tion grants is approximately 7.6 million US dollars.
Our education work is infuenced by three major
trends, all of which appear to be positive for the
feld. First, stakeholders are increasingly focused
on delivering improved learning outcomes for chil-
dren rather than simply providing access to educa-
tion. This focus on learning outcomes is important
for several reasons. It is an unfortunate reality that
even if students attend school, they may not be
learning. Enrolled students fail to learn if schools
lack critical infrastructure, teachers are not moti-
vated, or parents do not or cannot support
study at home (homework).
The second trend fnds donors and practitioners
paying increased attention to the hardest-to-reach
children. Some are living in physically remote rural
locations; many are in somewhat more accessible
but diffcult environments such as urban slums.
Wherever they are, these are the children who
havent been included in past education pro-
grams. Efforts are now focused on ensuring that
even the hardest to reach children are provided
quality educational opportunities.
Third, there is growing interest in linking health
with education, especially in early childhood.
Research demonstrates that model programs in
low- and middle-income countries combining
nutrition, psychosocial stimulation and basic
healthcare achieve the greatest impact with disad-
vantaged populations.
62
For example, treating
intestinal worms which infect a quarter of the
worlds population with high prevalence among
school-age children
63
in schools makes a great
deal of sense.
In Kenya, one study compared children who
received deworming pills for one year with
another group that received treatment for two
years. The children with the two-year intervention
stayed in school longer and also went on to earn
20 percent more when they reached young adult-
hood.
64
Health and education are also linked in
many Latin American countries where preschool
students receive school-based meals sprinkled
with micronutrient packets.
Landscape scope and process
In 2012 we conducted a child education land-
scape analysis to identify feasible and attractive
opportunity areas for the Optimus Foundation to
consider when setting its foundation strategy and
determining future program priorities. Here, we
present promising ideas and entry points and
the rationale behind them.
Child education
Access to quality education is a major challenge for children growing up in
remote settings like these boys in Afghanistan: the trip to and from school can
take hours each day, and there is no guarantee that upon arrival they will fnd
a well-trained and motivated teacher ready to teach them.
34
Key defnitions
We began the child education landscape by defn-
ing key terms. The United Nations Convention of
the Rights of the Child defnes a child as anyone
under the age of 18. While we are passionate
about education for all children, we place a strong
emphasis on children under the age of 8. It is well-
demonstrated that the greatest opportunity for
impact arises from early childhood programs in
this age range. According to The Lancet, Early
childhood is the most effective and cost-effcient
time to ensure that all children develop their full
potential.
65
To defne vulnerability, we consulted four indices
which assess dimensions of poverty and educa-
tional success. The Bristol Child Deprivation Index
and the Oxford Multidimensional Poverty Index
(MPI) both take a multi-dimensional view of pov-
erty and can be disaggregated to focus on educa-
tion-specifc deprivation. Bristol measures numer-
ous characteristics, including formal education.
The MPI covers 10 deprivation indicators, with
two years of schooling and school atten-
dance focused on education. We also con-
sulted UNESCO Statistics on the number of
school-age children who are not in school. Finally,
we examined the UNDP International Human
Development Index (HDI) which measures health,
education and living standards. The HDIs educa-
tion dimensions include mean years of schooling
for adults, and expected years of schooling for
children.
Applying these four indices helped us to defne a
set of sample countries for further analysis. Based
on educational vulnerability indicators, 14 nations
India, Ethiopia, Nigeria, Bangladesh, Tanzania,
China, Pakistan, D.R. Congo, Niger, Chad, Afghan-
istan, Mali and Colombia immediately stood out.
To this list we added two Latin American countries
Brazil and Mexico where UBS has a strong
presence and the potential to leverage its infu-
ence on behalf of vulnerable children. Egypt was
also included to represent the North Africa / Mid-
dle Eastern region. More than 70 percent of the
worlds educationally vulnerable children live in
these 17 sample countries.
17 countries selected
assample for education
landscape exercise
Child education
35
Our analysis also demonstrated that there are
huge education differences within countries, espe-
cially in middle-income countries. India is a good
example. Despite its progress toward certain
Millennium Development Goals and its recent re-
classifcation from low-income to middle-income
status, the sub-continent contains large pockets of
illiteracy. Some regions have literacy rates below
40 percent, which is worse than in many low-
income countries.
To ensure that we reach the most vulnerable popula-
tions, we included a number of middle-income coun-
tries with signifcant internal educational disparities.
These include Brazil, China, Colombia, India, Mexico
and Pakistan. The rapidly changing geography of
global poverty 72 percent of the worlds poor now
live in middle-income countries reinforced this deci-
sion (low-income states were home to 93 percent of
the worlds poor just two decades ago).
66
Literacy rate map illustrates pockets of proverty
in a middle income country
in %
Jammu and
Kashmir
Rajasthan
Himaghal
Pradesh
below 40
4050
5060
6070
7080
8090
90100
Punjab
Gujarat
Kerala
Tamil
Nadu
Karnataka
Andhra
Pradesh
Maharashtra
Madhya Pradesh
Chhattisgarh
Orissa
Sikkim
Meghala
Tripura
Mizoram
Manipur
Nagaland
Arunaghal
Pradesh
Assam
Harkhand West
Bengal
Bihar
Uttar
Pradesh
Haryana
Uttaranchal
Source: Census India Maps 2001
Select terms in the education feld
As discussed in the next section, educational vulnerability stems pri-
marily from three factors: lack of readiness for learning, lack of access
to education, and low quality education. Here, we defne key terms
that refect these factors and that will be used throughout this report:
Early Childhood Care and Education (ECCE) The period designat-
ed as early childhood begins at birth and continues through the eighth
year of life. It is the most critical period for brain growth and has sig-
nifcant impact on the childs future overall well-being. Successful EC-
CE programs follow an interdisciplinary approach and focus on health,
nutrition, education, living conditions, child protection and social wel-
fare. In addition to pre-primary schooling, usually beginning at age 3,
ECCE focuses on the links between a young childs cognitive, social,
and emotional development and the institutions or individuals re-
quired to deliver care.
Education for All Initiative (EFA) Launched in 1990, this initiative
was designed to bring the benefts of education to every citizen in
society. A coalition of national governments, civil society groups and
development organizations including UNESCO and the World Bank
committed to ensure that by 2015 all childrenhave access to and
complete, free, and compulsory education of good quality. EFA also
includes a commitment to expand and improve comprehensive early
childhood care and education, especially for the most vulnerable and
disadvantaged children. In 2000, 189 countries adopted two EFA
goals, which are also among the Millennium Development Goals.
67
Access to Education This term refers to students ability to access
appropriate educational institutions, materials and personnel.
68

Educational Attainment Often the focus of governments and do-
nors and frequently measured as matriculation grade educational
attainment refers to the highest grade an individual has completed or
the most advanced level attended in the educational system of the
country where the education was received.
69
Educational Achievement This refers to a set of capabilities lit-
eracy, numeracy, cognitive skills, critical thinking, knowledge, and so-
cialization that a child has acquired at any stage and that infuence
his or her ability to be a productive citizen.
70
36
Child education
The state of education for vulnerable children
There are approximately 1.8 billion school-aged
children in the world today, and more than half of
them do not receive basic quality education
71
. Lack
of access to adequate education fuels and facili-
tates the cycle of poverty. For the poorest children,
poverty is both a cause and consequence of lack
of education. Several statistics illuminate the
severity of the situation:
In the developing world, one third of all children
below the age of six will start primary school
with their bodies, brains, and long-term learning
prospects permanently damaged by malnutri-
tion and ill health.
72
The number of children out of school is falling
too slowly. In 2008, 67 million children were out
of school.
73

If progress does not improve, there will still be
56 million primary aged children out of school
by 2015. Of these, 23 million will be in sub-
Saharan Africa and a majority will come from
marginalized communities, especially those
affected by confict.
74
Millions of children leave school without acquir-
ing basic skills. In some sub-Saharan African
countries, young adults with fve years of educa-
tion have a 40 percent probability of being
illiterate. In the Dominican Republic, Ecuador
and Guatemala, less than half of grade three
students had more than very basic reading
skills.
75
We identifed a number of barriers to education in
low- and middle-income countries. The enormity
of some of these barriers poverty, for example
require enormous structural, political and eco-
nomic changes that exceed our resources. Wars,
conficts and natural disasters often prevent chil-
dren from attending school and result in exclusion
of certain groups. Gender norms, discrimination
and ethnic marginalization exacerbate educational
attainment of particular populations.
Through this analysis, we identifed several barri-
ers that could be addressed by the Optimus Foun-
dation. These are described below.
Child education barriers: our priorities
Teachers arent teaching
Children cannot learn if teachers do not teach.
Too often, teachers fail to show up for work;
teacher absenteeism is a serious but neglected
issue within the education feld. In 2002 and
2003, the World Bank examined this problem in
six countries Bangladesh, Ecuador, India, Indone-
sia, Peru and Uganda and found that, on aver-
age, teachers miss one day of work each week.
The situation is worse in Uganda and India where
the ratio is one day in four. In India, the research-
ers noted that instead of teaching, teachers are
often reading a newspaper, drinking tea or social-
izing with colleagues.
76
And there are scant conse-
quences for delinquent teachers: only 1 in 3,000
headmasters had ever fred a teacher for repeated
absences.
77
This problem is attributed to a lack of accountabil-
ity, incentives and motivation. Teachers have rela-
tively low social status in many communities,
which has a negative infuence on their behavior.
In many regions, especially remote regions, there
are few candidates for the job, and teaching is
often considered employment of last resort for
university and secondary school graduates.
78

Teachers are often poorly compensated, and many
need to secure additional income from private
tutoring and other activities.
79
When educational
reforms take place, teachers may be assigned
additional workloads without additional compen-
sation or acknowledgment. This further reduces
motivation and engagement, and presents an
additional challenge.
80
Teacher absence in government schools
in %
Jammu and
Kashmir
Rajasthan
Himaghal
Pradesh
1418
1822
2226
2630
3034
3438
3842
Punjab
Gujarat
Kerala
Tamil
Nadu
Karnataka
Andhra
Pradesh
Maharashtra
Madhya Pradesh
Chhattisgarh
Orissa
Sikkim
Meghala
Tripura
Mizoram
Manipur
Nagaland
Arunaghal
Pradesh
Assam
Harkhand West
Bengal
Bihar
Uttar
Pradesh
Haryana
Uttaranchal
Source: World Bank study by Chaudury et al, 2006
37
Parents have no faith in education
Teachers arent the only ones who may lack moti-
vation. Some children arent being sent to school
because their parents have no faith that education
is a worthwhile investment. Some parents may
believe that existing primary education holds little
value, and that secondary education is only useful
for securing government employment. In some
communities, parents do not see schools as part
of their community nor do they feel they can exert
infuence over what happens in them.
81
In the
eyes of many low-income families in rural areas,
schooling has become a system of extracting a
small minority of the youth from their local com-
munity, leaving behind little of local value for
those who do not pass the stringent selection
exams, and, in many cases, alienating those who
do leave their culture of origin.
82
But even if parents value education, the immedi-
ate opportunity costs are often too high. Children
provide a valuable labor source for the poorest
families. They tend agricultural crops, herd live-
stock, care for younger siblings and elders, or par-
ticipate in unskilled labor. Under these circum-
stances, time spent in school isnt necessarily
viewed as a good investment, and the future pay-
off from the students potential earnings doesnt
help the family today. Furthermore, future earn-
ings of educated persons, such as teachers, are in
many cases still lower than earnings for profes-
sions which require no formal education, such as
factory work.
The actual cost of schooling may be prohibitive as
well. Many free public schools have hidden
costs including the need to purchase uniforms,
books and other supplies. Considering the oppor-
tunity costs, and actual costs, many parents make
a rational choice not to send their children to
school.
Gender norms are also a signifcant factor in some
cultures. When parents can only pay for one child,
they will often send their son, making it extremely
diffcult for girls to complete the full school cycle
in many societies. This is doubly unfortunate
because research has shown that the children of
literate mothers have signifcantly higher educa-
tional outcomes (when all other factors are con-
trolled).
Teachers lack basic skills
Many countries do not provide adequate training
or continuing education for teachers. The result
isclassrooms flled with ill-equipped educators
who lack theoretical and practical skills to engage
and challenge their pupils. Teachers are often
only slightly better educated than their students;
in primary schools in some African countries (for
example, Madagascar and Malawi) most teachers
have only had two years of secondary educa-
tion.
83

Successful education systems must support both
basic and ongoing teacher training. This is critical
to achieve the required minimal quality standard
and to ensure that teachers have the necessary
skills to teach specifc class levels and student seg-
ments.
84

Unfortunately, comprehensive teacher training is
virtually non-existent in many low- and middle-
income countries.
Trained Ieachers (sampIe counIries, 2011)
|
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$CPINCFGUJ
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&4QH%QPIQ
'I[RV
'VJKQRKC
/CNK
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0KIGT
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0.0 4.5
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100
100
96
90
96
15
66
66
83
39
64
50
81
58
50
96
92
33
6TCKPGFVGCEJGTUKPRTKOCT[UEJQQN 6TCKPGFVGCEJGTUKPUGEQPFCT[UEJQQN
Source: UNESCO Statistics 2012
38
Child education
Inadequate systems and infrastructure
The availability of schools and skilled, committed
teachers isnt enough. Poorly managed education
systems marked by an absence of strategic
thinking and leadership, often subject to disrup-
tive and frequent policy changes do not serve
students well. Schools need strong leaders and
advocates, suffcient and steady budgets, effcient
and effective policies, and effective management
and accountability systems to realize success in the
classroom.
When schools are poorly organized, and teacher
compensation systems are mishandled, students
suffer. Teacher management at the national and
sub-national levels is nothing short of chaotic in
many countries . In some sub-Saharan African
countries, teachers regularly miss classes because
they have to travel regularly to the capital to col-
lect their own salary.
85
Generally, ensuring regular
pay of the teachers monthly salary appears to be
a serious challenge for various governments.
86
Learning is also seriously limited when teaching
materials, books, supplies, basic amenities and
curricula are insuffcient, inappropriate or other-
wise ineffective. Because in many developing
countries, both the curriculum and the teaching
are designed for the elite rather than for the
regular children who attend school, attempts to
improve the functioning of the schools by
providing extra inputs have generally been disap-
pointing.
87

Many classrooms are overcrowded with as many
as 100 pupils per teacher. In addition, many
schools suffer from unsafe water, inadequate sani-
tation and poor hygiene facilities. This affects the
health and safety of children as well as their edu-
cational achievements. Corporal punishment, mar-
ginalization and humiliation by teachers and other
students can also contribute to making schools
stressful places where children do not want to go.
Needs: defning the problem
These barriers to education for vulnerable children
result in three main problems that help to explain
why children do not thrive under the current cir-
cumstances:
1. Children are not ready for the transition into pri-
mary school
2. Children lack access to schools
3. Children are not getting quality education
Getting children ready to learn
Educational readiness refects a childs age-appro-
priate ability to engage in and beneft from initial
learning experiences. These abilities include social
and emotional skills, cognitive skills and general
knowledge, language skills, physical well-being
and motor development. All are critical prerequi-
sites for children to succeed in the frst years of
primary school. Readiness is essential for long-
term educational success. Childrens readiness for
school has a positive infuence on childrens overall
educational accomplishments over the course of
their entire lives, which go beyond the mere learn-
ing experience in a formal school setting.
Mental and physical stimulation during early child-
hood is essential: the period from birth to age 8 is
the most critical period of growth and learning in
a persons life.
88
Unfortunately, early childhood
care and education (ECCE) programs generally do
not reach the poorest and most disadvantaged
children who stand to gain the most from them in
terms of health, nutrition and cognitive develop-
ment. The situation is particularly grave in south
Asia and sub-Saharan Africa where over 200 mil-
lion children under 5 years are not fulflling their
developmental potential.
89
Such children are
insuffciently prepared for formal learning, and
unable to beneft fully from subsequent schooling.
It is important to note that while middle and
upper class children may achieve readiness outside
of formal school settings through appropriate
stimulation and care at home or in their communi-
ties poor children often live in environments
where this is not possible. For them, ECCE pro-
grams are essential, but often unavailable.
UNESCO data on pre-primary (day care) enroll-
ment can be used as a proxy for broader ECCE
access. In 2011, only fve percent (or less) of chil-
dren in Chad, D.R. Congo, Ethiopia, Mali and
Niger were enrolled in pre-primary centers.
NeI enroIImenI raIes in pre-primary schooI
o! age group (sampIe counIries, 2011)
KP
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Source: UNESCO Statistics 2012

39
Ensuring access to education
We believe that all children regardless of socio-
economic status, ethnicity, location, religion, gen-
der, physical characteristics or political status
should be able to take advantage of appropriate
educational opportunities. Access to education
also means that children must be able to reach
schools without being harmed, and they must feel
safe free from actual or perceived violence or
abuse once they arrive. Unfortunately, this is the
exception, not the norm, for many children.
ChiIdren ouI-o!-schooI (sampIe counIries, 2011)
|
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8
18
38
78
26
58
39
33
51
1
4
38
66
6
2
12
2TKOCT[UEJQQNCIG 5GEQPFCT[UEJQQNCIG
Source: UNESCO Statistics 2012
Despite widespread global commitment to the
Education for All (EFA) initiative, too many poor
and marginalized children are still out-of-school.
Such absenteeism is attributed to any number of
causes including distance to schools, schools that
are isolated or in dangerous locations, and schools
that lack suffcient facilities such as bathrooms
(which means that children, particularly menstru-
ating girls, cannot comfortably attend). Teachers
may be abusive. Family responsibilities including
work and caretaking may prevent children from
attending school. The list goes on
As illustrated in the fgure above, the situation is
bleak in many countries and unless critical action
is taken, the future may be even bleaker. The
2011 UNESCO EFA Global Monitoring Report con-
cludes that if current trends continue, there could
be more children out of school in 2015 than there
are today.
90
Ensuring quality education
Quality education requires adequate educational
resources (books and other teaching materials and
supplies), stimulating and relevant curricula,
proper organization (performance monitoring and
small class sizes), as well as competent and
respectful teachers. Improving the quality of learn-
ing, according to UNESCO, is extraordinarily diff-
cult but absolutely essential to reaching universal
primary education.
91
Merely attending school is not enough. Even
when children enroll in primary school, millions
enter late, drop out early, or never complete a full
cycle. Poor teacher quality and a lack of educa-
tional materials exacerbate the problem. As a
result, many children with access to education still
do not acquire basic skills to become successful
adults. Recent studies reveal the global extent of
this problem.
92 93 94
For example, in some countries
in sub-Saharan Africa, young adults with fve years
of education had a 40 percent probability of being
illiterate.
Low educational achievement also impacts self-
esteem and motivation. A child who expects to
fnd school diffcult will probably blame herself
and not her teachers when she cant understand
what is being taught, and may end up deciding
shes not cut out for school stupid, like most of
her ilk and give up on education altogether.
95
Approaches
Thus, we have identifed and are committed to
addressing the key needs of readiness, access
and quality for vulnerable and hard-to-reach chil-
dren. Considering the many barriers that stand
between such children and educational achieve-
ment, we selected three philanthropic
approaches that are attractive and feasible for
the Optimus Foundation to pursue. These are:
behavior change programs, capacity enhance-
ment and skills development, and enabling sys-
tems and infrastructure development three of
the 6 types of social intervention described in
a recent McKinsey publication, Learning for
Social Impact: What Foundations Can Do.
96
40
Child education
Motivate change
The frst approach focuses on shifting the way all
stakeholders behave towards education, creating
an environment in which both giving and receiv-
ing an education is more highly valued and
encouraged. Behavior change happens when peo-
ple are motivated by opportunities and incentives,
or new information, to adjust their mindset, make
different choices, and take new action. In many
cases, various incentives in education are known,
but need to be adapted to new local contexts.
Incentives can be either fnancial and non-fnancial
though fnancial incentives get the most attention.
For example, one study found that when teacher
compensation was linked to attendance, teacher
absenteeism fell from 42 to 21 percent. Students
also benefted, obtaining higher test results which
facilitated their entry into better schools.
97
Finan-
cial incentives can also motivate parents to send
their children to school. For example, Mexicos
Oportunidades program provides conditional cash
transfers to parents who send their children to
school and who get their children vaccinated.
98

Non-fnancial approaches also work. For example,
mothers groups can be powerful and cost-effec-
tive vehicles for change. When women convene
regularly, they work together to overcome shared
diffculties and create better futures for their entire
families. The group format is an effcient delivery
model which encourages knowledge sharing to
affect change. Other examples include the use of
locally relevant curricula based on local traditions
rather than imported textbooks as an incentive
to motivate attendance and attention in class.
For educators, accountability helps strengthen
capacity within the system. The Indian NGO
Pratham sets a nationwide benchmark for educa-
tion in its Annual Status of Education Report (ASER
survey). This report allows teachers, school person-
nel and parents to monitor school performance.
Results are published in the national press, encour-
aging schools to raise their standards. In Uganda,
the introduction of school scorecards with commu-
nity monitoring has resulted in improved pupil test
scores, and increased pupil and teacher attendance.
Strengthen human and organizational capacity
The second approach focuses on developing,
adapting, and testing new and alternative ways to
strengthen stakeholders skills and knowledge.
While respecting local expertise, indigenous
knowledge and community traditions, it is possi-
ble to bring new information and techniques that
help children prepare for school and help schools
prepare for children.
For parents, this can mean improving critical care
skills through instruction about their childrens
feeding, learning and emotional needs. Interven-
tions can also promote parents responsiveness
and attachment, encourage reading and play, and
suggest positive approaches to discipline. To work
well, good parenting programs need to be
adapted to ft local sociocultural contexts.
For teachers and school administrators, various
interventions are well-known but need to be
adapted to local contexts. For example, training-
the-trainer programs for continuing education of
teachers have been shown to be effective in differ-
ent settings. Other interventions have not yet been
developed or perfected, for example to make the
most effective use of new information and commu-
nications technologies to improve teachers skills.
Develop enabling tools
The third approach focuses on developing, adapt-
ing and testing new teaching tools, models and
systems that contribute to an enabling environ-
ment for childrens education. The focus is on
improving the infrastructure including course
materials, curricula, teaching tools, educational
software, teacher performance management sys-
tems and business models needed to help teach-
ers teach and students learn, and for schools to be
managed more effectively.
For communities, an innovative method of insti-
tuting daily payment of school fees, with no hid-
den extra costs (fees include uniform, food, trans-
port, books, etc) has been shown to widen access
to those who would normally be out of school or
in government schools. Managing a smaller daily
cash fow is an enabling tool for children to go to
school without the sudden fnancial shock associ-
ated with buying uniforms, books and school sup-
plies (and teacher fees even in supposedly free
government schools).
99
An integrated cloud-based school management sys-
tem is a new enabling tool for educators, with a
database of all students available online. Staff
equipped with portable tablets can track attendance,
students test results and payments more effectively.
Sometimes this requires rethinking assumptions
about education for vulnerable students. Other
funders and local governments focus on building
schools and hiring teachers to improve access to
education. This is a necessary frst step, but not
our role. Our goal is to help create an environ-
ment in those schools that enables children to
learn.
41
Opportunity areas
To identify opportunity areas where the Optimus
Foundation might focus in education, we mapped
needs (readiness, access and quality) against the
three approaches (motivate change, strengthen
human and organizational capacity, and develop
enabling tools). The following opportunity areas
represent a set of attractive and feasible options
for the Optimus Foundation (see fgure below).
Motivating early education
Defnition: This Opportunity Area involves adapt-
ing known incentives to new local socioeconomic
contexts, and testing their effectiveness in moti-
vating parents, communities and educators to
improve early childhood emotional, social and
cognitive development. Non-fnancial incentives
may include information and evidence; recogni-
tion of innovative achievement by groups or indi-
viduals; development of locally relevant curricula;
mentoring; and peer leadership training. Financial
incentives may include conditional cash transfers,
vouchers, and approaches to lower tuition fees or
to disperse hidden school costs over time in order
to reduce fnancial burden.
Rationale: Early childhood interventions have dem-
onstrated a high social return, but they are very
dependent on parental involvement and commu-
nity engagement. Too often, parents and commu-
nities lack information, incentives, resources and
opportunities needed to prioritize or adequately
support early childhood education. While the ele-
ments of behavior change have been well studied,
most of the research has been concentrated in
high-income countries.
Opportunity areas in education
Readiness Access Quality
Motivate charge Motivating early education
Strengthen human and organiational capacity Children ft for school Schools ft for children
Develop enabling tools
Grantee spotlight: Fair start Turkey and
motivating ECCE
Problem 30 percent of people in Turkey reside in rural areas. They
have signifcantly lower incomes, less access to education, and lower
health indicators than the general population. More than 1 out of 4
women in rural areas have never had any form of schooling. Hygiene
standards are extremely low only 41 percent of toilets are connected
to a drainage system. One out of 3 children living in rural Turkey are
not vaccinated against common childhood diseases, and infant mor-
tality in rural areas is 10 times higher than the national average.
Solution The Turkish NGO, Mother Child Education Foundation (ACEV),
strengthens the skills of parents and teachers in impoverished rural
communities to help prepare young children for formal school settings. It
brings together mothers groups as the delivery point for training and
skills building. The program has demonstrated measurable results includ-
ing improved hygiene through increased hand-washing, and reduced
corporal punishment. Fathers are engaged through traditional coffee-
house meetings. ACEV also builds bridges between mother groups and
government initiatives, and helps motivate preschool teachers and school
administrators.
Benefciaries This project reaches 1,880 children between 56
years old who are enrolled in preschool classes in 24 villages in
Central Anatolia, and provides indirect benefts to an additional
2,430 children between 06 years old.
42
Child education
Children ft for school
Defnition: This Opportunity Area involves devel-
oping, adapting and testing the effectiveness of
innovative new ways to stimulate emotional,
social and cognitive development during early
childhood. The focus is on strengthening the skills
of parents, communities and educators, and
improving systems and processes to create the
right environments for early childcare and educa-
tion. For example: good parenting programs
linked to community preschools; innovative transi-
tion models; networks and communities-of-prac-
tice for pre-primary centers and staff; and micro-
franchise crche models.
Rationale: Parents and communities need skills to
contribute to childrens emotional, social, and cog-
nitive development, enabling a smooth transition
from community to primary schooling. This frag-
mented area currently receives little donor or local
government support. There are several interven-
tions that can help to promote student readiness.
These include good-parenting programs, which
are linked to community preschools and primary
schools.
Grantee spotlight: Preschool for all children
Madagascar
Problem In Madagascar, primary education is compulsory between
the ages of 6 and 14. Children under six represent 20 percent of total
population, but in 2008 the government spent only 0.05 percent of its
total budget on education, and only 0.22 percent of that on Early
Childhood Education. National guidelines for early childhood educa-
tion have not been formalized. Only 7.3 percent of three to fve year
olds have access to preschool, mostly in urban areas. Madagascar has
3,275 preschool centers, but only 200 of these are in the public sector.
Private preschools are prohibitively expensive for most parents two
thirds of whom live below the poverty line.
Solution The Swiss NGO Aide et Action helps children acquire
knowledge and life skills at an early stage, preparing them for school
and supporting them during the frst years of primary education. This
Early Childhood Care and Development (ECCD) project places a strong
premium on parents, who are seen as critical to their own childrens
education. Researchers are working to link public and community pre-
schools, and to build partnerships between the Ministry of Education,
local communities, preschool educators and school headmasters. Their
primary focus is on semiurban and rural communities.
Benefciaries Through our support to this project partner, roughly
7,000 small children from resource-poor communities are enrolled in
ECCD programs half of them young girls. Locally appropriate pre-
school training schemes have been developed. Long term goals are to
build strong community consensus on the importance of preschool
education, and to increase funding and improve management of pre-
schools by the Government.
Schools ft for children
Defnition: This Opportunity Area involves devel-
oping, adapting and testing the effectiveness of
innovative new ways to improve child achieve-
ment in literacy, numeracy, critical thinking and
socialization. The focus is on strengthening the
skills of teachers and school administrators, com-
munities and parents, and improving systems and
processes to create enabling environments for
quality education. For example: educational meth-
ods and materials (including software) for chil-
dren, and for teacher training; community school /
low-cost private school federations; train-the-
trainer programs for teachers; and school perfor-
mance management & accountability systems.
Rationale: To ensure that schools serve children of
all ages, there must be a focus on quality educa-
tion. Clear metrics must be in place to ensure that
children achieve tangible outcomes and advance
to new learning levels.
Within this opportunity area, we aim to
strengthen the skills of teachers and school
administrators, and to improve underlying educa-
tion systems and processes, including school
management. Schools must be staffed with suff-
cient competent teachers and shaped by benef-
cial policies that support student achievement in
literacy, numeracy, critical thinking, and socializa-
tion.
43
Grantee spotlight: Access to quality education in India and Ghana
Context Recent research across India and sub-Saharan Africa has revealed an extraordinary phenomenon: poor families are sending their
kids to private schools in huge numbers. This is due to the emergence of private schools that charge very low tuition fees and are affordable to
families on the poverty-line. More than 2/3rds of all school-age children in poor urban areas of sub-Saharan Africa and India now attend low
cost private schools (2533% in rural areas). In impoverished areas of China and India, researchers have discovered thousands of such schools
where none offcially existed and measured educational outcomes far higher than local public schools (which often suffer from teacher ab-
senteeism, poor teacher training and low school management quality).
Challenge Quality varies enormously among low cost private schools. Support is needed to improve teaching and business models for
such schools in order to increase access to quality education for poor families. Low cost private schools remain controversial in the education
feld. Therefore, rigorous testing is needed to validate alternate models (e.g., micro-franchises; pooled procurement of quality teaching materi-
als; and comprehensive daily or weekly fees to avoid fnancial shocks from annual or monthly tuition fees, the purchase of uniforms, books and
other school materials).
Project This project strengthens local chains of private schools to provide quality education for poor families in Ghana and India. It uses a
three-pronged approach to improve the quality of learning. First, it provides tools including locally relevant curricula, assessment methods,
lesson plans and teacher manuals a school-in-the-box model. Second, it strengthens skills by training teachers, supervisors and school
managers from the local community. Finally, it offers quality schooling that is affordable to poor parents. The vision of the project partner is to
create a global movement of small franchise chains of low cost private schools. The project also includes an evaluation to test children in
project schools and control groups (local public schools as well as other private schools) to measure the impact of this intervention.
Benefciaries 18,240 children enrolled in 34 schools in Ghana, and 8,000 children enrolled in 20 schools in Andhra Pradesh, India (at least
fve percent of children all from the lowest wealth quintile will be on scholarships).
Opportunity areas in child education
Motivating early education Parents, educators, and communities
can be encouraged to promote early education through fnancial and
non-fnancial incentives.
Children ft for school Teachers, administrators, parents, and
communities require strong skills to create and support preschool
intervention programs and transition into primary schools.
Schools ft for children Effective, relevant and affordable tools
and systems can help boost quality education for children.
Closing thoughts
Vulnerable children are not ready for school; they
lack access to education, and they are disadvan-
taged by low quality educational opportunities. A
number of key barriers prevent vulnerable children
from receiving a quality education. Parents, com-
munities and teachers may not value education
and are not motivated to provide high quality edu-
cational opportunities for children. Insuffcient
resources, low human capacity, poor supervision,
and inappropriate didactic tools all result in a low
quality educational experience and low-perform-
ing schools that produce students with insuffcient
numeracy, language and other skills.
There are three ways to address these barriers: by
motivating change, strengthening human and
organizational capacity, and developing enabling
tools and systems. After mapping the needs
against our chosen approaches, we arrived at
three opportunity areas which have meaningful
overlap with our current portfolio and offer a logi-
cal future focus.
44
45
A brief summary: how we identifed
opportunity areas
The UBS Optimus Foundations next fve-year stra-
tegic planning process is scheduled to begin in the
next year. In anticipation, we conducted this phil-
anthropic market analysis to better understand the
development landscape in which we work, and
refresh our knowledge of the key trends, barriers,
and opportunities in each of our granting areas.
Mindful of the foundations size, resources, guid-
ing principles, and capabilities, we also want to be
realistic about the high impact goals the founda-
tion can expect to accomplish in the next few
years.
Eight criteria social impact, innovation, evidence,
capacity strengthening, bridge the gap, intui-
tive, and Optimus / UBS capabilities helped us
screen the available options. We mapped possible
approaches against needs in each of the three
felds, and defned specifc opportunity areas
within child health, child protection, and child
education as summarized on the next page.
Complementarity among UBS Optimus
Foundation Granting Areas
Although we conducted separate landscaping
exercises for each of our three focus felds, child
health, education, and protection are highly inter-
related. Childrens overall well-being is dependent
on the attainment of good health, educational
opportunities and protection from violence and
abuse. We highlight the following relationships
and connections:
Health: When children are sick with any of our fve
priority health conditions perinatal conditions,
respiratory infections, diarrhea, malnutrition, or
worms their ability to thrive is signifcantly
impacted, and so are their educational opportuni-
ties. Because poor health weakens children and
limits their mobility and motivation, many sick chil-
dren do not attend school. Those who do attend
are in no position to learn and often suffer aca-
demically.
Health conditions that affect very young children
those under fve have signifcant long-lasting
consequences that manifest several years later,
when its time to go to school. For example,
undernutrition in children who are under two
years of age, causes permanent damage to cogni-
tive ability.
Encouragingly, though, investment in child health
interventions especially if they are conducted in
early childhood before children are ready for
school has positive educational effects. Proper
diagnosis of childhood fever and deworming both
lead to long-term improvement in educational and
professional outcomes.
Education: The relationship between health and
education also works both ways education posi-
tively impacts health. Enhanced early childhood
education, in particular, improves childrens health
and health behaviors. The reason for this is simple:
children learn a number of skills at school, includ-
ing how to take care of themselves, prevent sick-
ness, and make healthy choices about diet, nutri-
tion, and sanitation practices.
Conclusion
Understanding the basic packages of what it takes for children to survive and
thrive in their local settings is one of the best investments that can be made.
This is being done by the Mother and Infant Research Activities organization in
their work with Nepalese communities.
46
Conclusion
Children who are surrounded by educated care-
takers also tend to be healthier; educated mothers
who can understand medical advice, and literate
communities are key determinants of health, par-
ticularly among the most vulnerable children.
Finally, educational settings can serve as important
locations for health interventions. Trained medical
professionals and community-based workers can
administer a variety of services vaccines, check-
ups, and even behavior change classes in the
school setting.
At the same time, however, it is important to note
that a negative relationship can exist between
education and child protection. Schools may not
be safe, and children can be abused by peers,
other students, or educators.
Child Protection: Child protection has an effect on
both child health and child education. When
children are subjected to abuse and violence,
there are tremendous negative consequences. The
psychosocial conditions associated with abuse
particularly, persistent fear and abuse negatively
impact a childs learning and healthy develop-
ment.
Abused and neglected children have lower stan-
dardized test scores and school marks, even when
socioeconomic status and other demographic fac-
tors are considered.
Child abuse and neglect are also correlated with
increased public health concerns, including
community and domestic violence, delinquency,
mental health disorders, alcohol and illicit sub-
stance abuse, obesity, suicide, and teen preg-
nancy.
Opportunity areas for child education
Motivating early education Parents, educators, and communities
are encouraged to promote early education through fnancial and
non-fnancial incentives.
Children ft for school Teachers, administrators, parents, and
communities are provided training and assistance to build the strong
skills necessary to create and support preschool intervention programs
and childrens transition into primary schools.
Schools ft for children Effective, relevant and affordable tools
and systems are developed and strengthened to help boost quality
education for children.
Opportunity areas in child protection
Strengthen capacity Develop the skills of funders and implement-
ers through training. Harness and enhance local knowledge and ca-
pacity.
Build a culture of evidence Develop assessment tools, methods
and best practices for the feld. Leverage existing research, integrate a
research component into implementation projects, involve community
leaders and make evidence-informed decision making the norm for
this sector.
Communicate what works Develop, codify and disseminate
knowledge to all stakeholders in order to advance the state of this
sector, improve policy and practice, promote more funding and provide
greater legal protections for children.
Opportunity areas in child health
First minutes of life Addressing the needs of vulnerable children
during this critical period surrounding birth with the adaptation and
delivery of solutions to children (delivery innovation) as well as tai-
lored solutions to ft local socioeconomic contexts.
Child-friendly care Providing appropriate nutrition and care to pre-
vent and treat infections including redesigning or re-formulating
health solutions to make them age-appropriate, and delivery innova-
tion to ensure that health services and products reach children in re-
source-poor settings.
Tailored for kids and communities Involving local communities
and experts to address the multi-dimensional determinants of health
to support the development of effective, sustainable and locally ap-
propriate solutions that meet the health needs of vulnerable children.
47
Shared opportunities in early childhood
care and development are a priority
In each of the three landscapes, we determined
what age range we should focus on, what priority
needs to address, and the best approach for deliv-
ering solutions. This process illuminated common
opportunities across the areas of health, protec-
tion and education that will help us leverage our
impact across the foundation.
Who: We place special emphasis on children age
05 given the high impact potential during the
early childhood years. In Health, the focus is on
surviving childbirth, appropriate nutrition and pre-
venting infections. In Protection, the focus is on
special research into preventive services that will
beneft younger children. In Education, the focus
is on child readiness, teacher quality, and enabling
systems. Further, the focus is on maternal inter-
ventions which beneft children during the early
childhood period, and strengthening capacities
among parents and grandparents to engage con-
structively with younger children.
Where: We identifed school as the ideal location
to administer child health and protection interven-
tions, as well as education interventions that go
beyond traditional academics. School-based inter-
ventions are well-suited for delivering nutrition,
hygiene, health literacy, and immunization pro-
grams as part of broader health initiatives. Schools
have a captive audience and are an excellent
venue to reach a large number of children with
More than two decades ago, the venerable Indian scientist
V. Ramalingaswami said, Its not about more money for health,
but more health for the money. As an independent foundation
seeking to improve child health, safety and education, knowing that
our capacity to do so depends on generous donations from the
clients of a large global bank, we ponder his words. In our view,
we have a great responsibility to children, yet nearly as great
a responsibility to our shareholders those generous clients
to ensure that our philanthropic investments are among
the most effective in the world.
This document reflects our commitment to both.
information and programs focused on how to stay
safe from sexual violence and abuse, and how to
get help if needed. Beyond academics, schools
can provide children with social and life skills and
encourage leadership. In addition, schools can
serve as community anchors, bringing not just par-
ents but other community members together for
their own education, health and anti-violence pro-
grams, and through informal activities which
strengthen community relationships.
How: Capacity strengthening consisting of both
skills building and technical assistance is funda-
mental to achieving goals in the area of early
childhood care and development. Formal support
to build technical knowledge, share best prac-
tices and ingrain polices and procedures is
required for teachers, health practitioners, police
and others addressing issues of child sexual vio-
lence and abuse, school systems, health systems,
policing and judicial systems. Informal support
to build understanding and softer skills for parents
and caregivers so they can help develop readiness
in pre-school age children can be achieved
through community groups and training provided
through community outreach workers.
48
Introduction
1 UNICEF. See http://www.unicef.org/mdg/childmortality.html and
http://www.unicef.org/crc/index_30229.html
Child health
2 Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M,
Marcus JR, et al. (2011) Progress towards Millennium Develop-
ment Goals 4 and 5 on maternal and child mortality: an updated
systematic analysis. Lancet 378: 1139-65.
3 Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA (2005) Commu-
nity-based interventions for improving perinatal and neonatal
health outcomes in developing countries: a review of the evi-
dence. Pediatrics 115: 519-617.
4 Multidimensional Poverty Index (2011). Available: http://www.
ophi.org.uk/policy/multidimensional- poverty-index. Accessed
15May 2012.
5 Minujin A, Nandy S (2012) Global child poverty and well-being:
Measurement, concepts, policy and action. Chicago: The Univer-
sity of Chicago Press.
6 We confrmed that our country selection represented more than
70 percent of vulnerable children according to OPHI (general and
health specifc), Bristol (general and health specifc), DALYs and
World Health Organization mortality rates. We also confrmed that
the sample countries were consistent with common poverty mea-
sures (e.g. children living on less than 1.25 dollars a day) as
reported in UNICEFs State of the Worlds Children report.
7 World Health Organization (2008) The global burden of disease:
2004 update. Geneva: WHO.
8 World Health Organization (2008) The global burden of disease:
2004 update. Geneva: WHO.
9 World Health Organization (2008) The global burden of disease:
2004 update. Geneva: WHO.
10 Macroeconomics and Health: Investing in Health for Economic
Development, Report of Commission on Macroeconomics and
Health, Chaired by Jeffrey Sachs. Submitted to the World Health
Organization, 2001.
11 Bleakley, H (2010) Malaria Eradication in the Americas: A Retro-
spective Analysis of Childhood Exposure. American Economic
Journal: Applied 2:1-45.
12 Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R
(2008) Effect of a nutrition intervention during early childhood on
economic productivity in Guatemalan adults. Lancet 371: 411-6.
13 Bleakley, H (2007) Disease and Development: Evidence from
hookworm eradication in the American South. Quarterly Journal
of Economics 122: 73-117.
14 Baird S, Hicks JH, Kremer M (2011) Worms at Work: Long-run
Impacts of Child Health Gains. Working paper, verion July 2011.
Available: http://elsa.berkeley.edu/~emiguel/workingpapers.shtml.
Accessed 30 May 2012.
15 World Health Organization (2008) The global burden of dis-
ease: 2004 update. Geneva: WHO.
16 UBS Optimus Foundation team analysis. Based on DALYs in mil-
lions in UBSOFs 15 sample countries in 2004. The total DALYs in
millions for perinatal conditions, respiratory infections, injuries,
childhood-cluster diseases, mental health conditions, malaria, mal-
nutrition, congenital anomalies, HIV / AIDS, respiratory diseases
was 348. Perinatal conditions, respiratory infections, and diarrhea
accounted for 172 DALYs in millions, or 50 percent of the burden.
Source: World Health Organization (2008) The global burden of
disease: 2004 update. Geneva: WHO.
17 UBS Optimus Foundation team analysis. In 2004, the DALYs
in millions for children aged 014 in low and middle-income
countries were as follows: perinatal conditions including prema-
turity, low birth weight, birth asphyxia, birth trauma, and infec-
tions was 124; respiratory infections, including upper and lower
respiratory infections was 76; diarrhea was 65; injuries was 47;
malaria was 32; childhood-cluster diseases including pertussis,
poliomyeltitis, diphtheria, measles and tetanus was 30; mental
health conditions was 28; malnutrition was 27; congenital
anomalies was 22; HIV / AIDS was 10; respiratory diseases was 8;
and digestive diseases was 6. Source: World Health Organiza-
tion (2008) The global burden of disease: 2004 update. Geneva:
WHO.
18 UBS Optimus Foundation team analysis. In 2008, the global
deaths in thousands per health condition were as follows: perina-
tal conditions, 1,848 (only prematurity and asphyxia); respiratory
infections 1,575 (only pneumonia); diarrhea, 1,336; malaria, 732;
childhood-cluster diseases, 372; HIV / AIDS, 201; Meningitis, 164;
and other infections, 1,962. World Health Organization (2008)
The global burden of disease: 2004 update. Geneva: WHO.
19 Bleakley, H (2007) Disease and Development: Evidence from
hookworm eradication in the American South. Quarterly Journal
of Economics, 122: 73-117.
20 Black RE, Allen LH, Bhutta ZA, Caulfeld LE, de Onis M, Ezzati
M, et al. (2008) Maternal and Child Under nutrition Study Group.
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21 Hill SR (2012) Putting the priorities frst: medicines for maternal
and child health. Bull World Health Organ 90:236-8.
22 Better Medicines for Children. World Health Assembly
Resolution, WHA60.20, 23 May 2007. Available: www.who.int/
entity/childmedicines/publications/WHA6020.pdf. Accessed
15May 2012.
23 Adeleye OA, Ofli AN (2010) Strengthening inter sectoral
collaboration for primary health care in developing countries:
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2010:272896.
24 Report of the WHO and UNICEF Preliminary Consultation to
Identify Priority Essential Medicines for Child Survival, Copen-
hagen meeting in 2010. Available: http://www.unicef.org/supply/
index_56401.html. Accessed 30 May 2012.
25 World Health Organization (2011) Fact sheet: Priority Medicines
for Mothers and Children. Available: www.who.int/medicines/
publications/A4prioritymedicines.pdf. Accessed 15 May 2012.
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49
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51
Interviews
Between February and April 2012, we interviewed a number of
experts in the areas of health, child protection and education and
would like to thank them for their valuable contribution to this
landscape analysis:
Abdeen, Yasmin Adder Corp (Education Consultancy Firm)
Acosta, Alejandro International Center for Education and Human
Development
Agagliate, Thierry Terre des Hommes (TDH)
Akkari, Abdeljlil University of Geneva
Balasegaram, Manica Mdecins Sans Frontires (MSF) Access
Campaign
Bartlett, Kathy Aga Khan Foundation
Bellamy, Carol Global Partnership for Education
Bermingham, Desmond Education Global Initiative, Save the Children
Bhutta, Zulfqar A Aga Khan University Medical Centre
Binka, Fred School of Public Health, University of Ghana
Boothby, Neil Program on Forced Migration and Health, Mailman
School of Public Health, Columbia University
Bruce, Florence OAK Foundation
Burnett, Nicholas Resource for Development Institute
Butchart, Alexander World Health Organisation (WHO)
Cairns, James Center on the Developing Child, Harvard University
Campang, Jose Plan International
Chiuye, Grace University of Malawi, CERT
Colenso, Peter The Cildrens Investment Fund Foundation (CIFF)
Costello, Anthony University College London Institute for Global Health
Currat, Louis Swiss Agency for Development and Cooperation (SDC),
Global Forum for Health Research (GFHR)
Dahl, Carol The Lemelson Foundation
Darer, Monica Plan International
De Lay, Brigette UNICEF West and Central Africa
Dottridge, Mike Dottridge Consultants
Feigelson, Michael Bernard van Leer Foundation
Finkelhor, David University of New Hampshire
Frederick, John Frederick Consultants
Friedman, Matt United Nation Inter-Agency Project on Human
Traffcking(UNIAP)
Ganguly Nirmal, Kumar Jawaharlal Institute of postgraduate Medical
Education & Research (JIPMER)
Germann, Stefan World Vision International Global Health Partnership
& Health Research, UBSOF Board
Gibbons, Michael Wellspring Advisors
Gksel, Ayla Mother Child Education Foundation (ACEV)
Goldman, Philip Maestral International
Guzman, Javier Director of Research at Policy Cures
Harris, Eva School of Public Health, University of California, Berkeley
Hotez, Peter Sabin Vaccine Institute
Houry, Saad United Nations Childrens Fund (UNICEF)
Iglsies, Jaume UBS Values Based Investment
IJsselmuiden, Carel Council on Health Research for Developenemt
Intebi, Irene International Society for Prevention of a Child Abuse and
Neglect (ISPCAN)
Karunakara, Unni Mdecins Sans Frontires (MSF) International
Kinn, Sue Department for International Development (DFID)
Klees, Steven University of Maryland
Knols, Bart K&S Consulting, In2care laboratory, UBSOF Board
Kooijmans, Joost OffceoftheUNSpecialRepresentative
of the Secretary-General on Violence against Children
Lansang, Mary Ann University of the Philippines Manila
Leisinger, Klaus Novartis Foundation for Sustainable Development
Lullies, Constanze Jacobs Foundation
Malombe, Joyce Wellspring Advisors
Marshall, Phil Research Communications Group
Matsoso, Precious Department of Health, Republic of South Africa
Mbacham, Wilfred Biotechnology Centre, University of Yaounde /
Multilateral Initiative on Malaria (MIM)
McLaughlin, Carol Center for High Impact Philanthropy, School of
Social Policy and Practice, University of Pennsylvania
Mesa, Nathalia Fundacion Carulla
Mills, Anne London School of Hygiene & Tropical Medicine
Miyahara, Junko Asia-PacifcRegionalNetworkforEarlyChildhood
Moree, Melinda BIO Ventures for Global Health (BVGH)
Morris, Saul Bill & Melinda Gates Foundation
Novy-Marx, Milena MacArthur Foundation
Orlando, James USG Secretariat for Orphans and Vulnerable Children,
USAID
Pablos-Mendez, Ariel United States Agency for International
Development (USAID)
Peterson, Kyle Foundation Strategy Group
Quayle, Ethel University of Edinburgh, UBSOF Board
Raynaud, Olivier World Economic Forum
Romualdo, Oliveira Universidade de Sao Paulo
Rosling, Hans Karolinska Institute & Gapminder Foundation
Serpell, Robert University of Zambia
Shuteriqi, Mirela Terre des Hommes (TDH)
Snewin, Val Wellcome Trust
Soudien, Crain University of Cape Town
Stuckenbrock, Denise Save the Children
Tanner, Marcel Swiss Tropical and Public Health Institute (SwissTPH)
UBSOF Board
Taylor, Aleesha Open Society Foundations
Tescarolo, Ricardo Congresso Nacional Marista de Educacao
Theis, Joachim United Nations Childrens Fund (UNICEF)
Thompstone, Guy Child Frontiers
Tooley, James Newcastle University
Torreele, Els Access to Essential Medicines Initiative, Open Society
Foundations
Walsh, Angela National Association for Prevention of Child Abuse and
Neglect (NAPCAN)
Wawire, Violet Kenyatta University, Kenya
Wessells, Mike Columbia University, Program on Forced Migration and
Health
Williamson, John Displaced Children and Orphans Fund, USAID
Winthrop, Rebecca Brookings Institution
Zhou, Xiao-Nong National Institute of Parasitic Diseases, China Centers
for Diseases Control and Prevention.
We would also like to acknowledge former team members who
made vital contributions to this analysis:
Eggenschwiler, Jacqueline
Froejd, Natasha
Gaus, Martina
Muhr, Grgorie
Widmer, Lukas-Lucien
Additional credits
Photos provided by various project partners and UBS Optimus
Foundation team members except for photos taken by Roohullah
Shinwari on page 33 and by Marcel Grubenmann, Switzerland,
on pages 52 and 53 respectively.
Acknowledgements
53
ab
UBS Optimus Foundation
Augustinerhof 1, P.O. Box, CH-8098 Zurich
Tel. +41-44-237 27 87, Fax +41-44-237 27 43
[email protected]
www.ubs.com/optimus