International child health: state of the art

Many published articles and policies describe what should be state of the art in global child health, and there are dozens of large initiatives aimed at implementing these policies. We have knowledge of what should work, yet struggle to effectively implement that knowledge and improve child health outcomes in resource-poor settings, even at the most basic level of ensuring sufficient food and clean water for the world's children. This article highlights many smaller programs that are operational in the field, demonstrating excellence in global child health efforts, and may approach state of the art in actual implementation. The examples include a grass roots primary health care program, a home-based neonatal care program, kangaroo mother care, ready-to-use therapeutic food (RUTF), a vitamin A program, point-of-use water purification, disasters and children, a pain management program, and a developmental disabilities program. This article also discusses the importance of strengthening human resources for health by, for example, training child health professionals in low resource countries. These programs show what can be done and could be replicated in other communities to improve child health, given a few committed individuals and modest resources. Ultimately, truly state of the art health care for children must be defined locally and championed by each state or nation. Nevertheless, there are overarching components and supports that are the responsibility of the global community, particularly those needed to assure that the basic human rights of children, including health, are met throughout the world.