• As this year’s World Health Assembly (WHA) begins, the International Rescue Committee (IRC) urges the international community to focus on last-mile delivery in light of growing axis of inequality between stable and fragile settings.

At the World Health Assembly, the IRC is calling on the international community to prioritize last-mile health solutions to fill the global delivery gap with a particular focus on immunization, malnutrition and sexual, reproductive, and maternal health. 

Disparities in global public health are becoming more pronounced between stable settings and those affected by crisis, compounded by COVID-19 and the overlapping challenges of climate change, poverty and conflict. In places where the IRC works, maternal and child mortality are 5 times higher than global averages. These fragile and conflict-affected settings are also disproportionately home to children facing acute malnutrition, as well as under-immunized populations and zero dose children under the age of 5.   

Dramatic improvements in global health in stable settings have been achieved largely by working through health facilities and government-led health programs and systems. In fragile settings, even the most basic facilities and services may be inaccessible or unable to sustain service delivery in the face of conflict and crisis and government programs are frequently unable to reach populations dealing with a humanitarian crisis.  

The IRC-led REACH Consortium, one of two multi-sectoral partnerships that GAVI has funded to reach zero-dose and under-immunized children. Funded by Gavi, the Vaccine Alliance, REACH was designed to close the immunization gap in Ethiopia, Somalia, South Sudan, and Sudan. Powered by a network of global and local partners, the REACH Consortium works to extend services to those beyond the reach of government systems and ensure that no child, wherever they live, is left behind.  

Dr. Mesfin Teklu Tessema, Head of the Health Unit at the IRC said: “Climate change, conflict and poverty are increasing the likelihood and reach of public health risks at global scale. The need for scalable, evidence-based solutions to bridge the last-mile gap and shore up global health has never been clearer. In the fragile contexts where public health challenges have mounted in recent years, a partnership model that relies not only on the governments but on the full complement of actors delivers. The initial progress is promising: we have delivered 1.5 million vaccines in the Horn of Africa and negotiated increased accessed to underserved communities, with access increasing from 16% to 77% in the first year. The REACH, people-first model must become the rule rather than the exception- not only to reach the 25 fragile countries that are home to over 90% of zero-dose children worldwide, but to make progress against the widening health gap between stable and fragile contexts.”  

Earlier this year, the IRC launched the Movement Against Malnutrition with a single goal of ensuring no child dies of acute malnutrition. Despite the existence of a simple, affordable treatment – Ready-to-use-Therapeutic Food (RUTF) – in places where IRC works, less than 1 in 5 children historically receive this life-saving solution. The IRC champions a simplified treatment approach which is scalable, cost-effective and proven to help more than 90 percent of malnourished children treated with it recover. Central to scaling this approach is the role of Community Health Workers (CHWs) in bringing this lifesaving care directly to affected communities.  

The IRC also supports women and girls living in fragile settings worldwide with simple, cost-effective, proven solutions to address sexual and maternal health– including working with local partners on ensuring minimum sexual and maternal health services in emergencies, and reaching the last mile through women’s self-care where health services or healthcare workers are unavailable. Flexible and sustained investment in comprehensive sexual and reproductive health must expand to ensure women and children survive and thrive. 

The IRC's health programs reach people in over 40 countries, providing life-saving services and tackling the root causes of disease. IRC’s health programming has reached 23.8 million people last year. Health comprises nearly half of the IRC’s program portfolio globally with a focus on scaling six priority areas including immunization, nutrition, contraception, infection prevention and control, and provision of clean water.