Call to Action
Progress toward Millennium Development Goal 4 is too slow.
    Over eight million children died before their fifth birthday in 2009 — a one third reduction from 12.4 million child deaths in 1990. But Millennium Development Goal 4 (MDG4) calls for a two-thirds reduction by 2015, which most countries will not achieve. Even among those countries that will meet MDG4, many still have communities with high rates of child mortality.  Since most of these child deaths are preventable, the global community must renew its efforts to achieve MDG4 with equity.

Pneumonia and diarrhea are the top two killers of children globally.
    Together they cause 1 in 3 child deaths, globally. Nearly all pneumonia and diarrhea child deaths occur in developing countries where children have limited access to health services, food, and healthy environments (sanitation, clean water, smoke-free air). The 2010 World Health Assembly Resolution 63.24 urges Member States to reduce pneumonia deaths through coordinated implementation of the WHO/UNICEF package of proven, high-impact interventions (Table 1).

New vaccines provide momentum to engage communities.
    Although multiple organisms cause pneumonia and diarrhea, in recent years vaccines have become available against the main causes of both diseases: pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) for pneumonia, and rotavirus vaccine (RV) for diarrhea. As these new vaccines are introduced, health workers have the opportunity to promote a package of ‘healthy actions’ —  the behaviors (‘essential family practices’) that increase a child’s chance for survival and healthy development, such as attendance for immunization sessions.

There are synergies between pneumonia and diarrhea interventions.
    In addition to the new vaccines,  ‘healthy actions’ such as early and exclusive breastfeeding, hand washing with soap, appropriate care seeking, and zinc supplementation prevent both pneumonia and diarrhea (see Table 1). While some of the ‘healthy actions’ take place primarily in the home, others require access to a combination of commodities and services.

The Communication Framework supports development of a Coordinated Communication Plan
    This will increase adoption of ‘healthy actions’ and demand for immunization. The Framework, designed primarily for new vaccine introduction, is also relevant for any country seeking to achieve MDG4 with equity by using communication to engage and empower communities to adopt ‘healthy actions’.