Empty prom­ises and dead chil­dren

Financial Mirror (Cyprus) - - FRONT PAGE -

Buried among the 169 tar­gets con­tained in the Sus­tain­able De­vel­op­ment Goals (SDGs) – adopted by the United Na­tions last Septem­ber amid a blaze of glitzy events, celebrity en­dorse­ments, and back-slap­ping by world lead­ers, aid donors, and non-gov­ern­men­tal or­gan­i­sa­tions – was the vi­tal pledge to elim­i­nate “pre­ventable child deaths” by 2030. It is a cause for our gen­er­a­tion – but one that will take a lot more than UN com­mu­niqués to ad­vance.

The last set of in­ter­na­tional de­vel­op­ment tar­gets, the Mil­len­nium De­vel­op­ment Goals, cer­tainly brought about im­por­tant progress; the num­ber of chil­dren who died be­fore reach­ing their fifth birth­day dropped from ten mil­lion in 2000, when the MDGs were adopted, to 5.9 mil­lion in 2015. Some of the world’s poor­est coun­tries have reg­is­tered some of the most sig­nif­i­cant gains.

This progress was driven by sev­eral fac­tors, in­clud­ing fall­ing poverty and heavy in­vest­ment in com­mu­nity-based health sys­tems. By de­ploy­ing nurses, mid­wives, and other health work­ers, th­ese sys­tems ex­tended the avail­abil­ity of pre­na­tal care, sim­ple ob­stet­ric in­ter­ven­tions, clean cord cut­ting, and post-na­tal care. Ethiopia, for ex­am­ple, has de­ployed a small army of some 38,000 health work­ers over the last decade.

In­ter­na­tional co­op­er­a­tion was also cru­cial. Aid for child and ma­ter­nal health has grown dra­mat­i­cally since 2000, and now stands at some $12 bil­lion an­nu­ally. De­vel­op­ment as­sis­tance has en­abled the cre­ation of com­mu­nity-based health pro­grams, and played a key role in sup­port­ing the de­vel­op­ment and de­ploy­ment of the vac­cines, mos­quito nets, and med­i­cal treat­ments that have cut child deaths from the ma­jor killer in­fec­tious dis­eases – pneu­mo­nia, di­ar­rhea, malaria, and measles – by some 70% since 2000.

Now for the bad news. In the time it takes you to read this ar­ti­cle, more than 30 chil­dren will die from causes that could have been pre­vented or treated.

Ev­ery year, more than one mil­lion chil­dren die the day they are born, and an­other mil­lion die within their first week of life. Al­most half of all child deaths oc­cur in the neo-na­tal pe­riod (the first 28 days) – and the share is ris­ing. The vast ma­jor­ity of th­ese deaths could be averted. Yet, if progress con­tin­ues at its cur­rent rate, there will still be some 3.6 mil­lion such deaths per year by 2030.

To jump-start progress, we must de­velop health-care and other in­ter­ven­tions that ad­dress the poverty, vul­ner­a­bil­ity, and in­equal­ity that place so many chil­dren, and their moth­ers, at risk. Mak­ing health ser­vices more widely avail­able is a start­ing point. But, all too of­ten, the poor are ex­cluded, even when the clin­ics ex­ist.

Con­sider In­dia, which ac­counts for one-fifth of child deaths world­wide. Nearly all women from the rich­est 20% of house­holds en­joy pre­na­tal care and skilled at­ten­dants at de­liv­ery; cov­er­age rates for the poor­est are less than 10% – worse than in much of sub-Sa­ha­ran Africa. Surg­ing eco­nomic growth has done noth­ing to re­duce the dis­par­ity.

And In­dia is just one ex­am­ple. Each year, some 36 mil­lion women in low- and middle-in­come coun­tries give birth with­out a skilled at­ten­dant.

An even greater num­ber of chil­dren do not re­ceive a post­na­tal health check. The vast ma­jor­ity of th­ese women and chil­dren have one thing in com­mon: they are poor. In­deed, be­ing born to a low-in­come mother raises the risk of child mor­tal­ity by a fac­tor of 2-3 in much of South Asia and sub­Sa­ha­ran Africa.

Wealth-based dis­par­i­ties in health out­comes ex­tend far be­yond preg­nancy and birth. Chil­dren born to poor moth­ers are less likely to be im­mu­nised or taken to clin­ics for treat­ment of po­ten­tially fa­tal dis­eases, such as pneu­mo­nia and di­ar­rhea.

Sur­vey ev­i­dence points to cost as a ma­jor bar­rier ex­clud­ing poor women and chil­dren from health care. Forc­ing des­per­ately poor women to pay for ma­ter­nal and child health care is a pre­scrip­tion for in­equal­ity, in­ef­fi­ciency, and child deaths. Pub­licly fi­nanced uni­ver­sal health cov­er­age is the proven an­ti­dote. Yet political elites in high-mor­tal­ity coun­tries like In­dia, Pak­istan, and Nige­ria – the same elites who have signed up to the SDGs – have con­spic­u­ously failed to de­liver.

If gov­ern­ments are sin­cere about de­liv­er­ing on the SDGs’ prom­ise on child mor­tal­ity, they must get se­ri­ous about en­sur­ing equity in health care. They could start by in­tro­duc­ing na­tional tar­gets to halve the dif­fer­ence in death rates be­tween the rich­est 20% and poor­est 20% over the next seven years.

But tar­gets not backed by fi­nance aren’t worth the com­mu­niqué pa­per they’re printed on. De­vel­op­ing-coun­try gov­ern­ments should be spend­ing at least 5% of GDP on health, elim­i­nat­ing charges on child and ma­ter­nal health care, and en­sur­ing that fi­nan­cial re­sources – and health work­ers – are al­lo­cated in a way that re­duces in­equal­i­ties in care.

For­eign aid also has a vi­tal role to play. Here, the em­pha­sis should be shifted from de­liv­er­ing dis­ease-spe­cific in­ter­ven­tions to build­ing up health-care sys­tems. We need a global so­cial compact on health to close the fi­nanc­ing gap – around $30 bil­lion – for achiev­ing uni­ver­sal health cov­er­age, which re­quires link­ing pop­u­la­tions to skilled health work­ers equipped to pro­vide ef­fec­tive care.

Sub-Sa­ha­ran Africa alone will need to re­cruit and train an­other one mil­lion com­mu­nity health work­ers to de­liver uni­ver­sal cov­er­age.

Any strat­egy for achiev­ing the 2030 tar­get for child mor­tal­ity must go be­yond the health sec­tor and fo­cus on the wider in­equal­i­ties – for ex­am­ple, in nutri­tion, education, and ac­cess to clean wa­ter and san­i­ta­tion – that fuel child mor­tal­ity. Girls will need added pro­tec­tion, so that they are not forced into early mar­riage and child bear­ing.

Chil­dren world­wide face a lethal com­bi­na­tion of in­equal­ity, in­jus­tice, and gen­der dis­crim­i­na­tion. They de­serve bet­ter. The prom­ise to elim­i­nate pre­ventable child deaths by 2030 is our chance to en­sure they get it.

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