Introduction | Case Studies | Facts

Reducing under-five Mortality Rate by two-thirds

In developing countries, one child in 10 dies before its fifth birthday, compared with 1 in 143 in high-income countries. In about 70 per cent of the deaths before age five, the cause is a disease or a combination of diseases and malnutrition that would be preventable in a high-income country: acute respiratory infections, diarrhoea, measles, and malaria.

Across the world, children are at higher risk of dying if they are poor. Another fact about child mortality is that throughout the world, child mortality is higher in males than in females, with only a few exceptions. In China, India, Nepal and Pakistan, mortality in girls exceeds that of boys. This disparity is particularly noticeable in China, where girls have a 33 per cent higher risk of dying than their male counterparts. These inequities are like to be because of preferential treatment of boys in family health care-seeking behaviour and in nutrition.

Where economic situation has improved in developing countries, there has been an overall decline in child mortality. Global child mortality decreased from 147 per 1000 live births in 1970 to about 80 per 1000 live births in 2002. However, the decline in child mortality is not consistent across time and regions. The most impressive gains in child survival over the past 30 years occurred in developing countries where child mortality was already relatively low, whereas countries with the highest rates had a less pronounced decline. Despite an overall decline in global child mortality over the past three decades, the gap between developing regions has widened.

At current rates of progress, only a few countries are likely to achieve the Millennium Development Goal of reducing child mortality to one-third of their 1990 levels. Going by the current trend, it is estimated the world will not meet the goal of reducing child mortality by two thirds until as late as 204530 years late.

What needs to be done?

'A Practical Plan to Achieve the MDGs' brought out by the UN Millennium Project puts weight on strengthening the country's health system as critical to achieving this goal. The top-most priority is given to providing access to an integrated neonatal package which includes immunizations for both the mother and child and integrated management of childhood illnesses through the range of preventive approaches available today to tackle issues of public health. While provision of safe drinking water and access to hygiene and sanitation facilities will undoubtedly improve the scenario, better education will lead to better health awareness which will ultimately lead to a better quality of life.

The cornerstone for the sustainability of any health package is community-based health care. Community involvement and participation is critical in improving the health and well bring of communities as they have the (local) knowledge on needs and priorities, which is also essential for the development of a sense of ownership. Different countries adopt different approaches, strategies and ideologies depending upon the ground situation. However, there are certain consistent elements in these strategies which are universal and which are at the core of any interventions; communication and education are two such core and consistent elements.

Lets us look at an example from Afghanistan. Top

Children of Afghanistan’’’
The government of Afghanistan has brought out a report titled 'Opening Doors to Opportunity', which takes a positive view of possibilities despite the enormous constraints in achieving the MDG targets in the country. According to this report, a majority of Afghanistan's children are stunted. It estimated that iodine deficiency accounts for an average 10-15 per cent decline in children's Intelligence Quotient. The under-five mortality rate is 257 per 1000, while the infant mortality rate is 162 per 1000. From 1990 to 2002 the under-five mortality has hardly changed. Afghanistan's MDG indicators are half a century behind the average for Asia. While on-going efforts are contributing to some progress in improving the health of children, the overall situation is grim.

The Ministry of Health (MoH), Government of Afghanistan, has developed and is implementing a 'Basic Package of Health Services for Afghanistan (BPHS)' which prioritizes the following 7 areas, viz. 1) Maternal and new born health, 2) Child Health and Immunization, 3) Public Nutrition, 4) Communicable Diseases, 5) Supply of Essential Drugs, 6) Mental Health and 7) Disability. With this programme, the MoH is widely viewed as a Ministry that is creating an effective enabling environment for delivery of set targets.

Recognizing the Need for Education and Communication
At the core of the implementation of BPHS lies the mobilization of community-based health workers and their training and capacity-building. It was soon realized that choosing health workers who are community related is not the same as involving communities in the development of further strategies for improved health provision. The focus of Community-based Health Care had initially been on the selection and training of health workers. As the Project progressed, it was felt that further investment was needed to develop appropriate training modules regarding communication and negotiation skills, participatory processes and related civic education.

The project also acknowledges the fact that the health sector needs to be supported by more accelerated reforms and expansion of education. Currently, progress in education is rather slow in Afghanistan. Investments in information and communication about personal habits related to health and hygiene as well as in education are imperative. The vicious circles of development are even more pronounced in Afghanistan, where health and education investments especially in girls, can have high rates of return.

The results of this initiative also depends upon the funding the MoH receives for this purpose. In 2003, it had put a request for $ 173.5 million 10% of the country's development budget. The amount committed by donors was $ 130.61 million, which means that approximately three quarters of MoH's request was supported. This is also is an indicator of the faith that external support has had in the management reforms at the MoH and its approach to the initiative.

¡ Infectious and parasitic diseases remain the major killers of children in the developing world, partly as a result of the HIV/AIDS epidemic. Although notable success has been achieved in certain areas (for example, polio), communicable diseases still represent seven out of the top 10 causes of child deaths, and account for about 60 per cent of all child deaths.

¡ No region, except Latin America and the Caribbean as well as Europe and Central Asia are on track to achieve the target of reducing, by 2015, the under-five mortality rates by two thirds of their 1990 levels. Progress has been particularly slow in Sub-Saharan Africa, where civil disturbances and the HIV/AIDS epidemic have driven up rates of infant and child mortality in several countries.

¡ More than 10 million children die each year in the developing world, the vast majority from causes preventable through a combination of good care, nutrition, and medical treatment. Mortality rates for children under five dropped by 15 per cent since 1990, but the rates remain high in developing countries.

¡ Child deaths have dropped rapidly in the past 25 years, but progress everywhere slowed in the 1990s, and a few countries have experienced increases in the same period. More...