RESULTS Health Advocacy Officer, Megan Wilson-Jones reflects on the latest child survival figures.
Upon hearing the latest child mortality figures released by UNICEF last week, I was struck by two diverging reactions. My initial feelings were impressed and inspired by the substantial global effort involved in reducing child mortality around the world. Since 1990, the annual number of deaths among children under-5 has almost halved from 12 million to 6.6 million in 2012. In just one year, the number of children dying has dropped from 6.9 million deaths to 6.6 million – a saving of 300,000 lives in just one year. That is impressive… isn’t it?
On deeper reflection, my feelings turned from impressed to disappointment. Why do 18,000 children die every day when the majority of these deaths can be prevented and treated? Why do the poorest children suffer this fate? With 82% of under-5 deaths occurring in sub-Saharan Africa and South Asia, the burden of child mortality falls disproportionally on people living in the poorest regions of the world. The diseases and conditions responsible for more than three quarters of all under-5 deaths include pneumonia, diarrhoea, malaria and newborn complications. The real tragedy of it all is that the solutions required to prevent the majority of these deaths are cheap, easy to use and proven to be highly effective. In particular, vaccines are one of the most cost-effective health interventions, able to protect children against a spectrum of diseases. In cases when children do fall ill, the interventions needed to save their life exist – no new tools or technologies are needed.  A simple solution of salt and sugar known as oral rehydration solution (ORS) is a life-saving intervention for children with diarrhoea. For pneumonia, antibiotics such as amoxicillin are highly effective in treating the majority of cases in children.
Considering that together a course of amoxicillin and ORS, that could in effect save the lives of two children, cost less than my morning coffee, leaves me disappointed. I am disappointed that despite the modest financial resources required to scale-up these life-saving interventions, they are still not reaching the majority of children who need them most – the poorest and most marginalised in society. Despite important progress made so far, more is needed and urgently.
In June 2012, the governments of Ethiopia and India, along with UNICEF and USAID re-energised the global commitment to child survival through ‘Committing to Child Survival: A Promised Renewed’, calling on governments, civil society, the private sector and individuals to take action to reduce child mortality. Just over a year later, the figures from the 2013 report indicate that global efforts are paying off. However, at the current rate of progress Millennium Development Goal 4 – to reduce child mortality by two thirds from the 1990 level, will not be reached until 2028 – 13 years behind schedule. If we allow this to happen, 35 million lives are at stake. That said, a number of countries have made dramatic progress in reaching their MDG 4 targets, with Ethiopia the latest country to reduce their under-5 mortality rate by 67%, following Bangladesh, Liberia, Malawi, Nepal and Tanzania.
Efforts to scale up life-saving prevention and treatment interventions are urgently needed, along with ensuring these interventions can be delivered through existing health systems and a strong workforce. Addressing child mortality also requires consideration of the broader social determinants of health including the environment in which children live and their ability to access clean water and sanitation, along with good nutrition. Progress therefore requires coordinated action across all actors involved both within and beyond the health system.
Through my understanding that the challenges to reducing child mortality are significant but not insurmountable, my conflicted feelings of being impressed, yet disappointed at the latest child survival figures are not unjustified. So next time you have your morning coffee, let’s not forget the small price it costs to save the life of a child and ask yourself, are you impressed or disappointed by these figures?