Seizing Opportunities: Getting child survival back on track

This blog has been co-authored by Neil Raw (Senior Policy Adviser – Child Health) at UNICEF UK and Chhavi Bansal (Senior Policy Advocacy Officer (Child Health)) at RESULTS UK.

In 2023, no child should die from diseases that we can prevent with access to vaccination, treatment for malnutrition, and clean water, hygiene, and sanitation (WASH) services. Yet, we are on the verge of an unprecedented child survival crisis due to ongoing global challenges which have added to pre-existing inequalities. 

In light of these challenges, a recent policy briefing developed by the UK Committee for UNICEF (UNICEF UK) explores the UK’s role in getting progress on child survival back on track. This blog discusses how we can still galvanise global action, refocus commitments and use opportunities to restore and even expand access to lifesaving healthcare services.

What do we mean by a child survival crisis?

Global challenges that include COVID-19, conflict, and climate change continue to pose an imminent threat to children’s health in all regions of the world and have led to declining coverage of key essential health services:

• Immunisation services have seen the largest sustained backslide in almost 30 years, leading to outbreaks of life threatening diseases – such as measles and polio – that could be easily prevented with access to vaccines.
• Over 1,000 children die each day from diseases attributable to unsafe WASH services.
• The East African region suffered the worst climate induced drought in 40 years and we are seeing significant increases in malnutrition, with a child becoming severely malnourished every 60 seconds in the worst affected regions. 

Despite significant progress made towards ending preventable newborn and child deaths, around 5 million children died before reaching their fifth birthday in 2020. Access to immunisation, and appropriate nutrition and WASH services, are the foundation for preventing potentially fatal infectious diseases such as measles, polio and pneumonia. WASH services are key in preventing the spread of infectious diseases, as evidenced during the COVID-19 pandemic. There is also a well established two-way relationship between nutrition and infectious diseases. Good nutrition is crucial for an effective immune system, including the response to a vaccine, while infectious diseases are noted to increase calorie needs. Therefore, a child who suffers from an infectious disease is at a greater risk of being undernourished and vice versa.

A responsibility to act

The UK Government, and all governments around the world, have a duty of care towards their citizens. Article 24 of the UN Convention on the Rights of the Child (UNCRC), states that “every child has the right to the best possible health. Governments must provide good quality health care, clean water, (and) nutritious food.” As a duty-bearer of the UNCRC, the UK Government has a responsibility to support children around the world to realise their right to the highest possible standard of health. This includes supporting initiatives that have a strong global infrastructure and an aligned goal of ending preventable child deaths, such as, Gavi, the Vaccine Alliance, a global partnership with the primary goal of increasing equitable access to essential vaccines; the Global Polio Eradication Initiative (GPEI), a public-private partnership with a key goal of eradicating polio everywhere and, frontloading (disburse the pledges in earlier years) the UK’s Nutrition for Growth commitments. Ensuring that the UK continues and expands on these commitments will be crucial in supporting improved quality of healthcare for all children.

How can these crises be addressed?

The causes and challenges of the child survival crisis are complex. It’s not sufficient for each of these causes and challenges to be addressed with a siloed approach; instead, a holistic approach is needed. Zero-dose children (children that don’t receive any vaccines at all) often also lack access to other essential health services, including nutrition and access to safe WASH facilities. When a child has access to immunisation services, it can also open the doors to other lifesaving interventions. For example, whilst accessing immunisation services, children may additionally access nutritional assessment or supplementation such as vitamin A necessary to prevent nutritional deficiencies, which has contributed to 1.5 million saved through polio campaigns, and education around hygiene awareness and behaviours, which has led to decreased diarrhoea prevalence in Nepal. This shows that access to immunisation services is not simply about a child receiving a vaccine, but about a child receiving access to a wealth of health services. Tackling multiple child health crises simultaneously should be a catalyst for there to be higher levels of collaboration, coordination and communication amongst services. This is known as an integrated service delivery and has been shown to maximise reach and improve child health outcomes.

We also need to advance progress on gender and health inequities. Women currently account for 70% of the global health workforce yet many receive little or no remuneration for their vital and demanding work. Prioritising the recruitment, retention and remuneration of community health workers will therefore be pivotal in addressing capacity gaps within the global health workforce and reducing disparities to accelerate progress towards the attainment of Universal Health Coverage (UHC).

What can the UK Government do in 2023?

1. Galvanise global action on restoring and expanding access to routine immunisation, tackling severe malnutrition, and safe WASH through political and diplomatic leadership at political platforms, including the G7, G20 and UN General Assembly. 

2. Be responsive to global challenges by protecting and increasing financial commitments to child health services, including immunisation, nutrition, WASH, and primary health care. Such as:

a. Disbursing in full all pre-existing commitments to Gavi, the Vaccine Alliance and the Global Polio Eradication Initiative. 

b. Commit additional resources to prevent severe malnutrition and front load spending on the commitment to Nutrition for Growth to respond to the acute crisis.    

3. Strengthen immunisation and health systems through coordination with all relevant partners and priority countries.

Furthermore, 2023 provides several opportunities to address pervasive inequalities and harness lessons learned from the COVID-19 pandemic to create a rights-based and equitable global health architecture. For example, the United Nations high-level meetings on Pandemic Prevention, Preparedness and Response and Universal Health Coverage offer an opportunity for member states to make tangible commitments to develop resilient health systems, strengthen global health workforce capacity, and improve efficiencies in reaching children with essential health services. 

It is vital that the UK utilises these opportunities for systematic reform to global health that will enable children to realise their right to the highest possible standard of health for years to come. 

To learn more please read the latest policy briefing developed by UNICEF UK.