The Bellagio Child Survival Study Group, which is made up of experts who took part in a team residency on « Knowledge into action : improving equity in child health » identified four urgent reasons to revive the stalled child survival revolution of the 1980s. Writing in the medical journal the Lancet, they say that advances in child health epidemiology have strenghthened the basis for sound programmes, that 63% of all child deaths could be prevented and that 98% of under fives who die are in developing countries. They also reveal huge failures in delivery of services to mothers and children who are poor.
To address these issues, WHO has developed a broad strategy to support countries in achieving the Millennium Development Goal to reduce child mortality by two thirds by 2015. A key element of the strategy, endorsed by the World Health Assembly in May, is the adoption of a life course approach to child and adolescent health. This recognizes that the quality of life at early ages is important not only for immediate wellbeing, but also for health and development later in life.
‘‘In the 1980s the child survival revolution greatly reduced child mortality but that movement has to revitalised. There is an urgent need to regain that momentum. More than 10 million children under five will die from easily preventable causes this year,’’ says Dr Tomris Türmen, Executive Director of Family and Community Health at WHO. ‘‘Child survival must be put back on the agenda if there is to be any hope of achieving the Millennium Development Goal of reducing child mortality by two thirds by 2015. These reports show that it can be done.’’
There have been some notable successes in the past in reducing child mortality. For example, better nutrition can break the vicious spiral of poor nutrition leading to illûhealth and illûhealth causing further deterioration of nutritional status often leading to death. Preventable communicable diseases in children can be drastically reduced through three activities: the Expanded Programme on Immunization, Integrated Management of Childhood Illness, and preventing motherûtoûchild transmission of HIV and reducing HIV among young people. All of these interventions have been shown to work but need to be dramatically scaled up. Further attention needs to be given to improving the health of new born children and their mothers. The health and survival of the child, especially in early infancy, is intricately linked with the health of the mother, her nutritional status, and the reproductive health care she receives.
An earlier goal set at the Child Summit in 1990 to reduce child mortality by a third is still far from being achieved. Instead of a 33% reduction under five deaths worldwide were reduced by only 10% by the year 2000. There are also enormous differences between regions and countries. In 2000, rates of child survival in subûSaharan Africa had not yet reached the level attained in the Americas in 1950. In Angola and Niger, 25 babies in every 100 babies born will die before the age of five years. In Europe the comparable rate is fewer than one in every hundred.
Drawing on the report of the WHOûconvened Macroeconomic Commission on Health, the yearly cost of scaling up child health interventions would be around US$7.5 billion û US$1.0 billion for vaccinations, US$4.0 billion for treatment of childhood illneses and US$2.5 billion for malaria prevention and treatment. The authors say this investment would be very cost effective.
Despite the urgent need to reduce the number of children dying the amount of development assistance for child health has decreased dramatically. In addition, there have been no clear mechanisms to track investments in child survival over the last decade. This has made it very difficult to link investments with better child health and a reduction in the number of children dying.
‘‘We urgently need to target financial and human resources for child survival more intelligently. We must put poor children and their mothers at the centre our efforts. We need to recreate a strong leadership and kickûstart a global movement. Then we will be in a position to use our knowledge to bring down the terrible toll of childhood deaths,’’ says Dr Hans Troedsson, Director of Child and Adolescent Health at WHO.