In the second post from New York, Steve Lewis reports on child health progress at the UN General Assembly.
Yesterday the UN General Assembly recommitted their efforts to meeting the Millennium Development Goals (MDGs) and began the formal process to decide the framework for the next 15 years. Some of the MDGs have been met, but the MDGs on Maternal Health and Child Health are among the most off-track. RESULTS has recently committed to increasing our advocacy on Child Survival issues, so this week I have been meeting with various speakers who are convinced that progress can be sped up if the required resources can be made available.
At an event last night Tony Lake, director of UNICEF, outlined the good news, that since 1990 the number of under-five child deaths has fallen from 12 million a year to 6.6 million this year. But there is still a long way to go. The majority of child deaths are preventable. Conditions such as pneumonia and diarrhoea kills over a quarter of children. There is “the fierce urgency of today’, to put in place the simple solutions that can prevent these deaths.
Princess Sarah Zeid of Jordan spoke movingly about her own experience of the critical role of trained health workers. “Three years ago I almost died in child-birth”, she explained, “only the presence of excellent health staff saved me and my beautiful child”. Fortunately all was well – but all women around the world should have the right to a trained health worker, and the commodities and services they need.
These commodities are not so complicated – the UN Commission on Life Saving Commodities for Women and Children has identified 13 under-utilised and over-looked life-saving commodities. Of these 13 commodities, 3 are specific to child health, which if scaled up could prevent death from conditions including including pneumonia and diarrhoea. In fact the Lancet health journal in June 2013 showed that nearly all deaths from diarrhoea, and two thirds of deaths from pneumonia, can be ended through relatively simple solutions.
Frances Day-Stirk, president of the international confederation of midwives, spoke about the importance of women’s rights and education. “I wouldn’t be sitting here if it wasn’t for my mother, a strong woman who believed in educating girls as well as boys. That wasn’t so common where I grew up. From that start I became employed and an empowered woman. For a girl who doesn’t have those benefits, she can get left behind, in some countries if she dies she is hardly even counted”. Frances also called for a greater emphasis on Exclusive Breastfeeding until the age of six months – “the single biggest remedy for the undernutrition that contributes to 44% of all child deaths”.
Doctor Tedros from Ethiopia took up the themes of health workers and data collection. Currently Minister of Foreign Affairs in Ethiopia he was previously the Minister of Health when the country massively expanded the number of Community Health Workers. “We knew that Primary Health Care was essential, and we took it to all corners of the country…. Using women as health promoters was key, in my country women seek health services from other women.”
Ethiopia now has 38,000 village health workers who can give prevention advice and carry out basic care or treatment. Thanks largely to this ‘Health Army’ the country have achieved MDG 4 (to reduce child mortality by two thirds) ahead of schedule. Ethiopia is now considered a role model in African health circles. One other aspect of their work is strong monitoring and data collection. “We strictly collect data in all our health facilities” said Dr Tedros, “and learn from our successes and failures. To make progress in health, accountability needs to be a mindset”.
To finish the evening, we returned to the theme of the MDGs, and how the next development framework should be different. Tony Lake identified a ‘fundamental flaw’ in the design of the current set of MDGs: “the MDGs have been very successful in pulling together global support for a short set of global goals. But there has been a basic mistake in the MDGS. They were based on national averages. So everyone looked for the low hanging fruit. The easy people to reach, the city dwellers, the better off. We now know that the poorest were left behind. In fact this has slowed us down. In the most remote areas there is more disease, so you get more results. So it’s more cost effective to work in the most disadvantaged areas. That will be the right thing to do.”
Over the next two years the global community will debate the exact make-up of the next development framework. It is unlikely that there will be such an emphasis on health issues in the next set of goals – but that does not mean efforts will tail off. With what the world knows now there is ample scope for a speed-up in progress. If enough funding is available it should be possible to put in place the components of much-improved health systems in almost all countries. Trained health workers, educated girls, access to medicines and health supplies, immunisation for all, and proper nutrition are the building blocks that will allow us to reach ‘health for all’ by 2030.