LONDON, 1 March 2005, Thank you. I am very pleased to be here representing UNICEF and the committed individuals from across UNICEF who played such a key role in the development of this series.
In particular I’d like to thank Dr. Rudolf Knippenberg – seated here in the front – for his lead role in authoring article 3 in the series, and to Neff Walker, Genevieve Begkoyian, and Pascal Villeneuve, who contributed across the series.
Backing the leading contributions of these three are UNICEF field staff throughout the countries we are talking about, whose work on the ground with our partners and with governments and communities have added substantially to the knowledge base of this series. Their ongoing work over many years is aimed at contributing real-world experience, observation, and knowledge to the global discussion, and I thank the Lancet and the Bellagio Group for initiating this series and providing a forum for the best knowledge and practices to be highlighted and promoted.
I have listened with great interest to my fellow panelists, and fully support what they have presented both here today and in the series itself. I have just a few observations I would like to add.
The focus of this series on neonatal deaths is important and timely. It is apparent from the data presented that the crucial first month of life, even the first week and first day, have been overlooked in global child survival programs. The good news is that this gap comes to light as a result of gains being made in child survival after the first month of life. Today in Geneva, for example, UNICEF and WHO will announce major progress in the reduction of under-five deaths due to measles – a reduction of some 38% since 1999.
But as this series makes clear, despite this type of progress in general under-five mortality we will not succeed in reaching MDG-4 without a renewed emphasis on reducing preventable deaths in the neonatal period.
This is a critical focus, and UNICEF’s strategic plan for 2006 thru 2009 places special emphasis on neonatal survival as a critical component of overall child survival. Our strategy – which is being finalized by the UNICEF board – reflects the global consensus on what needs to be done presented in both this and the earlier Lancet series.
Simply put, UNICEF strongly endorses the findings put forward in this series and we are committed to playing our part in the recommendations set forward in article four. In particular, I believe UNICEF will play an increasingly important role in helping governments develop the vigorous evidence-based programs and monitoring systems needed to attract new resources. And we will play an important role in pushing all the players to focus on reaching the most marginalized and empowering local communities to help design, manage and provide feedback on new initiatives.
In addition to the excellent case studies the series presents on work in India, Madagascar, Ethiopia, and Sri Lanka, we have also been working for the past six years on packages of interventions in several West African countries that use the approaches outlined in this series. Indications are very encouraging, with marked improvements not just in coverage rates for basic packages of interventions, but also in reduced mortality rates. Those findings will be published soon.
UNICEF’s ongoing work in these areas, in partnership with the World Bank, WHO, and governments, is at the heart of paper three, on how to move from analysis to action.
The series suggests that roughly $4 billion would be required over and above what is now being spent in order to reach virtually all children with the full set of packages, scaled up including clinical care. Getting there will take real time and investment. But what our work in West Africa suggests, and what the papers make very clear, is that we can save as many as a million newborns with much less expensive interventions based on family care and community outreach programs. Things as simple as prevention of malaria and tetanus; keeping the newborn warm: exclusive breastfeeding; and early recognition of illness and seeking care can make huge inroads with much more modest resources. These are low-technology things we can do now, even in the poorest environments with weaker health systems. And this is where UNICEF will be placing its emphasis over the next four years.
Finally, I’d like to say a few words on the importance of women’s health and empowerment. While the focus here is clearly on newborns, the articles make it clear that the continuity of care from mother to newborn to child is essential to success. And while we focus on health packages that strengthen this continuum of care, we must put equal emphasis on the overall status of women in many of the countries where the mortality rates are highest.
Articles one and three emphasize the need not just for good programs but for good overall policy. And that means involving local communities, especially women. It means in the short term empowering women with basic knowledge. It means providing essential commodities for use at household level. And in the longer run it means ensuring that all boys and all girls get a quality basic education.
For me one of the most striking statistics in this series is the fact that 60 to 80 percent of all neonatal deaths occur in children who suffer from low birth weight. What does that tell us? It tells us that the nutritional status and probably the economic status of the mother is poor to begin with. She was not in a strong position to give birth.
Sustaining success in reducing neonatal mortality in the long-term is dependent on many factors, including our own focus and commitment. But it surely depends on the empowerment of women – and that is not only a health issue, but a human rights issue.
I am proud to say that as part of its strategic contributions to sustaining progress over the long-term, UNICEF has made education for all boys and girls a vital part of its work. As I said at the opening of the Beijing +10 conference in New York this week, some have called me a “radical feminist” for arguing that human rights and equality for all men and women have something to do with the long-term survival and thriving of all children.
So I am pleased to see that these vital issues have been highlighted in the Lancet series as part of the external environment – along with AIDS and conflict – that impacts our work – and which we in turn must seek to have an impact upon.
I thank the authors of this series for their hard work and vigorous commitment to the issues. All of us who care about children are enriched by this excellent summary of where we are and where we need to go. Thank you very much.