Young Child Survival Development
Progress and challenges
Mozambican children today are more likely to have a healthy start to life than they did twenty years ago. Over the past two decades, the under-five mortality rate has decreased from 219 to 138 per 1,000 live births, the infant mortality rate from 147 to 90 per 1,000 live births and the maternal mortality ratio dropped to 520 per 100,000 live births.
Yet Mozambique still has one of the highest child mortality rates in the world. Gains in child and maternal well-being have not been even across the country, and large numbers of children and women, especially those living in remote rural areas, remain at risk. Every year, about 86,000 newborns die before reaching age one and an additional 38,000 die before reaching age five – nearly 340 every day.
Threats to child survival
Malaria, diarrhoea, acute respiratory infections, and vaccine-preventable diseases are the main causes of child deaths in Mozambique. And gains that have been made in reducing child mortality are now threatened by HIV and AIDS. About 410 people become infected every day, of whom about 85 are children infected through mother-to-child transmission.
Malaria is the leading killer of children, contributing to around 33 per cent of all child deaths.
Routine immunisation coverage against the major vaccine-preventable diseases – polio, measles, tuberculosis, diphtheria, pertussis and tetanus – stands at around 71 per cent, but this figure masks huge regional disparities across provinces.
Poor nutrition continues to affect many young children and their mothers. Forty-four per cent of children under the age of five are stunted, and malnutrition is the underlying cause of half of all child deaths. Mortality rates from severe malnutrition remain very high in health facilities and the community.
Limited access to health services
Lack of adequate health infrastructure and knowledge about basic health care among parents pose additional threat to child survival. As a result, many young children die at home before reaching a health clinic or hospital because parents are not informed or do not have easy access to medical services.
Health services are inadequate in terms of coverage and quality. Health facilities are few and far between, with 60 per cent of households living more than 30 minutes away from the nearest health facility. These facilities often have limited supplies and drugs, lack suitable sources of water and are staffed by overstretched health workers with insufficient training.
Maternal and neonatal health
About 40 per cent of Mozambican women become pregnant before the age of 20. The risk of death among pregnant teenagers is four times higher than for women above the age of 20.
Providing emergency obstetric care is the single most effective way to reduce maternal deaths. However, the healthcare infrastructure is facing particular challenges – maternity services are concentrated in urban areas and trained health professionals, medical supplies and equipment are in short supply.
What is being done
The key to making progress towards attaining the MDG goals related to child survival and maternal health is to reach every child and mother in every district with a few priority health interventions.
These interventions include low-cost, low-technology and high impact solutions such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated nets, improved breastfeeding practices and safe hygiene practices.
Evidence shows that, if implemented as a package and reaching 99 per cent coverage, these interventions together could prevent 63 per cent of current childhood mortality.
The way forward
UNICEF has developed an Accelerated Child Survival and Development Strategy to guide advocacy, policy and planning work with the Government and partners in Mozambique.
The strategy aims to address current gaps and missed opportunities in key priority areas:
Service delivery modes
In order to follow a coherent, strategic approach to scaling up these interventions, they are grouped according to three service delivery modes:
Family-oriented, community-based services that do not require a skilled health worker but that can be delivered on a daily basis by community health workers with periodic supervision from more skilled health staff.
Population-oriented, schedulable services that require health staff with certain skills and that can be delivered either by outreach or in health facilities in a scheduled way.
Individually oriented clinical services that require skilled health workers available on a permanent basis.
Between 2010 and 2011, UNICEF will focus on priority actions needed to accelerate the scaling up of these high-impact child survival interventions along three main strategic areas.
Strengthening capacity of care givers
The strategy places strong emphasis on community-based activities which aim to improve good nutrition and child care practices among families and health workers. This includes equipping all health workers with the knowledge they need to manage the most common diseases in a holistic manner.
Strengthening planning and service delivery
Implementing the Reach Every District approach is the key to increasing and sustaining immunisation coverage and achieving the eradication, elimination or control of vaccine-preventable diseases. This includes strengthening the capacity of provincial and district teams to promote participatory approaches and community action. Reach Every District aims at bringing vaccination services to remote communities and combine them with other health interventions, such as nutrition, malaria, and maternal health.
Supporting national policy development
At the policy level, UNICEF works with government and development partners to advocate for the best interest of the child, leveraging resources and ensuring that standards and norms are technically sound.