THE WAY FORWARD: UNITING FOR CHILD SURVIVAL
The State of the World’s Children 2008 calls on governments, donors, civil society and other stakeholders to unite for child survival and commit themselves to ensuring that the health-related Millennium Development Goals (MDGs) are met. It identifies some pivotal actions at the macro level that urgently require a unified response. These are:
- Create a supportive environment for maternal, newborn and child survival and health
Providing quality health care for women and children will require an environment in which they can survive and thrive. Peace and security are essential for the proper functioning of health programmes, whether they are facility-based services, extension-based services or community partnerships. When peace and security are threatened, it is vitally important to reach and protect children and their families. Although incorporating the concept of children as ‘zones of peace’ into international law has not been realized, ‘days of tranquility’, when fighting stops and brigades of health-care workers are able to administer vaccines, have been declared in recent decades in countries as diverse as Afghanistan, Angola, the Democratic Republic of the Congo, El Salvador, Lebanon, Somalia, Sri Lanka and Sudan.
Equally important is a child’s sense of inner security, which can be disrupted by armed conflict, high levels of violence and crime within communities or by living in an embattled home. Acknowledging children’s right to a protective environment is essential in preventing violence against them, and it must be followed up by appropriate legislation and effective enforcement.
Equity is another critical aspect of a supportive environment for children. In far too many countries, to be poor automatically means to be neglected and marginalized by the health system. In others children are excluded from essential services and practices on the grounds of gender, disability, race or ethnic origin. Ensuring that health systems and maternal and child survival programmes are rights-based and seek to rectify such inequities is imperative.
Sustained improvements in the health of women and children will also demand greater gender equality and the empowerment of women. No matter how or what health services are provided, many children will miss out unless women have wider decision-making powers within the household.
- Develop and strengthen the continuum of care across time and location
Children are most vulnerable at birth and during the first few days of life. Health care, therefore, is crucial during pregnancy, at birth and in the neonatal period. This continuum of care should extend through infancy and early childhood, with packages of essential services delivered to both mother and child at key points during the life cycle. Scaling up the continuum of care with packaged interventions could markedly expand universal coverage of essential care for mothers and children across their life cycles in an integrated primary-health-care system. The impact of achieving high rates of coverage could be profound. In sub-Saharan Africa, achieving a continuum of care that covered 90 per cent of mothers and newborns could avert two thirds of newborn deaths, saving 800,000 lives each year.
- Scale up packages of essential services by strengthening health systems and community partnerships
The health systems in many of the poorest countries are fragile and fragmented, beset with problems ranging from an acute shortage of skilled staff to lack of financing, equipment and supplies and the inability to generate and use information. Over the medium to long term, the surest way to achieve the health-related Millennium Development Goals is to strengthen national health systems. Community partnerships in primary health care can be effective in scaling up services in areas of a country that are hard to access and in strengthening health systems.
- Expand the data, research and evidence base
Understanding the situation of children’s survival and health around the world is often half the solution. The dearth of reliable statistics in many countries makes it difficult for policymakers to establish priorities, measure the effectiveness of programmes or monitor progress. Even vital registration systems – which record key life events, including birth and death – sometimes cover only portions of a country, if they are available at all. Accurate information and situation analysis on the state of health, nutrition, water, sanitation and hygiene, and HIV and AIDS among the world’s children are essential to formulating strategies to scale up community partnerships, the continuum of care and health systems for outcomes.
Household surveys, such as the Multiple Indicator Cluster Surveys; statistical reviews, such as the Progress for Children report card series produced by UNICEF; The Lancet series that have covered child, newborn and maternal survival and health; and publications assessing progress towards the Millennium Development Goals that have been produced by the United Nations Development Programme, the World Bank and the World Health Organization, among others, provide a rich array of resources for strategic planning in countries. These initiatives are complementing national efforts across the developing world to produce, analyse and disseminate key health data and information related to maternal, newborn and child inputs and outcomes. Although there is more than enough information to act, it is also true that there is still a need for more rigorous research and evaluation of what works, systematic sharing of good practices and greater sharing of new information.
- Make maternal, newborn and child survival a global imperative
Leveraging resources and making maternal, newborn and child survival a global imperative are inextricably linked. Both governments and donors must commit to releasing the necessary financial resources, technical assistance, and political will required to support governments in meeting the health-related MDGs.
What needs to be done for progress in child survival is clear. When it needs to be done, and who needs to be involved is also clear. The need to be united – in both word and deed – to ensure the right of mothers, newborns and children to quality primary health care is clearest of all. At the midpoint between the inauguration of the MDGs and their target date for fulfillment, much has already been achieved. The basis for action – data, research, evaluation – is already well established. The means are at hand. It is simply a question of will and of action – for there is no enterprise more noble, or reward more precious than saving the life of a child.