Even the poorest countries facing the most difficult circumstances – including poverty, armed conflict, natural disaster or complex emergencies involving displaced populations, food insecurity and disease – can take proactive steps to boost maternal, newborn and child health. While investment is undoubtedly a factor in preventing unnecessary deaths, the examples below offer proof of how much can be achieved using extremely limited resources. The key to all of these victories is community knowledge, involvement and empowerment.
In Angola, where the under-five mortality rate is the second highest in the world, the Ministry of Health has identified an essential package of child and maternal health care services to be delivered through three main channels: the fixed network of public health services, outreach and mobile services, and community-based activities.
In Benin, the president announced in early 2007 the abolition of all user fees for health services provided to pregnant women and to children under age five. National health and financial specialists worked with UNICEF, the World Bank, the United Nations Population Fund and the World Health Organization to refashion the state budget to reflect this new reality. Both domestic and foreign assistance funds were shifted to cover shortfalls the change engendered. As a result, the poverty reduction strategy for Benin, particularly as it relates to maternal and neonatal health and child survival, is much more child friendly – and more likely to help the country reach the MDGs.
Egypt has made striking progress towards Millennium Development Goal 4 during recent years, reducing its under-five mortality rate by 62 per cent between 1990 and 2006. But partly because of its large population of children under five, the country has the highest number of under-five deaths in North Africa, with 64,000 in 2006.
Eritrea is one of the few countries in sub-Saharan Africa currently on track to meet Millennium Development Goal 4. Its under-five mortality rate fell by roughly 50 per cent between 1990 and 2006. Eritrea is polio free, maternal and neonatal tetanus have been eliminated, and there have been no measles deaths in the past two years. There has also been a sharp reduction in malaria morbidity and mortality.
In 2007, Ghana launched a High Impact Rapid Delivery strategy for health care that has generated impressive results. All pregnant women have been reached by basic intervention actions, vitamin A supplementation reaches all children aged 6 to 59 months, and polio vaccination coverage is universal. No measles deaths have been recorded since 2004, and more than half of Ghana’s children and pregnant women now sleep under insecticide-treated mosquito nets.
In Kenya, more than 10 million insecticide-treated mosquito nets have been distributed since 2003 through integrated child and maternal health services that include immunization and antenatal care. This increased distribution resulted in 67 per cent of children younger than five sleeping under an insecticide-treated net.
Although child mortality in Malawi remains high by global standards, the country has made significant progress in reducing child deaths. From 1990 to 2006, the under-five mortality rate fell by 46 per cent, from 221 to 120 per 1,000 live births. This follows sharp improvements in immunization coverage, micronutrient supplementation, exclusive breastfeeding for children up to six months of age, safe drinking water, the use of insecticide-treated mosquito nets, and the expansion of high impact health interventions.
Morocco reduced its under-five mortality rate by 58 per cent between 1990 and 2006 following steady advances in immunization coverage. In 2006, more than 95 per cent of Moroccan children were immunized against the six major vaccine-preventable diseases by age one.
In Niger, 56 per cent of the population lives more than five kilometers from a health facility. To increase child survival by bringing health care closer to underserved rural communities, in 2000 the Government began implementing a strategy to use funds from a debt reduction programme to finance the construction of 2,000 community health posts. Trained community health workers offer a minimum package of curative and preventive interventions at these posts and promote disease prevention. The Government’s recent decision to make health care available free to children under five is another promising move.In Sierra Leone, United Nations agencies, including UNICEF, have developed a joint programme to support a government plan to address the devastatingly high under-five and maternal mortality rates – the highest in the world. The programme covers emergency obstetric care, immunization, and prevention and management of undernutrition. The overall aim is to reduce the 2005 rates of maternal, under-five and infant mortality by 30 per cent by 2010.