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Right in Principle, Right in Practice - by Anthony Lake, Executive Director of UNICEF

Anthony Lake

For decades it was simply accepted that a baby born in an affluent community/country has a far greater chance of leading a longer and healthier life than one born in poverty.   In spite of our efforts to build a brighter future for all children, this inequity was viewed as a harsh reality that is all but impossible to reverse.

 The odds are stacked against children born in the poorest countries.  For every ten children born in sub-Saharan Africa, one or two will die from something as preventable as a mosquito bite. About four will suffer the irreversible stunted growth that results from malnutrition. Three will never spend a single day in school. And instead of living an average of 80 years – as their peers in industrialized countries do – their life expectancy is about fifty. 

 A decade ago, the world set eight Millennium Development Goals (MDGs) aimed at improving these terrible numbers by 2015. We’ve made progress. But in many areas, a close look at the numbers shows us that with progress have come widening disparities between the most and least deprived – for child mortality, sometimes by more than 10%.   

 As the world considers the MDGs 10 years after their adoption. the big question is: can we reach the goals faster?

 The answer is we can—not just by spending more money but by spending it to greater effect.

 That’s the lesson of “Narrowing the Gaps to Meet the Goals,” a new study released in September by UNICEF. 

 Carefully researched and peer-reviewed, “Narrowing the Gaps” offers more than a new analysis – if argues for a new approach. It disputes the common beliefs that we save more lives in poor countries by focusing on those more easily reachable and that focusing on the very poor as a first priority may be right in principle, but is wrong in practice.   

 The outcome of UNICEF’s work shows that in this case, principle and practice go are very closely linked. An “equity” focus— approaches aimed at the most deprived and disenfranchised — will save more children per dollar than common alternatives. 

  Why? Partly because we have learned much about health since 2000—for example the way good nutrition in the first two years of life can avert the stunting that afflicts almost 200 million children in the developing world. Partly because new technology like cell phones allow us to communicate with the most isolated villages on the planet.
 The combination means we can now more efficiently deliver low-tech ways to help the poorest communities.  For example, to help prevent hundreds of thousands of women dying during pregnancy and in childbirth each year, often because they give birth without skilled help, we can train non-physicians to assist. 

  An equity focus doesn’t mean abandoning the many worthwhile projects underway. It suggests effective ways to build on them. UNICEF study’s modeling shows that if we build on them by focusing future efforts on the poorest people and the poorest areas, we will achieve dramatic results.

 By 2015, every $1 million shifted to this new approach in the poorest countries could save about 60% more children every year.

 Naturally, one study is not the last word on such a complex issue.  But the thoroughness of UNICEF’s data makes it much more than a first step. That’s particularly true because UNICEF researchers guarded against the impulse to satisfy our own biases by working with distinguished outside consultants. At a recent day-long review of the study, they enthusiastically supported this work.

 “Always do right,” Mark Twain wrote. “This will gratify some people, & astonish the rest.” 

 Being right in principle turns out to be right in practice. While the developing world desperately needs more money for health care, this approach offers more health care for the money we have. The policy implications that follow from what we found offer sustainable new opportunity to save and help many more children.

At UNICEF we have already begun to move where the facts lead us. We see results in simple things: the drop of polio vaccine squeezed onto a child’s tongue in Tajikistan, where we helped head off an epidemic; a Sudanese mother filling a container with clean water from the newly drilled borehole in her village; a young girl in a classroom in Afghanistan where only 40% of girls ever attend elementary schools. 

 In the final five years of the MDGs - a mission created with such hope, and carried on with such dedication -- we urge our partners to help the most children by focusing on those who need help the most.

And we urge readers to recognize that the fate of these children is linked to the fate of our own.  In order to create a better world for all of our children – regardless of where they were born – we must even the odds. This new study offers a bold vision of a world in which poverty need no longer be a life sentence for any child.



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