April 2005

Views expressed are those of the authors, not necessarily of the AFSC.

Launching the Second Child Survival Revolution

David Oot is Chairperson of the US Coalition for Child Survival www.child-survival.org, and Director of Health, Save the Children, www.savethechildren.org. This piece is reprinted from the Global Health Council's magazine, HealthLink, www.globalhealth.org.

Young child in Togo clutching a new insecticide treated bednet designed to protect him from Malaria. The net was provided to him in a new integrated child health campaign. Please see page 21 for details. Photo: UNICEF.

Each day, 30,000 children under the age of five die. Nearly 99 percent of these deaths occur in the developing world, and most are preventable. Diseases such as diarrhea, measles, pneumonia, malaria and neonatal illnesses - while virtually unknown as causes of death in developed countries - are still the biggest killers, with malnutrition contributing to over half of these deaths. In a recent article in the British medical journal, The Lancet, child health experts estimated more than 6 million of the 10 million children under-five who die each year could be saved with basic, cost-effective measures that are already available. [Peacework editor's note: The Lancet authors estimate that saving these lives would cost $7.5 billion per year.]

Regrettably, many in the developing world, and especially the poor, still lack access to these basic services, which result in this tragic and needless loss of life. Understanding the need for more resources in child health, the US Coalition and its partners aim to ignite a second Child Survival Revolution in 2005. The time has come to refocus on the basics and recommit ourselves to the children of the world.

This situation, though largely invisible, is not "new" news. Twenty years ago, the United States and its global partners launched the first Child Survival Revolution - a worldwide campaign dedicated to saving the lives of children through simple, cost-effective tools such as vaccines, oral rehydration therapy, antibiotics, and improved breastfeeding practices. This revolution made a real difference:

• Globally, these interventions contributed to a more than a 50 percent reduction in under-five mortality since 1960.
• Polio cases were reduced by 99 percent, tetanus deaths by 50 percent, and measles cases by 40 percent.¹
• Oral rehydration therapy reduced diarrhea-related deaths by half, and prevents an estimated 1 million under-five deaths each year.²
• More recently, twice-yearly vitamin A supplements saved more than 1 million lives between 1998 and 2000 alone.³

Despite these impressive achievements, the momentum generated by the first "child survival revolution" slowed considerably during the 1990's. Competing demands for human and financial resources in the developing world, shifting donor priorities, flagging leadership and commitment to child health, and the impact of HIV/AIDS, have all limited our ability to expand coverage of these proven interventions. In some countries, and especially in sub-Saharan Africa, a lack of resources has made it impossible to sustain the high levels of coverage, and therefore the accomplishments of the first Revolution. There are now twice as many deaths of children under-five in sub-Saharan Africa today than in 1960, and globally 40 percent of all such deaths occur in this region.⁴

While documenting progress in some regions and countries, the End-Decade Report prepared by UNICEF for the UN Special Session on Children in May 2002 produced some startling findings that resulted in a call for renewed focus and attention on this critical "unfinished agenda." For example, the Report found that:

• Only five out of 55 countries with the highest mortality rate (100 or more per 1000) for children under-five achieved the goal of one-third reduction in child deaths.⁵
• While some improvements in facility-based treatment of pneumonia and malaria were noted, lack of access to low-cost, effective drugs still contribute to three million deaths each year.⁶
• While exclusive breastfeeding rates (through four months) improved, only 50 percent practice exclusive breastfeeding.⁷
• Immunization coverage remained stagnant at 75 percent, and 30 million infants are not reached with routine immunization each year.⁸
• Deaths occuring during the first 28 days of life represent 40 percent of all deaths for children under-five, yet few programs focus on this group.⁹

These findings, as well as the growing concern about this "unfinished" and neglected agenda for children, resulted in the creation of the US Coalition for Child Survival. The Coalition was created to educate and advocate for increased attention and resources for child and maternal health programs, with a special focus on the US -- and especially the role of the US government in support of such programs. Our broad-based Coalition of nearly 180 members includes corporations, universities, private voluntary organizations (PVOs), non-governmental development assistance organizations (NGOs), faith-based organizations (FBOs), foundations, and individuals, all working together to:

• Improve understanding and awareness of unmet health needs, effective interventions and resources needed to improve child health and survival.
• Increase level of US public, private, multi-lateral funding and partnerships for child and maternal health and survival;
• Advocate and mobilize commitment and action to achieve child survival targets set forth in international agreements including the Millennium Development Goals and the United Nations Special Session on Children; and
• Broaden the membership of the Coalition and establish partnerships with other organizations to strengthen our overall impact and ability to achieve our objectives.

The Coalition believes that increased US leadership and funding is absolutely essential to increasing the quality, scale, and impact of child and maternal health programs. Despite the growing needs -- and potential impact -- of highly cost-effective interventions, US government funding for child survival and maternal health remained virtually stagnant between 1997 and 2003, while the number of women between the ages of 15-24 and the number of children under age five increased by 46 million.¹⁰ During this same period, funding for HIV/AIDS increased from about $120 million per annum to $3.0 billion per annum in FY 2005 -- a desperately needed investment to prevent the spread of HIV, and treat and care for those who are HIV-infected, or affected by HIV/AIDS.

Globally, however, less than 5 percent of the deaths of children under age five are attributable to HIV, while diarrhea, pneumonia, neonatal illnesses and malaria account for more than 60 percent of these deaths.¹¹ While there is clearly a moral imperative to invest in programs to address the HIV/AIDS crisis, there is also a moral imperative to prevent the tragic loss of millions of young lives that could be saved through increased access to these basic, proven, child survival interventions.

During the coming year, the US Coalition for Child Survival will continue our efforts to educate and advocate for increased attention and resources for child and maternal health in developing countries. This will include efforts to enhance public awareness by working with other broadly-related campaigns to incorporate key messages into their communications, mobilizing grassroots support and participation in this effort, and participating in a major new WGBH/Boston-led Global Health Campaign to draw attention to the needs and opportunities to advance child survival. WGBH will partner with US and global media organizations such as Time and National Public Radio, as well as global non-profit organizations specializing in delivering child survival services, in a six-part television series and related public campaign to advance child survival. The Coalition will also continue our efforts to engage key US policymakers on this issue, both within Congress and the Administration, and will focus increased attention on building the capacity of our members to become active and effective advocates for child survival.

We urge you to join us in making this second Child Survival Revolution a reality in 2005. As a member of the US Coalition for Child Survival, you can help by participating in its advocacy campaign, which include briefings on Capitol Hill, advocacy days, and letters to members of congress; organizing local events to raise awareness and encourage action within your own organizations and communities; participating in our speakers bureau; and participating in several important events, such as World Health Day, planned for this year. As a member of the Coalition, you or your organization will have access to up to date information about child and maternal health, and through our website will be linked to other organizations and individuals who share your interest in this issue.

In sum, the good news is that we know what to do. The tragedy is that we have not done more to save these young lives.

References

1. Annan, Kofi A. We the Children. Meeting the Promises of the World Summit for Children. (UNICEF: New York: 2001) p. 20.
2. Annan, Kofi A. We the Children. Meeting the Promises of the World Summit for Children. (UNICEF: New York: 2001) p. 24.
3. Annan, Kofi A. We the Children. Meeting the Promises of the World Summit for Children. (UNICEF: New York: 2001) p. 20.
4. Progress Since the World Summit for Children: Statistical Summary (UNICEF:New York:2001) p.3.
5. Black, Robert, et al. "Where and Why Are 10 Million Children Dying Every Year?" The Lancet, Vol. 361, June 28, 2003. (Lynhurst Press, Ltd. London) 2226-2234.
6. Jones, Gareth, Richard W. Steketee, Robert E. Black, Zulfiqar A Bhutta, Saul S. Morris and the Bellagio Child Survival Study Group. "How Many Child Deaths Can we Prevent This Year?" The Lancet, Vol. 362. July 5, 2003. (Lynhurst Press, Ltd. London) p.68.
7. Annan, Kofi A. We the Children. Meeting the Promises of the World Summit for Children. (UNICEF: New York: 2001) p. 29.
8. Annan, Kofi A. We the Children. Meeting the Promises of the World Summit for Children. (UNICEF: New York: 2001) p. 22.
9. Tinker, Anne and Elizabeth Ransom. Healthy Mothers and Healthy Newborns: The Vital Link. (Population reference Bureau: Washington, D.C.: April 2002) p. 5.
10. Save the Children, Child Survival Issue Brief, Vol.1, January 2004, p. 11
11. World Health Organization. Proportional Mortality Under-fives, Year 2002, World, http://www.who.int/child-adolescent-health/OVERVIEW/CHILD_HEALTH/map_02_world.jpg[accessed Dec. 20, 2004].

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