Five years away from the target date for the Millennium Development Goals, the global commitment to cut child deaths by two thirds, and transform the opportunities of millions of the world’s children, hangs in the balance. The world as a whole is off track, and the poorest countries in Africa and South Asia will not reach the goal without a fundamental change of direction. Business as usual will not get us there.
In the year 2000, world leaders gathering at the United Nations collectively committed to a series of goals to tackle poverty and its underlying causes. The eight Millennium Development Goals, set for the year 2015, include ambitious but achievable targets for halving hunger and extreme poverty, attaining universal primary education and cutting child and maternal deaths. With five years to go before reaching the target date, a stock take of progress is due: in the second half of 2010, the international community will again convene at the UN to review the goals and identify the steps needed to reach them.
From the perspective of children living in the world’s poorest countries, this review is desperately needed. While movement towards all of the goals is uneven and on current trends most will be missed, it lags furthest in the area of health. Only 30% of the progress needed to reach the MDG 4 target of cutting child mortality by two-thirds by 2015 has happened. Progress on the closely connected target of cutting maternal deaths is even further off track.
The upshot is that over 24,000 children continue to die each day before they reach their fifth birthday. Put simply, this is the biggest child rights violation of our age. Overwhelmingly, these deaths are caused by poverty: 99% of under-five child deaths take place in developing countries, the clear majority of them from easily prevented neo-natal complications and infections, and conditions such as diarrhoea and pneumonia. A lack of proper nutrition and safe water and sanitation are a factor in over half of all these deaths.
To make a change we need a major rebalancing of health strategies, with far greater emphasis on proven, low-cost preventive measures, and on the role of the family and community as the first and most important point of health care intervention in a child’s life. This will in turn require governments and donors to work with a broader definition of health systems, which incorporates issues that often lie beyond the immediate remit of health ministries – such as water and sanitation, and nutrition – and the direct role of skilled health professionals.
This change of approach needs to come first and foremost from within the 30 high burden countries that are at the centre of the global child health emergency. Some of these countries are already showing the way: the experiences of Malawi, Tanzania, Bangladesh and other low-income countries that have succeeded in making major inroads into child mortality rates are instructive. New policies need to be coupled with a new politics that responds to the needs and priorities of children, their families and communities, and treats the current scale of child death and illness as an inexcusable violation of basic rights.
Yet even where these conditions exist, the poorest countries cannot address child health alone. Donor countries have a crucial part to play in achieving the MDG4 of cutting child mortality rates, by increasing their level of financial commitment, but also by using that money more intelligently to support single national health plans, budgets and monitoring systems.
The review of the Millennium Development Goals in the second half of 2010 provides an opportunity to generate renewed momentum and commitment in this area, at a time when some donors’ resolve on international development is weakening in the face of domestic fiscal pressure.
Experience demonstrates that progress on child health cannot be achieved by any one actor, or single intervention. Achieving MDG 4 will require organisations and individuals to collaborate, across professional, technical and institutional boundaries, and to sacrifice some pride and jettison some prejudices in doing so.
The potential outcome, however, should provide a focus – by the MDG target date the right actions in combination can cut the annual toll of child deaths by almost 6 million, and change the lives of these and millions of other children, their families and communities for the better. This goal is a moral imperative worth pursuing in its own right, but is also one of the soundest investments the international community can make in future economic and social development.
Martin Luther King, almost half a century ago in a moment of tumultuous political change and hard choices, spoke of the ‘fierce urgency of now’. Five years away from the target date of the Millennium Development Goals, in a period of economic downturn and political flux, no task demands more immediate and concerted action, and a greater sense of fierce urgency – from governments, donors and civil society – than ending the silent emergency that each year needlessly claims the lives of almost 9 million children under the age of five.
Get behind the Child Health Now campaign and add your voice to the call on the British government to play a leading role in ending the silent emergency that claims almost 9 million lives a year. Urge the prime minister to commit more aid to child health, and to give it in ways that ensure more child health for the money. Call on him to ensure that next year’s review of the Millennium Development Goals comes up with clear plans for the poorest countries to get back on track for the 2015 target. With your help, we can make a change.