Saving children under five in three simple steps...

Even within high-burden countries, life chances are not distributed equally.

In Tanzania, for example, the child mortality rate in Ngorogoro district is 40 per 1,000 births whereas in Ruangwa it stands at 250.

Urban Moshi district has over 12 health workers per 1,000 people, compared with 0.3 in the rural district of Bukombe.

Health Care continues to be deeply unaffordable and in some extreme manifestations reported in Kenya, women have been locked up in maternity wards until they pay their delivery bills.

“The first tier of healthcare for children is the household level, and beyond that the immediate community.

“Yet relatively little attention is paid by most governments to low-cost and easy-to-deliver measures that can be taken at this level that can have a decisive impact on child health, from handwashing and breastfeeding to early identification of pneumonia,” the report reads.

To improve children’s health globally, World Vision calls for national health strategies that go beyond the current focus on formal health systems and single disease initiatives, to interventions in the areas of safe water and sanitation, nutrition and family care.

A couple of stories of progress in the report provide a ray of hope in an otherwise gloomy situation.

“Despite being one of the poorest countries in the world, Malawi has almost halved its under-five mortality from 210 per 1,000 in 1990 to 111 per 1,000 in 2007.”

Malawi was able to do this through proven, low-cost measures, including increasing the number of children delivered by a skilled attendant to 60 per cent, increasing immunisation cover to 99 per cent, and increasing Vitamin A supplements from zero to 86 per cent.

Community management of pneumonia and wide scale food security programmes, therapeutic feeding and promotion of exclusive breastfeeding also played a significant role.

Similarly, a 90 per cent reduction in deaths from measles in Southern Africa has been achieved through near-comprehensive vaccination since 2001.

Provision of insecticide-treated bednets to every household in Ethiopia has, since 2005, resulted in a 61 per cent reduction in malaria cases.

These successes show that most child deaths are avertable.

Comparable successes will be achieved only where governments, organisations, communities and individuals work together to ensure that there is commitment to following through on decisions made and proper allocation and use of resources earmarked for children’s health.