Critical health care failing to reach women and children in high mortality countries, despite gains in fighting child killer diseases
Leading global health experts, policy-makers and parliamentarians convened in Cape Town 17-19 April 2008 to address the urgent need for accelerated progress to reduce maternal, newborn and child deaths, if internationally-agreed targets are to be met.
According to the 2008 report Tracking Progress in Maternal, Newborn & Child Survival released on 17 April, few of the 68 developing countries that account for 97% of maternal and child deaths worldwide are making adequate progress to provide critical health care needed to save the lives of women, infants and children. Parliamentarians attending the 118th Assembly of the Inter-Parliamentary Union in Cape Town, 13-18 April, joined global health experts and policy makers to discuss the role they can play in accelerating action to achieve Millennium Development Goals 4 and 5 on reducing child and maternal mortality.
Over 10 million women and children still die each year from causes which are largely preventable and treatable. The majority of maternal and child deaths occur in Africa and South Asia, with African countries south of the Sahara increasingly bearing the global burden of mortality. One in five children are born in African countries south of the Sahara, yet some 50% of all child deaths globally occur in the region, as do half of maternal deaths worldwide. In Niger, for example, women face a lifetime risk of dying in pregnancy or childbirth which is as high as one in seven.
Tracking Progress in Maternal, Newborn & Child Survival uses existing data to measure coverage of key interventions and approaches proven to reduce maternal and child mortality. The 2008 report highlights the rapid progress that many of the 68 countries are making in providing vaccinations, vitamin A supplementation coverage and insecticide-treated mosquito nets to prevent major killers such as measles and malaria.
Nonetheless, treatment for potentially fatal illnesses and other vital health services still fail to reach the majority of women and children according to the findings. These services are dependent on strong health systems that can provide 24-hour care within the community, at health clinics, and through a functioning referral system when more serious intervention is necessary. Access to these services is most critical at the time of birth and during the first two weeks of life which are riskiest for mother and infant.
Tracking Progress in Maternal, Newborn & Child Survival identifies a series of missed opportunities to save lives:
- Family planning: The unmet need for contraceptives is high. Only one-third of women in the 68 priority countries are using a modern contraceptive method – a proven means of boosting maternal and infant survival;
- Skilled care at birth: Only around half of women and newborns benefit from a skilled birth attendant at the time of birth, and even fewer receive care in the critical days and weeks after childbirth;
- Clinical care for sick children: Only about one-third of children with pneumonia – the biggest single killer of children – receive treatment;
- Nutrition: Undernutrition is the underlying cause of 3.5 million child deaths annually, and as many as 20 per cent of maternal deaths.
Despite these missed opportunities, the report also notes that a number of countries, including China, Haiti, Turkmenistan and several African countries south of the Sahara, have made demonstrable progress in reducing deaths of children under-five in the past three years. Sixteen of the 68 Countdown priority countries are now ‘on track’ to achieve Millennium Development Goal 4.
To pave the way for a well-functioning 'continuum of care', governments and their partners must address obstacles such as weak health systems, funding shortages, and inequalities in access to care. The report findings show poor families missing out twice, on skilled care at birth and on care for newborns and children when they are ill. Other barriers include armed conflict and a high HIV prevalence, which together have erased any gains in child survival in at least 12 African countries.
Overall funding from donor governments for maternal, newborn and child health has increased in recent years, with Official Development Assistance (ODA) rising from US$2.1 billion to almost US$3.5 billion between 2003-2006, a 64 percent increase. This investment has resulted in significant health gains, notably to boost immunization levels and prevent malaria. Nonetheless, health systems for maternal, newborn and child health remain grossly under-funded in relation to the needs of priority countries. Total donor funding for maternal, newborn and child health still represents just three percent of total donor aid disbursements. Most donor assistance is delivered through specific projects and only five percent has been dedicated to general budget support in recipient countries.
The Countdown findings are also the subject of a special issue of the medical journal The Lancet.