Opinion: Are new UN child health estimates good news?


A Congolese baby receives treatment for cholera at a clinic in the town of Goma, Congo, Nov. 10, 2008.


Uriel Sinai

CAPE TOWN, South Africa — Are new United Nations estimates on child mortality good news or bad?

Both actually. Good news, because global child deaths continue to drop.

Bad news, because that progress isn’t reaching all families around the world, and it isn’t reaching newborn babies as often as older children. Every year, 7.6 million children under 5 still die, almost all from preventable causes.

Why is this? It’s not for lack of knowledge about what would save these lives. Nor is it for lack of technology. Saving a premature baby’s life, for example, can be as simple as teaching a mother how to wrap her newborn to her own bare skin, keeping the baby warm and properly breastfed.

But too often, there is simply no one equipped to deliver basic lifesaving care to families who need it most. More than anything else, babies and children die for lack of frontline health workers.

The leading killers of children today are newborn complications, pneumonia, diarrhea and malaria. If the world chooses to tackle the health worker crisis, far fewer children will die needlessly from these causes.

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I wouldn’t be alive today if not for two brave health workers ready to fight for my survival in rural Uganda. My mother was in labor for more than 24 hours in a bush hospital with no running water and no electricity.

The midwife recognized that without a caesarian section both my mother’s life and mine could soon end. So the midwife found and convinced a doctor who had observed a C-section, but never performed one, to do the procedure.

Almost 50 years later, many parts of the world have made tremendous progress. The annual number of child deaths has been cut by more than half.

Yet in 2010, around 50 million women gave birth with no skilled help at all. And more than 60 countries have an absolute shortage of health workers needed to ensure basic health services.

They all fall below the World Health Organization’s minimum threshold of 23 doctors, nurses and midwives per 10,000 people.

Almost all of Africa and most of Asia face such shortages, and these are the regions where most child deaths occur. In comparison, the United States has 125 of these health workers for every 10,000 people. Switzerland, with the world’s highest density, has 200.

In the world’s poorest countries, low pay and brain-drain make it a daunting challenge to recruit and deploy highly-skilled workers like doctors to where they’re needed most.

Health workers are often concentrated around cities, but most deaths occur in rural areas. That doesn’t mean babies and children born in these places must continue to die. In fact, some countries with extreme shortages of doctors, nurses and midwives are among those to have reduced child mortality most.

Nepal, Bangladesh and Malawi are three examples of very poor countries on track to meet the U.N. Millennium Development Goal of reducing child mortality by two-thirds between 1990 and 2015.

Many countries are far from achieving that goal. But with international support, these three nations have trained and deployed large numbers of community health workers to prevent and treat the leading causes of child death.

You don’t need to go to medical school to diagnose a child’s pneumonia and dispense lifesaving antibiotics that cost around $1. You don’t need to be a registered nurse to administer a vaccine or provide family planning to space births, bed nets to combat malaria or simple rehydration solution to treat diarrhea.

You don’t even need to be a midwife to counsel pregnant women to eat nutritiously or to recognize danger signs that mean they should immediately seek care at the nearest health facility.

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Yet such basic care could prevent millions of child deaths. It could also link to higher-level care when needed and free higher-level health workers, like doctors and midwives, to focus on what only they can do.

World leaders meeting at the United Nations this week should take note of what some countries have achieved and make concrete commitments to address the health worker gap elsewhere.

Last year, many of them signed onto Secretary General Ban Ki-moon’s “Every Woman Every Child” strategy to dramatically reduce maternal and child deaths. Without more and better equipped health workers that won’t happen.

I am just one of countless people who owe their survival to health workers who fought for their lives. It’s time the world fought for frontline health workers.

Dr. Joy Lawn is Director of Global Evidence and Policy for Save the Children’s Saving Newborn Lives program, an African-born pediatrician and a team member for new U.N. estimates on newborn and child mortality.