by Nellie Bristol and Janet Fleischman
The Child Survival Call to Action shows the U.S. government navigating a new approach to global health and development. Launched at a summit on June 14th and 15th at Georgetown University and co-convened by the U.S., Ethiopia and India in collaboration with UNICEF, the event set out an ambitious road map for ending preventable child deaths in a generation. After all the high-level speeches and compelling evidence about how to help all children reach their fifth birthday, the real challenge will be to energize and coordinate a wide collection of partners and to demonstrate measurable success, all in an era of strained resources.
While remarkable advances have been made in the last fifty years to reduce deaths in children under five, USAID and its partners want to “bend the curve” faster. In 2010, child deaths totaled 57 per 1,000 live births worldwide. The Call to Action sets a vision for every country to reach 20 per 1,000 child deaths or below by 2035. A Global Roadmap presented at the summit calls on countries to define their own targets and develop five-year benchmarks to monitor progress.
Secretary of State Clinton outlined strategic shifts required to support the Call to Action. First, she called for moving resources to the locations where the problem is greatest. “Eighty percent of children’s deaths occur in 24 countries, but those countries don’t receive nearly 80 percent of global support or funding,” she said. “We want to work with those governments that are willing to lead the effort within their own borders.” She also urged prioritizing attention on populations within countries with the highest child mortality rates. In addition, she said, efforts should focus on the most effective solutions for fighting diseases causing the most deaths, naming pneumonia, diarrhea and neonatal complications. Clinton also promoted broader development factors including family planning, education for women and girls, and inclusive economic growth, in addition to “mutual accountability” for progress across governments, donors, civil society and the private sector. “The U.S. is committed to making these five shifts part of our broader effort to change the way we do business in development,” Clinton said.
The road map and the summit itself illustrate the new approach to foreign aid: collaboration and partnerships, country leadership instead of donor dictates and integration of services instead of a disease specific focus. They also highlight other new realities in the development arena in that they promise little additional funding and put the onus on the countries themselves to ensure progress.
The summit attracted attendees from 80 countries, including ministers of health, donors, representatives of the private sector, faith-based organizations, and USAID implementing partners. It grew out of a 2011 GAVI pledging conference, but U.S. officials wanted to broaden the scope to child health generally. The issue is considered to be a priority for Secretary Clinton. Child survival also gives a more identifiable focus to the Global Health Initiative and offers USAID an appealing funding pitch to use on Capitol Hill. Organizers hope the combination of sponsors, the U.S., Ethiopia, India and UNICEF, can generate future regional and global gatherings focused on child health.
With increased attention, accelerated success in child health seems plausible. In discussing the current situation, Robert Black of Johns Hopkins noted that child mortality declined 35 percent globally from 1990 to 2010 with reductions in diarrhea, pneumonia and measles leading the way. But high rates of child death persist in some regions with deaths during the first month of life constituting 40 percent of the total.
Nonetheless, experts say, innovations including new vaccines and improved delivery systems show better outcomes are possible even in resource poor settings. A presentation by the Institute for Health Metrics and Evaluation Director Christopher Murray listed six low-income countries that have seen rapid reduction in child deaths, including Sierra Leone and Cambodia. According to his analysis, a global under-five mortality rate of 15 per 1,000 can be achieved by 2035 by improving access to maternal education, speeding the pace of innovation through increased investment in research and development and operational research and enhancing health system efficiency.
Even with the dedicated encouragement of donors and the latest in analysis and statistics, the difficult work will come in country capitals and hard-hit regions as governments and their partners grapple with the realities of inadequate health systems and slim resources. How momentum from the Call to Action will lead to changes to U.S. global health efforts remains to be seen. What is most important, according to Secretary Clinton “is what happens when we leave this summit—what happens on Monday and the next week and the week after that into the years ahead, because we can only meet our ambitious goal if we keep up our efforts day after day and year after year, and if we are relentless about holding each other to the task.”