“The means are at hand. It is now a question of will and of action — for there is no enterprise more noble, or reward more precious than saving the life of a child.”
— UNICEF, The State of the World’s Children 2008
Twenty-five years ago, UNICEF’s The State of the World’s Children report launched the first “child survival revolution.” Cataloguing a series of life-saving interventions, the report was a clear call to action on behalf of children dying from preventable and treatable diseases. UNICEF’s The State of the World’s Children 2008 report returns to the topic of child survival. The report documents the tremendous progress in children’s health in recent decades, highlights the strategies and partnerships that have proven most effective, and outlines the challenges that remain. Like its predecessor a quarter century ago, The State of the World’s Children 2008 makes clear that the most significant barriers do not require medical innovation, but political will and commitment.
On March 13, a House Foreign Affairs subcommittee will hold a hearing on child survival issues, including those addressed in UNICEF’s report. For more information, please see the “Call to Action” section of this document.
Poor Countries Not on Track to Meet Child Health Goals
UNICEF reports that, for the first time, the number of children worldwide dying before reaching their fifth birthday dipped below 10 million, to 9.7 million. Between 1960, when approximately 20 million children did not live past the age of five, and 2006, child mortality rates fell by 60 percent. Despite this progress, more than 26,000 children under age five still die every day from largely treatable and preventable causes.
Much of the developing world is not on track to meet international goals for child survival. Millennium Development Goal (MDG) 4 — which the United States and every other nation pledged to achieve — calls for a two-thirds reduction in child mortality rates (from the 1990 level) by 2015. According to UNICEF’s report, of the 60 poor countries that account for 93 percent of global child deaths, only seven are on track to meet MDG 4. The failure to achieve adequate progress is most acute in South Asia and Africa. Of the 46 countries in sub-Saharan Africa, only three are on track to meet MDG 4. Almost half have made no progress in child death rates since 1990.
Many children in developing countries die for want of basic medical attention for ailments rarely fatal in the developed world. One in five child deaths — 2 million annually — are due to pneumonia (see below), and diarrheal diseases account for nearly another 2 million. Forty percent of child deaths occur among newborns, most from severe infections, birth asphyxia (difficulty breathing), or complications due to preterm birth. Measles, malaria, and HIV/AIDS together account for 15 percent of child deaths.
The interventions necessary to prevent these deaths are well established. Essential newborn care, such as immunizing mothers against tetanus, clean delivery conditions, drying and wrapping a baby immediately after birth, promoting breastfeeding, immunization, and treating infections with antibiotics could save 1 million babies a year. A 2-cent capsule containing a vitamin A supplement given two to three times a year helps prevent blindness and death. An additional 500,000 children could be saved if all had access to this nutritional supplement. Providing insecticide-treated bed nets to families in malaria-ridden areas could prevent another million deaths a year.
Investing in child survival is critical to building a sustainable future. Not only will providing proper health care result in children around the world growing into productive, healthy members of society, but it will also result in improvements in maternal health and population dynamics. Families will have less children as the odds for survival increase, and can better care and provide for the children they do have.
Pneumonia: The Forgotten Killer
Pneumonia, perhaps more than any other disease, clearly illustrates both the tragedy and opportunity of child mortality. Pneumonia, UNICEF reports, kills more children than any other disease — more than AIDS, malaria, and measles combined. Children in developing countries often contract pneumonia as a direct result of their impoverished environment. Lack of proper nutrition, including micronutrients like vitamin A, and the nutrition-sapping effects of multiple bouts of diarrhea makes children more susceptible to diseases that are far less prevalent in the developed world. Also, UNICEF reports, living in crowded homes or being exposed to smoke from indoor cooking fires can also increase a child’s odds of developing pneumonia.
When properly diagnosed, pneumonia can be treated inexpensively with antibiotics. UNICEF promotes a community-based approach to managing pneumonia, empowering families and caregivers to administer treatment according to advice from local health workers. An analysis of this strategy at sites in Tanzania and six other countries found a resulting 37 per cent decrease in child deaths due to pneumonia.
Success at the Community Level
In 1999, UNICEF reports, 47 percent of India’s children under three were underweight. The causes, the report states, were largely due to “the inadequate knowledge of caregivers concerning correct infant and young child feeding, frequent infections worsened by bad hygiene, high population pressure, the low status of women and girls, and suboptimal delivery of social services.” The Indian government instituted a strategy of providing basic healthcare to children through a network of community workers, but the quality of care provided by the workers was inconsistent.
UNICEF partnered with the Indian government to better train the workers in six states and 1,000 villages. After three years, more than 6 million patients were reached, and surveys were conducted to assess the impact of the program. More children were being breastfed, and vitamin A supplementation and immunization rates were higher. Undernutrition levels fell as well. All of this was achieved at a relatively low cost to the government — approximately US$150–$200 per village per year.
Although the program is still underway and more can be accomplished, these findings and developments show what an inexpensive, comprehensive, collaborative approach to child survival can achieve.
UNICEF Leading the Way in Africa
Further progress in child survival will require new and innovative approaches and a clear plan to deliver proven child survival interventions to the most vulnerable children. UNICEF recently launched an initiative concentrating on more than 16 million people in parts of 11 countries in West and Central Africa that have high under-five child death rates. The Accelerated Child Survival and Development (ACSD) program integrates low-cost, highly-effective interventions that dramatically improve child survival over a short period of time. ACSD provides an incredibly important global model not only in the impact it has shown is possible, but because it focuses on closely tracking results, and identifying and addressing bottlenecks in service delivery.
Working in partnership with the African Union, UNICEF has developed a strategic framework from rapidly scaling up primary health service coverage to reduce child mortality. Providing even a minimum package of high-impact, low-cost interventions could reduce under-five mortality by 30 percent. Implementation of a full package of services could reduce child mortality rates by more than 60 percent, and put countries on track toward meeting MDG 4.
U.S. Lacks Plan to Reach Child Survival Goal
Despite a pledge to work toward the Millennium Development Goals, the United States has no strategy to help achieve the global target of a two-thirds reduction in child mortality. While Congress has spared child survival funding from proposed cuts in recent years, funding remains well below estimates of the U.S. share of the global resource estimates.
Without a coherent strategy to reduce child deaths, the modest resources that are directed toward child survival are subject to budgeting decisions at odds with public health goals. In his budget justification for the 2008 fiscal year, President Bush proposed spending US$6.5 million on maternal and child health programs in Jordan, where some 4,000 children under age five die annually. In Ethiopia, however, which suffers nearly 100 times as many child deaths in a year, the president proposed a maternal and child health budget of just US$6 million. This would amount to $1,625 per child death in Jordan, and just over $15 in Ethiopia.
If the United States is to contribute meaningfully to the achievement of Millennium Development Goals stressed in UNICEF’s The State of the World’s Children report, Congress must demand a comprehensive child survival strategy to guide budgeting decisions rationally according to disease burden.
A Call to Action
On March 13, the Africa and Global Health Subcommittee of the House Foreign Affairs Committee will hold a hearing on child survival. The hearing is expected to draw attention to a number of child survival issues, including the Child Survival Act. Members of Congress must address these critical issues in order to put the world on track to achieving MDG 4. The U.S. must develop a strategy to ensure child health funding is directed to the most effective interventions in the areas with the greatest need. The bipartisan U.S. Commitment to Global Child Survival Act, currently introduced in the House and Senate, would require a comprehensive strategy to reduce child mortality that prioritizes countries with the highest number and most severe rates of death. Congress should act on this legislation, ensure that the strategy is adequately funded.
The U.S. should also give direct support to UNICEF’s innovative child survival programs, including the Accelerated Child Survival and Development program. UNICEF estimates that a minimum health package scaled up in Africa would cost about $1,000 per life saved. A modest U.S. investment of $100 million could potentially save 100,000 young lives next year, and prevent thousands more cases of permanent mental and physical disability due to severe illness.
UNITED NATIONS (Reuters) – The U.N. Security Council rebuked Eritrea on Wednesday for refusing to cooperate with a U.N. investigation of clashes on its border with Djibouti that left a number of Djiboutian soldiers dead.
Djibouti accused neighboring Eritrea of moving troops across the border in June, triggering several days of fighting that killed a dozen Djiboutian troops and wounded dozens more. Eritrea denies making any incursions.
After the incident in the volatile Horn of Africa, the U.N. Security Council called for a fact-finding mission to go to the region to determine what happened and who was responsible. Asmara refused to let the mission come to Eritrea.
“The members of the council welcomed the cooperation of the Djibouti authorities and regretted that the mission could not go to Eritrea,” Burkina Faso’s U.N. Ambassador Michel Kafando told reporters after a Security Council meeting.
The council also “expressed its concern regarding the tension and militarization on the contentious border zone that may lead to open clashes” in the future, said Kafando, the president of the Security Council for September.
French Ambassador Jean-Maurice Ripert said the council had asked U.N. Secretary-General Ban Ki-moon to step up his efforts to get in contact with Asmara.
Ripert said the Eritrean government was “refusing any form of contact with the U.N.”
Kafando said council members also called for demilitarization of the border zone and normalization of relations between the two countries.
Eritrean Ambassador Araya Desta said the reason his government wanted nothing to do with the Security Council’s fact-finding mission was that the council had issued a statement immediately after the June clashes that appeared to blame Eritrea without waiting to find out what had happened.
In a unanimous statement passed on June 12, the Security Council urged both sides, “in particular Eritrea,” to commit to a cease-fire, show maximum restraint and pull back forces to previous positions.
“The condemnation is already done,” Desta told Reuters. “It was illegal.”
Djibouti hosts French and U.S. military bases and is the main route to the sea for Eritrea’s archfoe and Washington’s top regional ally, Ethiopia.
The United Nations withdrew a peacekeeping force from the volatile Eritrean-Ethiopian earlier this year after Asmara cut off fuel supplies to the U.N. troops and personnel. The force had been in place since 2000 after a two-year war between the the two countries that killed some 70,000 people.
ADDIS ABABA — Ethiopian development researcher Dr. Nigussie Haregeweyn won an award of the Belgian Development Cooperation Prize 2007 (BDCP), Belgian Embassy in Addis Ababa announced.
A scientific research works award winner, Dr. Nigussie’s essay under the theme “Sediment-bound nutrient export from micro-dam catchments in northern Ethiopia” is deemed one of special contributions to sustainability and poverty reduction.
The embassy stated that Dr. Nigussie’s study is framed in “a wonderful example of co-operation between Ethiopian and Belgian research units which involves quantifying the mechanisms at play in soil erosion and sediment and nutrient retention (nitrogen, phosphorus, carbon, potassium, calcium and magnesium) and consequently assessing their impact on the efficiency and cost of agricultural practices in Ethiopia.
The essay moreover engages the factors that cause increased erosion often linked to human activity (mainly climate change and poor use of soil: deforestation, agricultural practices, building, etc.). The numerous negative impacts include increased sedimentation in the catchments whose barrages were built in order to manage water resources better.
Comparing several small basins, the essay also recommends better management which makes it the first study of its kind to be carried out in Ethiopia especially in the region where the loss of nutrients can not be easily compensated by fertilizers given the severe financial constraints to which the population is subject. “This fact alone is enough to prove the significance of this work and its contribution to sustainable development as the quality of the approach is an exhaustive end-to-end and multidisciplinary study, remarked the embassy’s statement.
The researcher holds a Master of Soil Engineering and Water Conservation, Alemaya University, Ethiopia, and Doctor in Geography, Katholieke Universiteit Leuven, Belgium, and presently following a specialized training at the Royal Museum for Central Africa, Tervuren, Belgium.
ADDIS ABABA — The International Society of Obstetric Fistula Surgeons (ISOFS) held its first annual meeting in Addis Ababa from September 15-16, 2008.
The conference was organized in collaboration with the Ethiopian Society of Obstetricians and Gynecologists, Addis Ababa Fistula Hospital, Johnson and Johnson, UNFPA and other partners.
The Secretariat of ISOFS, Dr. Biruk Tafesse said the participants, medical practitioners discussed on issues of training with a main theme of “Trained human power for quality Fistula care.” In addition to that scientific papers were also presented on fistula issues at the two day meet.
The conference also discussed and endorsed a final draft of the constitution, which was prepared by the ISOFS. According to the secretariat, the final draft includes national and international legal codes, professional ethics, standardization of practice, regarding memberships and other issues.
“Even if we don’t have the exact figure of the Fistula cases in Ethiopia and also in the world because it is hidden, its estimated that around 25,000 fistula cases are existing in Ethiopia. In addition to that eight to nine thousand delivery end up in fistula,” Dr. Biruk told The Daily Monitor.
ISOFS established before a year with the objectives of ensuring a high standard of obstetric fistula care services in the world, playing advisory role in treatment, prevention and research pertaining to obstetric fistula and its squeal.
Specialists in the field of fistula were gathered from different countries including USA, Nigeria, Bangladesh, and Uganda and attended the first annual meeting in Addis Ababa.
The Export Import Bank of India (Exim Bank) will file a reply in the Bombay High Court Sep 18 after the court stayed it from releasing funds to the Ethiopian government through lines of credit.
In a ruling Sep 9, the Bombay High Court barred the Exim Bank from dispersing dollar640 million through credit lines in favour of the Ethiopian government for setting up sugar mills in the African nation.
The ruling came after Uttam Sucrotech International, which owns several sugar mills, filed a petition saying Exim Bank’s tendering process was non-transparent and that it had favoured Overseas Infrastructure Alliance, one of the bidders for the project.
The Indian government offers lines of credit to trading partners among developing countries to import Indian equipment, technology projects, and goods and services on deferred credit terms.
These credit lines enable the recipient countries to set up developmental projects in variety of sectors including sugar, Uttam Sucrotech’s area of interest.
An Ethiopian company, Tendaho Sugar Factory Projects (TSFP), floated a tender inviting bids to design, manufacture, supply and deliver a single turnkey project for five packages that was financed by an Exim Bank credit line.
Uttam Sucrotech and Overseas Infrastructure Alliance were among the 10 bidders for the tender for five packages for setting up juice extraction plant, steam generation plant, power generation plant, process house plant and electrical work.
“There has been material alteration in the terms of bidding after the bidding process was over in that there was no condition of appointment of single EPC (engineering, procurement and construction) contractor in the notice inviting tender (NIT),” the petitioner has alleged.
The petition said Tendaho wrote to Uttam Sucrotech only after the bidding was over to say: “As per the requirement of Exim Bank, we will be required to appoint a lead EPC contractor and other awarded contractors would automatically become sub-contractors to the lead EPC contractor”.
Overseas Infrastructure, engaged in development of project infrastructure, attained the position of the lead contractor and Uttam Suctrotech was selected as the ‘sub-contractor’ for the juice extraction package and power generation package.
The petition said though the tender for these two packages was bagged by Uttam Sucrotech, the deal went to Overseas Infrastructure despite the fact that it did not even bid for either of the packages.
Moreover, the petition said, Overseas has asked Uttam Sugar to reduce the price of its contract by 15 percent, which would be required to be paid to Overseas to discharge its obligation of single EPC contractor, failing which Uttam Sucrotech would be replaced by a new sub-contractor.
In the first hearing Sep 9, Exim Bank in its reply to the court said “it is not concerned with what and how the borrowers conduct themselves”.
It rains a lot in Addis Ababa. The day can start with nice bright sun, shining down on the highest city in Africa, but within hours it can become dark and gloomy, with drizzle pouring on the rocky soil. A little rain can bring the temperature to below ten degrees with a chilly wind. Since I have arrived in this beautiful mountain city, I have spent most of my late afternoons and early evenings on the balcony of a Family Guest House, sitting on a chair gazing at the sprawling city as rainwater washes the roads, buildings, trees and hills.
This downpour never stops the daily life in the city. From the balcony, I can see cars running on the Bole road. People are walking to and fro, holding umbrellas over their heads. I can see Shewangiazaw Derbe, the caretaker of this guesthouse, sitting on the chair, a sheet wrapped around his body, observing the raindrops on the ground with undivided attention. Once in a while the phone would ring and he would get up to answer it. Sometimes he would come up with a bottle of water or coffee to the guest on my floor. Sometimes he would stop at my request and chat with me.
The conversation always starts with rain. Shewangiazaw informed me that it is not typical for all of Ethiopia. Some areas in Ethiopia only have a few showers throughout the year and often face drought. His hometown Debre Birhin, in the Amhara region, has had little rain this year, though it is not as severe as other parts of the country. Through several rain-induced conversations I have got to know him a little better.
Shewangiazaw left his home almost six years ago to support his two brothers and younger sister. One of his brothers took up farming on the small land they had, producing beans, maze and Teff. The youngest brother and sister are still in school. His has four more sisters and all are married off.
He works seven days a week and only gets few days leave every year, with a salary of 500 Birr (approximately 30 GBP) and a room to sleep. He tries to send half his salary to his siblings so they can continue with their education. However it has become harder by the day. Nowadays, he is spending more of his salary on food. He informed me that the price of food has gone up two to three times in the last year. “A kilo (2.2 pounds) of tomato used to cost 3 Birr few months ago, now it cost 7 Birr. 50 cents Injera cost almost 3 Birr”, Shewangiazaw said, “I don’t know why but the price is going up every day.”
The increase in food prices, coupled with two failed crops within the year because of lack of rain, has pushed millions of people in Ethiopia near to starvation. In an interview with the Financial Times, Meles Zenawi, the prime minister of Ethiopia, said: “The increase in food prices has pushed a significant number of Ethiopians, particularly among the urban poor and in some pastoralist regions and areas of drought, to the brink…” Recently in a statement, the United Nations has described the food crisis in Ethiopia as “alarming”. The UN Office for the Coordination of Humanitarian Affairs reports that “the food security situation in Ethiopia has deteriorated to alarming levels in the wake of drought conditions throughout much of the country”. The UN says that more than four million Ethiopians need emergency assistance and a further eight million need immediate food relief. The Daily Monitor reported, quoting WFP that around 737,000 Ethiopian are enrolled in its Targeted Supplementary Feeding programme (TSF), designed to address the problem of acute malnutrition among pregnant women, nursing mothers and children under five.
Shewangiazaw started to repair his house but had to stop in this tough economic situation. “Money was good back then. Tips were good. Nowadays it is becoming less. People don’t have money to tip, I guess,” he said. He hopes the situation will become better and he will able to finish his house. Once he is done with the house and his brother and sister are out of school, he plans to become a taxi driver in Addis Ababa. As the new years starts in Ethiopia, people like Shewangiazaw have had to put their dreams on hold and hope for the best in the future.
