East African Countries Lead the World in Preventing Child Deaths But Poorest Children Being Left Behind - Save the Children

Children triggering in their community, Sidama, Ethiopia

Photo by Berhanu Tunsisa, Plan Ethiopia

PRESS RELEASE

Countries of East Africa are making significant progress in reducing preventable child deaths, according to a new report by Save the Children that shows how Ethiopia and Tanzania have already met their targets set out under the Millennium Development Goals and Rwanda, South Sudan and Uganda are not far behind.

In a new evaluation of countries' progress in tackling preventable child deaths developed by Save the Children, the NGO warns that globally, four million more lives could have been saved if governments had focused equally on the poorest children as they have done on the 'low-hanging fruit': the less-poor children in less-remote areas.

The report, Lives on the Line, looks at how countries are progressing towards meeting their Millennium Development Goal of reducing preventable child deaths by two-thirds. However, in contrast with many progress reports, the research focuses not just on the speed of progress, but on the quality of that progress: whether it is equitable (reaches all income groups) and whether it is sustainable; measured as political will, regardless of national wealth.

In this measure of quality of progress, one of the world's poorest countries, Niger, ranks top of the global table for reducing preventable deaths. Despite having scarce resources and recurring droughts, Niger has cut the number of under-fives dying unnecessarily by nearly two thirds since 1990 and is on track to achieve the UN's global goal on child mortality.

The country's progress is striking because - unlike others - it has managed to do better across all income groups, and in the countryside as well as urban areas.

Save the Children's regional director for East Africa, Hussein Halane, said, "Niger's political leadership and investments have made them the country to watch for continued dramatic progress in ending preventable child deaths for good. But in East Africa we are also making historic gains in the fight against child deaths. Rwanda comes in at number 3 on the global index and this is to be applauded – we are getting there. But we must be aware that in many parts of the region, the poorest children are being left behind. In Kenya, in particular, the poorest children's chances of surviving are lagging further and further behind those of the richest children. Across the region, our leaders must work to ensure that children of all backgrounds have an equal chance to survive."

The report shows how countries in the region are taking different paths, but there have been some common features of each success story. Countries that provide better access to quality health care; improved nutrition; a concerted effort to address inequities - especially those faced by women and girls - and improved governance and accountability, have all seen successes.

Mr Halane continued, "Bold political leadership at the highest levels often delivers a leap forward in efforts to save children's lives. In our own region, initiatives such as Kenya's announcement of free maternity services in government health facilities and Ethiopia's health extension programme, which was launched in 2004 and employs 40,000 health extension workers, have been an important factor in those countries' success in expanding health care coverage and are already paying dividends in reducing child mortality."

Other areas that have garnered positive developments include delivering health care at the community level and investing in training and equipping frontline health workers.

Kenya is the country in the region struggling most to meet its commitments to Millennium Development Goal 4. According to the report, although the new government has made positive strides, malnutrition remains a "significant obstacle" to reducing child mortality with more than a third of all Kenyan children suffering stunted growth due to chronic malnutrition. The report acknowledges that government initiatives relating to breastfeeding and fortified nutrition should be welcomed.

Ethiopia has achieved MDG 4, but many sections of the population continue to experience very high rates of child mortality. Children in the poorest 40 percent of the population are twice as likely to die than children in the top 10 percent; girls are 25 percent more likely to die than boys; and children living in rural areas are 37 percent more likely to die than children living in urban areas.

Tanzania has also already reached its target under MDG4, although with an estimated 179,000 children who die every year before their fifth birthdays, the country has among the highest numbers of preventable child deaths in sub-Saharan Africa. Although public health sector financing more than doubled between 2006 and 2012, only about 10% of the government budget is dedicated to health, far below the 15% recommended under the Abuja Declaration. Like other similar African countries, Tanzania's child survival indicators show huge inequities with some regions like Lindi having much poorer survival rates.

Uganda ranks amongst the 15 low-income countries that have achieved reductions in under-five mortality of more than 10% since 1990 – but this rate is still below the required pace to meet the MDG 4 target. Public health sector spending on health has stagnated at 8-9%.

Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. The number of annual child deaths has fallen by 63 percent. Progress in child survival has come thanks to a variety of efforts, notably improved access to strengthened primary health care, high national health insurance coverage and high and sustained immunization coverage. But 154,000 children (mainly in rural areas) continue to die each year before their fifth birthday, mostly from preventable causes, and chronic childhood malnutrition remains high at 44.2%. Disparities in quality of care exist between urban and rural areas.

South Sudan has managed to reduce the under five mortality rate by 59% since 1990 but basic health coverage remains extremely poor. Child survival rates are hampered by one of the lowest levels of immunization in the world, persistent rates of extreme poverty – more than 90% of South Sudanese live on less than a dollar a day – and malnutrition, with 18% of the population suffering from chronic hunger.

• Save the Children is calling upon the governments of East Africa to:
• Commit to ending preventable child deaths;
• Publish and implement fully-costed national healthcare plans that reach every child, including newborns, with the objective of reaching full coverage by 2030;
• Launch national campaigns to reduce malnutrition so that every child has the nutrition they need to survive and thrive;
• Increase public spending on health.

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  Save the Children (Westport, CT)