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Child Survival: The Most Elusive MDG

Shanta Devarajan's picture

The Millennium Development Goal of reducing child mortality rates by two-thirds between 1990 and 2015 is proving to be one of the most difficult for African countries to reach.  A recent book published by some colleagues at the World Bank   points to some reasons why.  Many of the determinants of child mortality lie outside the health sector—they include water, sanitation, and malnutrition.  Yet this MDG is often seen as the province of the health sector, requiring health inputs.  At a recent launch of this book, I asked why, since we have known for a long time that these environmental factors affect child mortality, has it been so difficult to make progress in child survival. One reason may be that, precisely because it has so many determinants, no one in government is willing to hold him or herself accountable for reducing child mortality. 

The one set of people who are accountable, because they care deeply, are the parents of the children who risk dying before their fifth birthday.  But these are the same people who either lack the knowledge or the means to protect their children.  Rather than doing more studies on the many determinants of child survival, I suggested that we use the information in the book for two purposes: (i) inform citizens so they can hold politicians accountable for actions on the factors, such as clean water or improved sanitation, that help children survive; and (ii) inform parents so they can better protect their children.


Submitted by Valerie Leach on
Shanta - thank you for raising the issue of child survival so early in your role of Chief Economist, Africa Region. The basic problem is that issues of children are not given priority by governments - it's not just a question of the relative priority of water and sanitation over roads, health and education; it's the fact that many issues affecting children are assumed to be in the private domestic sphere to be handled by families, with support from charitable institutions if needed. Governments absolve themselves of responsibility by claiming other urgent demands on national resources. It is the political economy of children which must change, supported by more demanding analyses of the effectiveness and impact of public spending on children - in many countries, half of their citizenry. with best wishes Valerie

Submitted by Dr. Lasisi A.M. on
World Health Organization strategies for child survival has done a lot in changing the fate of children especially in developing world but unfortunately, some of the parametres in the strategies including family planning, food supplimentation practises, immunization, oral rehydration practises and breast feeding have deeply routed psychosocial element that are difficult to influence by routine educational effort. Similarly, the increasing poverty burden and bad governance has added extra family pressures that further compromises the impact of these strategies. A targeted assessment of the mpact of psychosocial variables will be a good starting point for specific identifyable burden in an identifyable community while the global demand for democracy, rule of law and social accountability should continue.

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