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.