Sustained government drive brings down deaths among children under the age of five by 67% compared with 1990 figures
Ethiopia, a low-income country in the drought prone Horn of Africa, has achieved the millennium development goal to cut the mortality rate for children under the age of five ahead of the 2015 deadline, according to figures published on Friday.
The statistics, contained in a 2013 progress report, Committing to child survival: a promise renewed, compiled by the UN children’s fund Unicef, the World Health Organisation (WHO), and the World Bank Group, showed Ethiopia has reduced child deaths by more than two thirds over the past 20 years. In 1990, an estimated 204 children in every 1,000 in Ethiopia died before the age of five ; just six countries had a higher rate. The latest data shows that by 2012 the rate had dropped to 68, a massive 67% fall in the under-five mortality rate.
Bangladesh, Liberia, Malawi, Nepal and Tanzania have also achieved the target.
According to the report – which examines trends in child mortality since 1990, analyses the main causes of under-five deaths, and highlights national and global efforts to save children’s lives – the annual number of under-five deaths has fallen from 12.6 million in 1990 to 6.6 million in 2012.
Some of the greatest advances in cutting child deaths are being made in east and southern Africa. Between 2005 and 2012, the regions achieved an annual reduction rate of 5.3% – the highest in the world.
In Tanzania, the Help Babies Breathe Alliance has trained and equipped more than 100,000 health workers, resulting in a 47% reduction in deaths during the first 24 hours of life. In Zambia and Uganda, meanwhile, safe deliveries in health facilities have been promoted through the training of hundreds of health workers in emergency obstetric and newborn care, along with the availability of essential supplies and equipment for the treatment of postpartum haemorrhage and eclampsia.
However, there are still some anomalies. Kenya has experienced an increase in the overall under-five mortality rate, from 96 deaths per 1,000 births in 1990 to 108 per 1,000 in 2012. The rise has occurred despite the introduction of free maternal healthcare, and despite some regional success in cutting deaths.
The western and central regions of Africa are making the least progress globally. Almost one in every eight children born there will not reach their fifth birthday and the annual rate of reduction, while increasing, remains the slowest in the world.
Political instability, recurrent emergencies and disasters, widespread extreme poverty, and some of the lowest budgetary allocations to basic social services in the world have contributed to the dismal child survival rates in these regions.
Unicef states that without faster progress in all regions, it will take until 2028 for the world to meet the target on reducing deaths among under-fives.
Government commitment and resources have contributed to Ethiopia’s progress on the issue.
“The government has set some very bold and extremely ambitious targets. It has then backed them up with real resources and real commitment sustained over the last 10 years,” said Dr Peter Salama, Unicef country representative for Ethiopia, pointing to the country’s health extension programme.
“The programme put on the government payroll more than 36,000 health workers and deployed them to more then 15,000 health posts across Ethiopia … That is the single most important reason why Ethiopia has reduced its under-five mortality rate.”
Dr Kesetebirhan Admasu, Ethiopia’s health minister, agreed. “I believe it is the work of these amazing community health workers who have really put the country to achieve these results,” he said. “The key factor is political commitment. With that commitment and with the commitment of the government in putting actual money, real money beyond setting the policy … [it] has helped to attract more donors to the programme.”
Salama said the fact that the health extension programme has been government-owned rather than donor-led has contributed to its success, and means the gains made are sustainable in the longer term. But he added that further progress in cutting child deaths will be increasingly difficult to achieve.
“An increasing number of the remaining child deaths [in Ethiopia] are attributed to newborn deaths – those in the first 28 days of life. These newborn deaths are intrinsically linked to maternal health and nutrition [which is] more complicated to deal with because it implies much more high-skilled service delivery. Without addressing this, it’s going to be hard to see the same level of progress that has been made in the last decade.”