Reducing child mortality: the challenges in Africa.

• Author: Shoo, Rumishael

In 1960, Africa contributed to approximately 14 per cent of the global child mortality burden. Today, sub-Saharan Africa alone accounts for almost 50 per cent of child mortality, although it constitutes only 11 per cent of the world population. If Millennium Development Goal 4--reduce child mortality by two thirds--is to be achieved, Africa has the challenge of accelerating the narrowing of this gap. On average, children under-five mortality dropped from 188 per 1,000 live births in 1990 to only 171 in 2003. This corresponds to an overall decline of just 9 per cent (0.7% annually), while the MDGs target an average annual rate of reduction of 4.3 per cent. It is clear that a number of challenges needs to be overcome in Africa to reduce child mortality.

Low coverage of interventions and weak delivery systems. Our analysis in 13 eastern and southern African countries shows that universal coverage of scientifically proven cost-effective interventions would reduce child deaths from the current 2 million to just 650,000. Even if partial coverage of the 60-per-cent target for malaria--as agreed in the Abuja Declaration--and 70 per cent for other interventions were achieved, mortality would be reduced by almost 50 per cent. Coverage of child survival interventions remains extremely low in many countries. Of the 24 preventive and treatment interventions reviewed in 2000, only four (measles, breastfeeding, vitamin A and clean delivery) had a regional coverage of above 50 per cent. In fact, eight interventions had coverage below 5 per cent. (1) At the same time, observations in southern Africa indicated a deterioration of caring capacities among caregivers as poverty levels and food insecurity increased. A survey of coverage of interventions in 2006 found that a number of countries are making progress in scaling up coverage, but this remains insufficient to meet MDG 4 for Africa as a continent. (2)

Community and household-level interventions have highest impact, but are given lowest priority. Interventions delivered at community and household levels were found to have the highest impact (61%). Unfortunately, most health systems are set up in such a way that allocation of human, material and financial resources favours facility-based, curative care. Where community-based programmes have been set up, they tend to operate on a small scale, with little support from the formal health system. (3) The low coverage and poor performance of the health system...