Addressing child mortality

WaterAid's report Fatal neglect: How health systems are failing to comprehensively address child mortality shows how the aid system is not responding to the causes of child mortality in a targeted manner.

>> Read the press release about the report's release

>> Read how a WaterAid/PATH discussion event rallied support for action on diarrheal disease

The Millennium Development Goal to reduce by two-thirds the number of children dying before their fifth birthday by 2015 (MDG 4) is seriously offtrack. In Sub-Saharan Africa, on current trends, it will not be met until 2064.

The international health agenda is failing to mobilize the required response to critical causes of child deaths. The paper assesses how and why the international aid system is overlooking diarrhea, the second-biggest killer of under-fives after acute respiratory infections.

Poor sanitation is a major cause of diarrhea, yet remains seriously neglected, attracting low priority from donor governments and developing country governments alike. The World Health Organization estimates that 28% of under-five
deaths are attributable to poor sanitation and unsafe water. The neglect of these environmental determinants of child health
is having a profound effect.

The recent and positive focus on ‘health systems strengthening’ has been largely confined to addressing the challenges that exist in the delivery of health services. To meet MDG 4, however, the agenda must now go further. Long-standing commitments made by the health community must be met. These include the Declaration of Alma-Ata which underlined the importance of primary health care, of which sanitation and safe water is one of the eight key elements.

Until all determinants of child health are adequately addressed, particularly environmental determinants such as sanitation
and water, MDG 4 will remain beyond our reach. 

Developing country governments and donors
should adhere to these general principles:

1. In health planning, the under-five disease burden and all its determinants should be comprehensively addressed.
2. In health policy, strengthening health systems should continue to be a priority, but sufficient focus should also be given to the wider determinants of poor health, particularly poor sanitation.
   

Three concrete steps must urgently be taken:

1. All national health plans should confirm clear links between country health information systems, particularly disease prevalence data, and the process of planning and budgeting.
2. All countries should have a mechanism for inter-ministry coordination on reducing child mortality, with a joint agenda to deliver relevant strategies.
3. All national health plans should contain an adequate and costed strategy for environmental health.

Download Fatal neglect: How health systems are failing to comprehensively address child mortality (PDF 1MB)

• 50% of deaths from diarrhea are from acute watery diarrhea where the sufferer cannot be rehydrated
• 35% are through persistent diarrhea (lasting 14 days or longer)
• 15% of deaths are through dysentery (or bloody diarrhea)

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