We all know there's a link between poverty and child mortality. Too many children in poor nations die before their fifth birthdays because they lack what rich-country kids take for granted - good nutrition, clean water, sanitation, vaccines, medicines.

But is it inevitable that poor countries should have high child death rates? To put it another way, are governments in developing countries powerless to improve the survival prospects of their children?

That's a question Save the Children asks with the launch of a campaign to relight a fire under the Millennium Development Goals (MDGs).

In 2000, governments agreed to global development targets that included slashing the under-five mortality rate by two-thirds by 2015. Eight years on, progress is patchy at best. Save the Children estimates that unless things change we'll be lucky to achieve the goal by 2045.

In a report out this week, the children's rights agency ranks countries according to how well they're using what they have to boost child survival rates. It shows that poverty need not be a death sentence for children as long as countries make decent policy choices.

"A child's chance of making it to its fifth birthday depends on the country or community it is born into," says David Mepham, Save the Children's director of policy. "This sounds like a lottery, something beyond human control, but this should not be the case.

"While poverty and inequality are consistent underlying causes of child deaths, all countries, even the poorest, can cut child mortality if they pursue the right policies and priorities the poorest families."

Take Bangladesh - one of the few nations on track to meet its child mortality MDGs despite a relatively low gross national income (GNI). According to Save the Children's Wealth and Survival Index, Bangladesh has 32 fewer child deaths per 1,000 births than you'd expect from its per capita GNI level alone.

How the charity calculates this is fairly complex, but what's important is that Bangladesh's child mortality rate doesn't fit neatly with its poverty indicators. What's going on here?

Save the Children points to a government initiative launched in 1998 to tackle childhood illness and reduce fertility levels.

In contrast, Angola comes bottom of the Wealth and Survival Index, despite oil riches that effectively make it a "middle income country" in terms of per capita GNI.

"So this imbalance between wealth and child survival might more plausibly be attributed to Angola's grossly unequal distribution of wealth, one of the worst in the world according to the U.N.," the report says.

"While a small elite has benefited from Angola's abundant oil reserves, this resource has not brought benefits to the vast majority of the population and the country still has the second-highest mortality rate in the world, at 260 deaths per 1,000 live births."

Here's how the 41 countries that accounted for 90 percent of child deaths in 2005 stack up according to the Wealth and Survival Index.

Ranking	Country	Excess Mortality Index (0 = performing as well as expected given gross national income per capita; positive number = higher child mortality than expected; negative number = lower child mortality than expected)
1	Nepal	-56.33
2	Yemen	-43.94
3	Malawi	-38.27
4	Indonesia	-36.04
5	Tanzania	-35.56
6	Bangladesh	-31.69
7	Egypt	-28.74
8	Madagascar	-27.33
9	Philippines	-23.92
10	China	-17.64
11	Sudan	-13.96
12	Ethiopia	-12.41
13	Kenya	-10.97
14	Brazil	-10.29
15	Cambodia	-4.91
16	India	0.37
17	Pakistan	1.78
18	Senegal	7.21
19	Ivory Coast	12.83
20	Uganda	13.31
21	Mozambique	14.12
22	Mexico	17.55
23	Burundi	20.16
24	Ghana	24.13
25	Rwanda	31.59
26	Zambia	40.99
27	Democratic Republic of Congo	45.29
28	Cameroon	50.18
29	South Africa	51.26
30	Nigeria	58.08
31	Guinea	66.57
32	Burkina Faso	70.89
33	Mali	77.52
34	Chad	84.35
35	Niger	100.94
36	Sierra Leone	117.58
37	Angola	162.00

(Index carried out for Save the Children by U.N. Development Programme's Human Development Report Office)

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