Boosting Number of Health Workers in Communities is Key to Closing Gap and Saving Lives

Study Ranks Philippines First, Ethiopia Last 

WESTPORT, Conn. (May 6, 2008) - More than 200 million children under age 5 do not get basic health care when they need it, with the poorest children missing out and most at risk of dying, according to the ninth annual State of the World's Mothers report issued today by Save the Children, a U.S.-based global independent humanitarian organization.   

The report includes the first-ever Basic Health Care Report Card of 55 developing countries that shows  which countries are doing the best and the worst at reaching children with basic health care. Together these countries account for nearly 60 percent of the world's under-5 population and 83 percent of all child deaths worldwide. Basic health care is defined as a package of lifesaving interventions that includes prenatal care, skilled care at childbirth, immunizations and treatment for diarrhea and pneumonia.

Eight of the 55 countries in the Basic Health Care Report Card reach 60 percent or more children under age 5 with basic health care. The Philippines comes out on top of the Report Card. In 30 of the 55 countries, less than half of all young children receive health care, including bottom-ranked Ethiopia, where more than 80 percent of children under age 5 do not receive basic lifesaving care.  

Although some countries are doing a good job of reaching all children with basic health care, a closer look shows disparities in health care provided to the poorest children compared to the best-off.  Top-ranked Philippines does a good job at reaching all children under 5 with basic health care. Yet, the poorest Filipino children are 3.2 times more likely to go without basic health measures.

The Report Card also looks at child survival rates of 52 countries among children who are better off and those who are very poor. Within countries, poor children are dying in much greater numbers than the best-off children. In 12 of the 55 countries, the poorest children are three or more times more likely to die than the richest children.  These countries include Azerbaijan, Brazil, Bolivia, Cambodia, Egypt, India, Indonesia, Morocco, Nigeria, South Africa and the Philippines. Peru has the widest gap in child death rates between the rich and poor. The poorest Peruvian children are 7.4 times more likely to die than the richest Peruvian children.  

"A child's chance of celebrating a fifth birthday should not largely depend on the country or community where he or she is born," said Charles MacCormack, president and CEO of Save the Children, upon issuing the report. "We need to do a better job of reaching the poorest children with basic health measures like vaccines, antibiotics and skilled care at childbirth. These

simple measures, while taken for granted in the United States, are not reaching millions of children under age 5, and can determine whether a child lives or dies in poor countries and communities." 

To close the child survival gap and save lives, the report recommends a coordinated global effort to train, equip and supply more community health workers who can reach the poorest, most marginalized communities. These health workers, often volunteers, do not need to be highly educated to master the skills needed to deliver basic health care measures. Experts

predict that over 60 percent of the nearly 10 million children who die every year could be saved by delivering basic health services through a health facility or community health worker. The report highlights several countries, including India, Nepal and Ethiopia, that are making progress in saving lives through successful community health worker programs. 

"The last mile or kilometer - the distance between the health clinic and the home - in developing countries is the most difficult to reach with basic health services," said MacCormack. "Yet, to save the majority of young lives lost each year, you need to bring care closer to home, where most children get sick and die."

"By investing in community health care workers, we can save millions of children who die every year from causes like malaria brought on by a simple mosquito bite. Our on-the-ground experience shows that these programs work. Lives are saved," adds MacCormack.                                               

"When your child gets sick with a common illness in the United States, you go to the doctor or pick up medicine at the local drugstore," said Save the Children's newly appointed Ambassador Jessica Lange. "But, that is not the reality for millions of mothers in the poorest countries and communities around the world, where nearly 10 million children under age 5 die every year.

"Take Ethiopia, for example, where more than 4 out of 5 children do not get basic health measures," said the Academy Award-winning actress, herself a mother of three, who visited Ethiopia with Save the Children this past March. "The good news is that Ethiopia is taking aggressive steps to reduce its child death rate through a community health worker program. In remote villages in Ethiopia, I met mothers whose babies are alive today because they got the advice and lifesaving medicine they needed through this program."

Among the report's key findings: 

• More than 200 million children under age 5 lack basic health care. Among the 55 countries evaluated in the Basic Health Care Report Card, the Philippines, Peru, South Africa and Indonesia/Turkmenistan (tied) are doing the best job in getting basic health care to all children under age 5. Countries doing the worst are Lao People's Democratic Republic, Yemen, Chad, Somalia and Ethiopia. 

• The poorest children are least likely to get lifesaving health care and are more likely to die. In Mali and Nigeria, for example, the poorest children are 2.5 times more likely to go without health care. In India and Indonesia, the poorest children are three or more times more likely to die before reaching their fifth birthday than best-off children.
  

• Closing health care coverage gaps could save more than 6 million children each year. If all children - rich and poor alike - were to receive a full package of essential health care, more than 6 million lives would be saved each year. Closing the survival gaps in India and Nigeria alone would prevent nearly 20 percent of global child deaths.
  

• In more developed countries, children most lacking in basic health care and at risk of dying tend to be from low-income, ethnic minority groups. In the United States, America-Indian and Alaska-Native infants are nearly 50 percent more likely to die than white infants, and African American infants are 2.4 times more likely to die than white infants. 
  

In addition to its special focus on the child survival gap, the report includes Save the Children's ninth annual Mothers' Index, which identifies the best and worst countries to be a mother and child by looking at child and maternal well-being in 146 countries. Sweden takes top place, while Niger takes last place in the ranking. The United States places 27th. 

Recommendations:

To reach more children under age 5 with basic health care measures and save lives, Save the Children recommends that countries: 

• Design health care programs to better target the poorest and most marginalized mothers and children. To save lives, we need to close the coverage gap for all children, but especially the gap between the rich and poor.
  

• Invest in community health workers to reach the poorest of the poor with essential life-saving care. Many children die from causes that do not require doctors or hospitals, and could be saved by training, equipping and deploying more community health workers who can deliver this basic health care.
  

• Deliver a basic package of maternal, newborn and child health care that takes into account the
  realities for poor people in developing countries.  The tools to save mothers' and children's lives work best when they are delivered together as a package and along a "continuum of care" that links communities, local health facilities and hospitals.  Most health systems devote significant resources to hospital-based care, but most sick children in developing countries never make it to a hospital.

The report also calls on governments to close the child survival gap by stepping up commitments to deliver basic health care, especially to the poorest children, in developing countries. The U.S. share of this commitment, known as the Global Child Survival Act (H.R. 2266 and S1418), would help save the lives of millions of newborns, babies and young children globally. The legislation, backed by over 100 members of Congress, both Democrats and Republicans, is awaiting action before the House Committee on Foreign

Affairs.  In the Senate, the legislation has been voted out of the Senate Committee on Foreign Relations and is poised to be considered before the full Senate.

"Each day that we wait to act on this legislation, nearly 27,000 lives are lost. We can do better," said MacCormack. "We urge Congress to get behind this legislation and give mothers and their children the chance to celebrate Mother's Day not only this year, but in years to come."

More information 

For more information on the State of the World's Mothers 2008 report, contact Save the Children at 203-221-4233. The report also will be posted at www.savethechildren.org.