Put children’s health first

from the New Straits Online

By : Su Aziz

In conjunction with World Health Day yesterday, Unicef is reiterating the aim of reducing child mortality by two-thirds as outlined in the Millennium Development Goal (1990-2015). SU AZIZ writes.

DID you know that around 26,000 children die before their fifth birthday? That translates to a loss of around 9.7 million young lives per year. A staggering number and nothing less than a global tragedy which has immense humanitarian, economic and political consequences.

The majority of these child deaths are the result of pneumonia, diarrhoea, malaria and measles, all of which are preventable and treatable. However, it is malnutrition which weakens children’s ability to ward off illnesses. Next is the lack of safe water and sanitation that contributes to more than half of these deaths. Then there is HIV in some parts of the world, due to conflicts and marginalisation.

Millennium Development Goal (MDG) 4 aims for a two-third reduction of under-five mortality rates between 1990 and 2015 by implementing child survival intervention strategies.

Unicef Malaysia representative Youssouf Mohammad Oomar says child survival “is a scientifically proven intervention strategy aimed at reducing unnecessary deaths”.
It includes simple yet cost effective measures such as immunisation, oral rehydration therapy, sleeping under insecticide-treated mosquito nets, vitamin A supplementation and community-based antibiotic treatment for pneumonia, all of which will prevent children dying before they turn five.

Unicef is highlighting child survival in conjunction with World Health Day yesterday because child survival is generally recognised as the best indicator of the wellbeing of a country and its overall development,” says Youssouf.

“Healthy children and mothers reflect a country that is concerned about its people and its development. Investing in the health of children and their mothers is not just a human rights imperative, it is also a sound economic decision and one of the surest ways for a country to set its course towards a better future,” says Youssouf.

“However, with the target date for MDG 4 drawing near, critical questions arise. How can momentum on maternal, newborn and child survival be recaptured and progress be accelerated in the next seven years? These are critical questions and UNICEF hopes the State of the World’s Children (SOWC) 2008 report will rejuvenate and accelerate progress in making good our promises to children.”

Youssouf elaborated that to meet the aim of MDG 4 by 2015, the number of child deaths must be cut to fewer than five million per year and at a much faster rate than before.

“We have our work cut out for us. The bulk of the effort must be focused on the most difficult situations and circumstances. For instance, the poorest countries, the most impoverished, isolated, uneducated and marginalised districts and communities, nations ravaged by AIDS, conflict, weak governance and where there’s a chronic under-investment in public health systems and physical infrastructure.”

According to the report, children in Malaysia are doing well in terms of survival, health and development in the past decade.

“Where once children died of preventable diseases, today many more survive because of immunisations and improved conditions and care. Where once the risk of mothers dying in childbirth was immense, today the country has a safe motherhood programme that is accessible through all hospitals, including the Ministry of Health’s Family Health Clinics.”

The SOWC reports that Malaysia’s under-five mortality rate has declined from 22 per 1,000 live births in 1990 to 12 in 2006. According to a UNICEF report card titled “Progress for Children” released at the end of 2004 to track world progress in meeting MDG 4, Malaysia’s under-five child mortality rate of progress was reported at eight per cent between 1995 and 2004, placing the country at the top of the ladder in the East Asia and Pacific region and second only to Malta in the world.

“However, while these are admirable achievements, these statistics also indicate that some 7,000 children under the age of five die in Malaysia each year, due mainly to preventable diseases such as diarrhoea,” says Youssouf.

“The groundwork for ensuring the health and well-being of children was laid in the 1950s,” said Youssouf, when the country first started the maternal and child health clinics which helped place health issues firmly on the political and social agenda.

Mayors, governors, parliamentarians, civil society activists, the media and the academia had a hand in the development of healthcare in Malaysia.

“This resulted in impressive gains for the people. A primary healthcare system was put in place to meet the needs of its citizens, particularly children.

“Ninety five per cent of the population in Peninsular Malaysia today live within five-kilometres-reach of basic health care services while in East Malaysia nearly 75 per cent of the population have the same access.

“Outreach to remote areas are also carried out by Village Health Promoters in Sarawak and the Flying Doctors in Sabah.”

Youssouf said Malaysia should continue this good practice of combining both investments in strong national health systems with the best disease-specific initiatives to create a continuum of care for mothers, newborns and young children which extends from households to local clinics, to district hospitals and beyond. The concept of social mobilisation in the early days was clearly proven as a powerful tool to promote health.

For the 10 per cent of children and mothers living in the remote areas of East Malaysia, a range of services and interventions is required to overcome different challenges.

“But key to all of these interventions is strengthening the capacity of families and communities to care for and protect infants and children,” says Youssouf whose strengths and experiences lie in socio-economic development from his days in the Ministry of Economic Planning and United Nations Development Programme in Mauritius.

“We need to focus on cohesive and inclusive community organisation where programmes are built on established structures within the community.

“These programmes must be socially inclusive including community members, hospitals and clinics in their planning, evaluation and delivery. They should provide services that cannot be safely replicated elsewhere, such as obstetric care.

“District health systems are also required to serve as focal points for public health programmes. In Malaysia, you have a wonderful example in the Sarawak Village Health Promoters programme which is built on this model of partnership.”

Provincial and federal governments must show active support by integrating these programmes into their policies, plans and budgets.

This way, we can also eliminate other risks, such as children and their families becoming “invisible” due to stigma and discrimination against drug users, sex workers, and people living with HIV which prevent them from bringing their children for health care.

“Making children visible requires creating a protective environment for them.

“Key to this is responsibility. All members of society can contribute to ensuring that children do not become invisible. While families and the state have the primary responsibility for protecting children, ongoing efforts by individuals and organisations at all levels are essential to break patterns of abuse.

“Additionally, we need to overcome stigma and discrimination so that those who are marginalised are not afraid to step forward for their children. This may require the ratification and implementation of legislation as well as community health outreach programmes.

“An open discussion by civil society and the media of attitudes, prejudices, beliefs and practices that facilitate or lead to abuses can also help.”

Awareness can come from empowering communities as well as households to participate in the healthcare and nutrition of mothers, newborns and children.

“Community health workers can take messages to rural areas. Village heads and religious leaders can support health messages to encourage their community to engage in good healthcare practices such as breastfeeding for the first six months of an infant’s life, timely immunisation, and the use of safe water.”

Naturally, all forms of media and even the Internet can help to introduce and create public awareness.

“The commitment to child survival is as old as Unicef. Since our early days, we have been committed to delivering basic health interventions to children who need it most — children in countries ravaged by war and children stuck in poverty.

“In the 1980s, Unicef helped inspire a global child survival revolution, while in the 1990s, we led efforts to help the world achieve the first set of goals focused on children’s health and wellbeing.

“Our 60 years of experience tell us that we can turn back child mortality. Countries will be able to meet their commitments to the Millennium Development Goals.

“Participation is critical. There is need to be united — in both word and deed — to ensure the right of mothers, newborns and children to quality primary health.”

At the midpoint between the inauguration of the MDGs and their target date for fulfilment, much has already been achieved. The basis for action — data, research, evaluation — is already well established. The means are at hand.

Dissemination of information is key to engage participation. People are eager to learn about what is best for their children.

“Now, it is simply a question of will and action — for there is no enterprise more noble, or reward more precious than saving the life of a child.”

So, what are we waiting for?

For more information on Child Survival log onto http://www.unicef.org/malaysia/index.html.