The Millennium Development Goals (MDGs) were the world’s time-bound and quantified targets for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate shelter, and exclusion-while promoting gender equality, education, and environmental sustainability. They are also basic human rights-the rights of each person on the planet to health, education, shelter, and security (United Nations).
One of the MDGs was reducing child mortality which targets reducing by two-thirds, between 1990 and 2015, the under-five mortality rate. It had three indicators which includes the under-five mortality rate, infant mortality rate and the proportion of 1 year-old children immunized against measles (United Nations) .
The WHO promoted four main strategies to reach the MDG on reducing child mortality and these includes appropriate home care and timely treatment of complications for newborns, integrated management of childhood illnesses (IMCI) for all children under five years old, expanded program on immunization (EPI) , and infant and young child feeding(IYCF). These child health strategies are complemented by interventions for maternal health, in particular, skilled care during pregnancy and childbirth (WHO, 2015).
The Millennium Development Goals’ series of time-bound targets had a deadline of the year 2015. It is now 2017, so how far have we reached or achieved with our targets specifically in MDG 4 which is reducing child mortality?
In the recent Millennium Development Goals Report, it stated that substantial progress has been made in reducing child mortality. This statement was supported by the fact that the global under-five mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1,000 live births between 1990 and 2015. According to the report, the number of deaths of children under five has declined from 12.7 million in 1990 to almost 6 million in 2015 globally. And since the early 1990s, the rate of reduction of under-five mortality has more than tripled globally. In sub-Saharan Africa, the annual rate of reduction of under-five mortality was over five times faster during 2005–2013 than it was during 1990–1995. Measles vaccination helped prevent nearly 15.6 million deaths between 2000 and 2013. The number of globally reported measles cases declined by 67 per cent for the same period and about 84 per cent of children worldwide received at least one dose of measles containing vaccine in 2013, up from 73 per cent in 2000. (United Nations, 2015).
However, despite the impressive improvements, the current trends were not sufficient to achieve the MDG target. The goal was to reduce by two-thirds the child mortality rate which means from 90 per 1000 live births in 1990 it should be 30 per 1000 live births in 2015. But we are still far from reaching this number with the current child mortality of 43 deaths per 1000 live births. I think, globally, we will need more years to achieve this target and accordingly if current trends continue, the world as a whole would reach the MDG 4 target in 2026 – more than 10 years behind schedule (Level and Trends in Child Mortality, 2015).
From my own point of view, eradication of poverty and hunger (MDG 1) could have a very huge impact in achieving the MDG 4. Data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) suggested that under-five mortality rates are almost twice as high for children in the poorest households as for children in the richest. This data remains true in the sub-Saharan Africa region where poverty incidence is highest and it is also the region with highest number of child mortality. The region carry about half of the burden of the world’s under-five deaths—3 million in 2015 (United Nations, 2015).
The goal to totally eradicate poverty as a global problem seemed impossible but efforts done resulted in profound achievements such that the extreme poverty has declined significantly over the last two decades (United Nations, 2015). With continued interventions to eradicate poverty and hunger, I think it will have a positive effect on reducing child mortality.
Another most powerful determinant of inequality in survival is the mother’s education. The survey from DHS and MICS also claimed that mothers with secondary or higher education are almost three times as likely to survive as children of mothers with no education (United Nations, 2015). Achieving universal primary education, specifically promoting women’s education and empowerment, socioeconomic disparities will be reduced and child survival will be improved.
In a study done by Liu et. al, (2015) it showed that Of the 6•3 million children who died before age 5 years in 2013, 51•8% (3•257 million) died of infectious causes and 44% (2•761 million) died in the neonatal period. The three leading causes are preterm birth complications, pneumonia, and intrapartum-related complications. As we can see, most of these causes affects the newborns or neonates which means that maternal health is also very significant in reducing child mortality. By providing adequate and quality antepartum care to all pregnant women, preterm birth complications and intrapartum-related complications will be avoided. In a study done in Sub-Saharan Africa countries, it showed that prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality (McCurdy, Kjerulff, & Zhu, 2011).
The global trend in child mortality is consistent with the Philippine situation. Latest data revealed that the number of infant and under-five deaths continued to decrease from 2006 to 2011. In 2006, the number of infant deaths was at 24 per 1,000 live births and under-five deaths at 32 per 1,000 live births. In 2011, deaths decreased to 22 and 30 per 1,000 live births, respectively (The Philippines Fifth Progress Report Millennium Development Goals, 2014). However, the rate fell short of meeting the MDG target during the end of 2015.
One big problem seen why we cannot achieve this target is that there is a disparity among the regions. The State of the World’s Mothers report by Save the Children organization showed that Metro Manila successfully cut its under-5 mortality rate by half over a 15-year period. But despite this improvement, data from the National Demographic and Health Survey (NDHS) in 2013 revealed that child mortality in other regions outside Metro Manila was still high. The Autonomous Region in Muslim Mindanao (ARMM) has the most number of under-5 deaths with 55 per 1,000 live births (Save the Children Federation Inc., 2015).
From what I have observed, inequalities in health outcomes among the regions can also be attributed to the devolution of local health services. The impact of devolution resulted to service fragmentation and gave challenging opportunities for the local leadership to perform. Some local government units were more successful than others because they gave priority attention to health concerns and programs.
Accordingly, local government units in Metro Manila were able to improve the quality of basic social services, maternal services, public-private partnerships, investment in health workers, and policy reforms, among others. As compared to the ARMM situation where there is lack of access to basic social services brought about by decades-long conflict in the region (Save the Children Federation Inc., 2015).
Currently, the national government and the Department of Health has created a strategy called the Universal Health Care High Impact Five (UHC-HI-5). It aims to produce the greatest improvements in health outcomes and the highest impact on the priority, vulnerable population, with focus on five critical UHC interventions such as maternal care, infant care, child care, HIV-AIDS and service delivery network. I think this strategy will give a promising result in reducing child mortality and will decrease the disparities among the regions, however, the promising outcomes will again be based upon the support and active participation of the local government unit to implement the strategy.
Another reason that I see why the MDG target was not achieved in the country was the inadequate supply if vaccines. The top causes of child mortality in the Philippines are due to vaccine-preventable diseases such as pneumonia and diarrheal diseases (DOH, 2014). In the past years pneumococcal vaccines were expensive and can only be availed by those who can afford it. It was only in 2015 that the government began to procure PCV 13 vaccines to be included in the Expanded Program on Immunization. But the supply is still not enough to cover all the target children. In 2012, the Philippines made history as the first in Southeast Asia to vaccinate newborns against rotavirus but the supply of vaccines was not sustained because accordingly it was expensive and the government cannot afford to procure it up to the present.
Globally and locally, the Millennium Development Goal 4 of reducing child mortality requires a great deal of political will. We need committed leaders to plan and implement sound strategies and ensure adequacy of resources to achieve the goal of reducing child mortality. The significant decrease in several countries, even poor communities, shows that it can be done. However, more work is needed to improve child survival rates. Maternal, newborn and child care should still be a priority in the post-2015 global development agenda.
By: Roselle Kristine D. Waguis