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Rapid Child Mortality Decline in Sub-Saharan Africa

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Sub-Saharan Africa witnessed unprecedented declines in child mortality over the past two decades. The average child mortality rate decreased from 174 per 1,000 in 1990 to 121 per 1,000 in 2010 and the rate of decline has increased from 1.9 percent a year over 1990–2000 to 2.5 percent a year over 2000–2010 according to UNICEF. Research shows that there is an accelerated decline in child mortality and in 34 countries of the region and the rate of decline increased during the MDG period from 2000 as compared to the previous decadei. East and Southern Africa have achieved larger gains as compared to Central and West Africa. Countries including Angola, Ethiopia, Eritrea, Liberia, Madagascar, Malawi, Niger and Rwanda have experienced steep declines in the two decades spanning 1990 to 2010.

The African Development Bank works towards allying partners to strengthen health systems in Africa. On July 4-5, 2012, the African Development Bank in collaboration with Harmonization for Health in Africa (HHA) partners organized a high level dialogue between Ministers of Finance and Health on “Value for Money, Sustainability and Accountability”. The conference gathered Ministers of Finance and Health and/or their representatives from 54 African countries, African parliamentarians as well as over 400 participants from the public and private sectors, academia, civil society and media globally. His Excellency Hamadi Jebali, Prime Minister of Tunisia, Dr. Donald Kaberuka, President of the African Development Bank, and Dr. Margaret Chan, Executive Director of the World Health Organisation delivered the opening remarks.

Distinguished guests such as Dr. Michel Sidibe, Executive Director of UNAIDS, Dr. Babatunde Osotimehim, Executive Director for UNFPA, Mr. Gabriel Jaramillo, General Manager of the Global Fund to Fight AIDS, Tuberculosis and Malaria and Mr. Seth Berkeley, CEO of the Global Alliance for Vaccines and Immunizations (GAVI) delivered keynote speeches.

High-profile speakers like Julio Frenk, Dean of the School of Public Health, Harvard University and Hans Rosling, Chairman of Gapminder Foundation also delivered keynote speeches during the conference.

This conference emphasized the urgent need for greater domestic accountability, reduced dependence on foreign aid and value for money in the delivery of health services in Africa. It gathered the expertise from all over Africa as well as globally featuring speakers from India, China, Brazil, Vietnam and Kyrgyzstan. This high level dialogue culminated in a Tunis Declaration endorsing, among other things, the prioritization of high impact interventions, which lead to results.

The current patterns indicate that high level of economic growth is not a prerequisite for improving child survival as several low-income countries have been effective in reducing child deaths within a short period of time. Some of the biggest gains in child survival in Sub-Saharan Africa have been attained by increasing the coverage of childhood immunization. Even countries with weak health systems have had success by increasing the coverage of childhood immunization. Childhood immunization delivered through vertical programs has been able to circumvent limitations of weak health systems and is arguably the most successful health program in Africa. Decrease in malaria-related mortality has been another significant contributor to child mortality decline in the region.

Many countries have rapidly increased their malaria prevention coverage particularly with ITN use but also indoor residual spraying and Intermittent Presumptive Treatment for pregnant women.

Treatment for Acute Respiratory Infections (ARI) and diarrhea, two of the biggest killer diseases of childhood, has also improved significantly in the region.

Program strategies that have been successful in countries such as Ethiopia and Tanzania have included deployment of community health workers for provision of primary health care in rural areas.

The success in Tanzania has been attributed to the scale up of several key child survival interventions and doubling of public expenditure on health, implementation of governance reforms such as greater decentralization that gave districts substantial financial resources and opened up opportunities for local problem solvingii. In Ethiopia, the Health Extension Worker Program significantly increased the proportion of children vaccinated and the proportion of children and women using insecticide treated bed netsiii . In Rwanda, the establishment of Mutuelles de Sante increased access to child health services. Rwanda also introduced the pneumococcal vaccine to combat ARI which led to a substantial decline in child mortality.

Greater efforts are now needed for rolling out successful interventions to sustain the current levels of progress. Multi-pronged approaches are needed to upgrade human resources for health, improve the quality of clinical care and expand community outreach services for child health. The introduction of interventions such as family planning for birth spacing that have not yet been utilized on a large scale, but have been shown to be effective in other regions, can lead to further gains in child mortality decline.

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