India, China hold key to world meeting MDGs - UNICEF
Global achievement of the health related Millenium Development Goals,
the MDGs, depends largely on India’s success and on China accelerating
progress even further, according to a new UNICEF report which examines
the latest trends in child and maternal health.
In this year’s State of Asia-Pacific’s Children 2008, UNICEF says it
is a “fundamental truth” that unless India achieves major improvements
in health, nutrition, water and sanitation, education, gender equality
and child protection, global efforts to reach the MDGs will fail.
China too needs to make significant strides to regain early progress
it made in child survival. In 2006 2.5 million child deaths occurred in
these two countries accounting for nearly a third of all child deaths:
India (2.1m) and China (415 000). However the region’s robust economic
growth, the fastest in the world since 1990, has lifted millions out of
poverty.
Child survival, regarded by UNICEF as a key test of a nation’s
progress in human development and child rights, has improved
considerably. But gains have been overshadowed by deepening disparities,
which means health care often fails to reach the poorest. This is a
region with half of the world’s children, spanning 37 countries and two
hemispheres.
The report underscores a disturbing trend across the region: public
health expenditure remains well below the world average on 5.1 per cent,
with South Asia spending only 1.1 per cent of GDP and 1.9 per cent being
spent in the rest of Asia-Pacific.
In addition, as more services within countries are privatised and the
government share of health budgets diminishes, public facilities become
more run down and health workers leave for better paid jobs in the
private sector or outside the country.
“The divide between rich and poor is rising at a troubling rate
within subregions of Asia-Pacific, leaving vast numbers of mothers and
children at risk of increasing relative poverty and continued exclusion
from quality primary health-care services,” the report says.
Pneumonia, diarrhoea and malnutrition are the major causes of child
death in the region. But vast inequities in income, geography, gender
and ethnicity are essentially what stand in the way of children
surviving and thriving.
The most fragile period for a child in Asia-Pacific is during the
very first moments of life - if the baby is born without the help of a
skilled birth attendant due to poor access or cultural practices, and if
the mother is underweight, the chances of that baby staying alive
becomes increasingly slim.
In China most under-five child deaths occur within the first week of
life, largely due to a lack of obstetric services. In India one out of
every three women is underweight putting them at risk of having low
birth weight babies and these babies are 20 times more likely to die in
infancy than healthy babies.
South Asia is also the only sub-region in the world where female life
expectancy is lower than male life expectancy and where girls are more
likely to be underweight than boys. Pakistani boys are more likely to be
immunized than girls and have better access to health care.
“Unless discrimination against women and girls is addressed as part
of overall strategies to improve child and maternal health, high rates
of maternal and child mortality will remain stubbornly entrenched,” says
the report.
Civil conflict also affects a child’s chance of survival — the two
countries where a child has the hardest struggle to survive and thrive
beyond his or her fifth birthday, are countries that experience ongoing
conflict - Afghanistan and Pakistan.
On the other hand despite the civil strife in Sri Lanka, that country
has managed to cut child deaths by half since 1990, and stands out as a
country that has budgeted well for children.
As the world has moved past the half way mark and into the final laps
towards the Millennium Development Goals’ 2015 target line, what is
needed now is political will and sound strategies to dramatically
increase investment in public health services that specifically target
the poorest and most marginalized.
Without improved health care, 13 of the Asia-Pacific countries will
struggle to reduce the child mortality rates by two thirds.
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