This blog post was written by Amy Sarah Ginsburg, MD, MPH, Senior Advisor in International Programs at Save the Children U.S.A, and Kurabachew Abera, MD, MPH, Health and Nutrition Team Leader for Save the Children Ethiopia. Save the Children believes every child deserves a future. In the United States and around the world, they give children a healthy start in life, the opportunity to learn and protection from harm. Save the Children is a Global Health Council 2017 member.
“We are living in the midst of a pneumonia pandemic. No disease kills more children.”
– Kofi Annan, former United Nations Secretary-General
As we mark World Pneumonia Day this month, we reflect on our progress in the fight against pneumonia as well as the work ahead. A Save the Children report, Fighting for Breath, shows child mortality rates are at an historic low, however even this “good news” means 5.6 million children died in 2016 before their 5th birthday.
Why are millions of children still unable to access life-saving nutrition, vaccines, and medicines? How can we ensure all families have access to the health care they need to protect their children from pneumonia and other illnesses? The answer is simple: we need to reach the unreached. The reality, however, is one of the most daunting global health challenges we have yet to face.
Today’s global health landscape has greater complexity than we encountered in past decades. We have made remarkable progress by addressing a then-universal challenge of developing countries – the lack of access to basic health care interventions such as antiretrovirals, vaccines, and contraception. Aggressive strategies, developed by global institutions and skillfully implemented by countries, began to close – though not eliminate – the access gap between industrialized and impoverished countries. This global approach, coupled with significant economic gains in many African and Asian countries, yielded dramatic results. By employing a largely “one size fits all” approach, we succeeded in saving millions of lives.
The success of this approach has fundamentally changed the challenges ahead. As is widely acknowledged, the communities untouched by global advancements are often the poorest of the poor, war-torn, geographically remote, mobile/pastoralist and/or historically underserved. Inequities in communities’ abilities to access basic health care are not only between rich and poor countries, there are often significant disparities within countries. Our continued progress is dependent on our ability to understand, navigate and influence these diverse communities.
Ethiopia’s experience illustrates this point. Nationally, the country has demonstrated remarkable progress in expanding access to health care, reducing hunger and undernutrition, and improving its economy. Since 1990, Ethiopia has reduced its child mortality rate by more than 75% from 203 to 58 per 1,000 livebirths. The success is largely due to increased use of tools and approaches made possible by the health extension program, a home-grown innovative community health program that increased access to basic health care.
Though Ethiopia has made significant headway, analysis shows this progress is uneven. The more remote areas of the country, such as the developing regional states of Somali and Afar, have made relatively few health gains. Many of these communities have weak linkages to the overall health system, which is inadequately resourced and often inaccessible. Cultural factors inhibit appropriate health practices, and there are few sources of accurate health information. Not surprisingly, there is poor uptake of the life-saving reproductive, maternal and child health interventions that are responsible for the dramatic health gains in other regions. As a result, the child mortality rate in these regions remains stubbornly high at nearly twice the national average.
In Afar and Somali, as in so many other communities around the world, cultural, geographic, political and economic forces converge at the community level and serve as complex barriers to improved health. Unfortunately, there is no “one size fits all” strategy to reach the unreached. We need careful analysis of local facilitators and barriers and community engagement to determine the best way forward.
Save the Children is developing country advocacy initiatives to strengthen the capacity of countries to address their complex health challenges. In Ethiopia, we are working in Afar and Somali regions to identify significant health system gaps, and engaging communities and policymakers to develop ways to close them. Our current work in Ethiopia focuses on maternal, newborn and child health including prevention and treatment of childhood pneumonia, the leading infectious cause of death for children. Save the Children is working with the Ministry of Health of Ethiopia to ensure universal access to quality neonatal and child health services. To this end, improving quality and scaling up integrated community case management and community-based newborn care as part of the package of the health extension program in Afar and Somali regions are priorities. Coupling community-based advocacy with efforts to improve child health, allows us to drive change by promoting health interventions -including immunization, nutrition, and access to care- that can reverse persistently high rates of child mortality.
Our work in Ethiopia recognizes that countries are both innovators and implementers – to shape and sustain change we need to strengthen the work of in-country stakeholders, leaders and partners. We must find new ways to provide catalytic investments, build government and community capacity, and to foster evidence-based and systems innovations that can save lives. This means listening to, empowering and holding accountable, governments and stakeholders closest to the most difficult problems.
Our global vision of achieving the ambitious Sustainable Development Goals requires us to find new ways to improve the health of families in the poorest and most remote regions of the world. As we evaluate the global health community’s annual progress and consider priorities for the year ahead, high among them should be increased support for country advocacy. This is complex, incremental and important work. It is the path we must travel to meet our global goals and save children’s lives.