New Child Survival Data Offer Evidence of Progress, Challenge to Do More

This summer the U.S., led by USAID Administrator Raj Shah, convened a Call to Action to accelerate gains in child health and eliminate preventable child deaths. Today UNICEF released new data suggesting we’re on the right track. The number of children under five dying fell from 12 million in 1990 to 6.9 million in 2011.  That’s real progress.

The Call to Action rallied leaders from scores of countries around the world, but left many observers wondering if real action would follow the talk. In Washington, action is often measured in budgets. Right now budget memos are flying back and forth between the Office of Management and Budget (OMB), the State Department, and USAID as the Administration determines its spending proposal for fiscal year 2014.

How should the Call to Action and this progress report from UNICEF inform the Administration’s next budget proposal?

1. Increase funding for child survival.

This seems like a no-brainer. But the reality lurking awkwardly behind the rhetoric of the Call to Action was the President had proposed a $27 million cut to maternal and child health programs in the upcoming fiscal year 2013. (The House has sensibly proposed reversing the cut, while the Senate has gone farther and proposed a $100 million increase.)

Since the FY13 budget proposal was released months before the Call to Action, USAID was given a pass for this apparent misalignment of budget and priorities. Next time (assuming the elections allow a next time), child survival advocates will be looking for a substantial increase to see if this Administration is serious about ending preventable child deaths. In FY11 the Administration proposed $700 million for maternal and child health programs, a high-water mark in any President’s budget (Congress didn’t come close to fully funding it).  That strikes me as a good benchmark for the next budget proposal.

2. Follow the Roadmap.

Among the most encouraging outcomes of the Call to Action was a roadmap (pdf) that described the strategic shifts necessary to speed up progress in reducing child deaths. These shifts included focusing resources on the countries where most deaths occur, prioritizing vulnerable populations like the very poor, and investing in high impact solutions to the biggest killers of children.

USAID is already off to a good start here, well on its way to making good on its three-year, $450 million pledge to GAVI to fund new vaccines, including those to prevent the two biggest killers of children, pneumonia and diarrhea. According to the latest UNICEF data, these two conditions account for 39 percent of child deaths.

A good next step would be increased investment in scaling up the treatment of pneumonia and diarrhea. Oral rehydration solution (ORS) is a time-tested treatment of dehydration from diarrheal disease that has saved some 50 million lives since its introduction in the 1970s. UNICEF and the World Health Organization now recommend adding zinc to the treatment regimen, which improves recovery and can prevent recurring illness. However, of the millions of kids who suffer potentially life-threatening bouts of diarrheal disease, less than 1 percent are getting the optimal ORS and zinc treatment. This is both a scandal and huge opportunity for leadership.

Ten countries with some of the highest burdens of deaths from these two killers have developed detailed, country-specific plans to expand effective treatment of pneumonia and diarrhea. At least half of the cost of these plans will be borne by the countries themselves, but they need support from donor countries to ensure the plans are fully funded and implemented. USAID should step up and fill a significant portion of the funding gap.

3. Don’t rob Peter to pay Paul.

With the pressure on to up the child survival budget, an expedient but misguided approach would be to increase child survival funding at the expense of accounts less en vogue with USAID leadership like tuberculosis or neglected tropical diseases. It’s one thing to apportion the slices differently, but quite another to make the whole pie bigger. A real test of this Administrations leadership and commitment will be whether it can boost investment in child survival programs while keeping its commitments on a range of other global health priorities.

The President’s budget proposal will come out in February 2013, but decisions are being made now. Let’s hope the Administration – from USAID to OMB and all the acronyms in between – read this UNICEF report as I do: evidence that we can make progress, and a challenge that we need to make it faster.