This blog post was written by Amy Sarah Ginsburg, MD, MPH Senior Consultant in International Programs at Save the Children USA, and Kurabachew Abera, MD, MPH, Health and Nutrition Team Leader for Save the Children Ethiopia. Save the Children believes that every child deserves a future. In the United States and around the world, they give children a good start in life, the opportunity to learn and protect themselves from the dangers. Save the Children is a member of the Global Health Council 2017.
"We live in the midst of a pandemic of pneumonia: no sickness kills more children."
– Kofi Annan, former Secretary-General of the United Nations
As we celebrate World Pneumonia Day this month, we are reflecting on our progress in the fight against pneumonia and future work. A report by Save the Children Fighting for Breath shows that infant mortality rates are historically low, but even this "good news" means that 5.6 million children died in 2016 before their 5th birthday
Why are millions of children still unable to access nutrition, vaccines and life-saving medicines? How can we ensure that all families have access to the health care they need to protect their children against pneumonia and other diseases? The answer is simple: we must reach the excluded. The reality is however one of the most formidable global health challenges we still face.
The overall health landscape of today is more complex than the one we have seen in recent decades. We have made remarkable progress in addressing a universal challenge for developing countries: the lack of access to basic health care such as: antiretrovirals vaccines ] and contraception . Aggressive strategies, developed by global institutions and skillfully implemented by countries, have begun to fill – but not eliminate – the gap between industrialized and impoverished countries. This comprehensive approach, coupled with significant economic gains in many African and Asian countries, has yielded spectacular results. By employing a largely "universal" approach, we have managed to save millions of lives.
The success of this approach has fundamentally changed the challenges ahead. As widely recognized, communities spared from global progress are often the poorest of the poor, war-torn, geographically remote, mobile / pastoralist and / or historically underserved. Inequalities in the ability of communities to access basic health care are not only between rich and poor countries, there are often significant disparities within countries. Our continued progress depends on our ability to understand, navigate and influence these diverse communities.
The experience of Ethiopia illustrates this point. At the national level, the country has made remarkable progress in expanding access to health care, reducing hunger and undernutrition, and improving its economy. Since 1990, Ethiopia has reduced its infant mortality rate by more than 75 percent, from 203 to 58 per 1,000 live births. The success is largely attributable to the increased use of tools and approaches made possible by the Health Extension Program, an innovative community health program that has increased access to basic health care.
Although Ethiopia has made significant progress, the analysis shows that these advances are uneven. The most remote parts of the country, such as the developing regional states of Somalia and Afar, have made relatively little progress in health. Many of these communities have weak links with the entire health system, which is under-resourced and often inaccessible. Cultural factors inhibit appropriate health practices and there are few accurate sources of health information. It is not surprising that reproductive, maternal and child health interventions that save lives and are responsible for dramatic progress in health in other regions are poorly implemented. As a result, the infant mortality rate in these areas remains stubbornly high, almost twice as high as the national average.
In Afar and Somalia, as in so many other communities around the world, cultural, geographic, political, and economic forces converge at the community level and are complex barriers to improving health. . Unfortunately, there is no single strategy for reaching the excluded. We need a careful analysis of facilitators and local barriers and community engagement to determine the best path forward.
Save the Children develops National Advocacy Initiatives to strengthen the capacity of countries to meet their complex challenges in health. In Ethiopia, we are working in the Afar and Somali regions to identify important gaps in the health system, and engage communities and policymakers to develop ways to close them. Our current work in Ethiopia focuses on maternal, newborn and child health, including the prevention and treatment of childhood pneumonia, the leading infectious cause of death in children. Save the Children is working with the Ethiopian Ministry of Health to ensure universal access to quality neonatal and child health services. To this end, improving the quality and scaling up of integrated community-based community case management and neonatal care as part of the health extension program in the Afar and Somali regions are priorities. Linking community advocacy with efforts to improve children's health enables us to drive change by promoting health interventions – including immunization, nutrition and access to care – that can reverse high rates of infant 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 stakeholders, leaders and partners in the country. We need to find new ways to catalyze investments, strengthen government and community capacity, and foster evidence-based innovations and life-saving systems. It means listening, empowering and holding governments and stakeholders closest to the most difficult issues accountable.
Our global vision of achieving the ambitious goals of sustainable development demands that we find new ways to improve the health of families in the poorest and most remote regions of the world. As we assess the annual progress of the global health community and consider priorities for the coming year, increased support for advocacy in countries should be important. It is a complex, progressive and important work. That's the way we have to go to achieve our global goals and save the lives of children.