A Plan for Saving 6 Million Children

Each year nearly 11 million babies and children quietly perish... and the global community barely blinks.

It's not exotic diseases that claim the lives of these children; they're dying from preventable and treatable conditions such as malnutrition, pneumonia and diarrhea—mainly in sub-Saharan Africa and South Asia.

In an effort to halt the staggering body count and draw worldwide attention to a continuing tragedy, public health researchers—including the School's Robert Black—have developed a proposal to save the lives of 6 million children in the 42 countries where 90 percent of the deaths occur. The program calls for delivering 23 interventions proven to reduce child mortality.

"We need to put child survival back on the map," says Black, MD, MPH, chair of International Health and an author of the study, which appeared in the June 25 issue of The Lancet. "It's compelling to see what can be done with these proven interventions; it doesn't take a new discovery to achieve this." The total price tag? An estimated $5.1 billion, which breaks down to $1.23 per person in the affected countries, and covers care to all children in need of services. The cost of saving a child's life was calculated at $887.

Although child mortality was a priority among global health leaders in the 1980s, momentum slowed in the 1990s, as HIV infection and tuberculosis commanded more of the world's attention and money. Meanwhile, children continue to die needlessly, due to inadequate funding of existing interventions and inefficient health delivery systems, says Black, who coauthored a 2003 child survival series in The Lancet that laid the groundwork for the new study. "Essentially, the world has not cared enough to address this horrendous mortality," he says.

Researchers hope that a straightforward plan to save young lives using simple, effective methods will lead to a renewed global interest.

"I think it's a necessary step to be able to put before those who can provide resources—the rich world—the price tag for saving lives," Black says. "Five billion dollars is a lot of money, but it's quite doable."

The centerpiece of the effort is an intervention timetable that spans a child's life from a month before birth to age 5. Eighteen mother-and-child visits to a health care worker over that span—at a cost of $4.7 billion—provide access to essential preventive measures, including vaccines, antimalarial treatments and vitamin supplements. Breastfeeding and hygiene education, as well as childbirth under the care of a skilled attendant are also among the interventions. The number of health contacts are kept to a minimum through an integrated delivery system that combines services when possible. (For example, a visit four months after the child's birth may include an Hib vaccine for the infant, together with continued education for the mother about breastfeeding and avoiding contaminated water.)

The treatment component of the initiative provides health care and medications to treat diarrhea, pneumonia, dehydration and other major contributors to child deaths. To achieve greater efficiency, trained health outreach workers would deliver many of the interventions in community-based settings, rather than in medical facilities.

Assuming the child-survival initiative gains support, the next challenge is to sustain the provision of these basic interventions to children. Training must be increased for nurses, doctors and midwives, and medical facilities and care delivery systems will need expansion.

Black says he's encouraged by some movement on the part of industrialized countries to address child mortality. But real progress also depends on another factor.

"This is a dual message," he says. "Not only are we saying the rich world will have to pay for this; the countries themselves need to devote more resources to their own people."