POVERTY: Fairer spending could save 4m children by 2020,

6 September 2010

Selma Shakil, 27, with her daughter Fizar, in Delhi. Her son, Muzzamil, died in July last year aged one. Two million children die before the age of five every year in India, says Save the Children.
Millions of children die before their fifth birthday because developing countries skew public health spending to the rich rather than the poor, a leading charity says today. This misdirecting of money jeopardises the chances of meeting a crucial target of the UN's millennium development goals, says Save the Children.
The charity says that 4 million child deaths could be averted over a 10-year period if the 42 developing countries which account for 90% of all under-five mortality took an "egalitarian approach". The warning comes before a UN summit in New York later this month which will review progress towards meeting the eight goals.
One of the biggest concerns is that not enough is being done to cut the number of child deaths across the globe. Although UN nations agreed to reduce child mortality by two-thirds from its 1990 level by 2015, progress has been steady and slow – and exacerbated by the rising inequalities within poor nations.
Save the Children says this target will not be met at current rates and efforts are in danger of going "off-track" – only 3.5 million more children survive past their fifth birthday today than 20 years ago. The scale of the task is such that at least 1 million more children every year will need to live past five to achieve the UN's 2015 target.
"Nearly three-quarters of the countries with the highest child mortality burden will not reach the goal on current trends," says the report, A Fair Chance in Life.
The charity says cutting child mortality rates does not depend on how rich a country is or how fast its economy is growing. Patrick Watt, the charity's director of development policy, said health depends on fairness not wealth. He pointed out that people in Gabon were as rich as counterparts in Argentina, but had a child mortality rate almost four times higher.
"Growth is not the only answer either," says Watt. "India has had growth of 8% a year, but its current rate of reduction in under-five mortality is just 40% of what's needed to achieve by 2015 … This nails the myth that only growth is needed to end poverty – you need to focus on equity."
The problem, says Watt, is that there is a growing gap between who benefits from public spending: a poor child in Peru is five times less likely to live past five than a rich child; in India three times less likely and in Nigeria two and a half.
The gap in many parts of the globe is widening rather than narrowing, warns the charity. Save the Children says that in developing nations it is the children of the wealthiest fifth of the population who have disproportionately benefited from the focus on infant mortality to the extent that "in some cases the poorest fifth of the population [are] no better or even worse off".
It highlights what has happened in Burkina Faso, where a reduction in child mortality rates masks an actual increase in child mortality among the poorest 20% of the population. Sub-Saharan Africa, where close to one child in seven still dies before their fifth birthday, faces the greatest challenge. Although the mortality rate in the region has fallen, high fertility levels mean the absolute number of child deaths has increased since 1990, from 4.2 to 4.6 million.
Even in this part of the world, fairer access to public health resources would have saved lives. In Kenya, where there was an increase of nearly 150,000 under-fives' deaths between 1993 and 2003, an "egalitarian approach", says the charity, would have actually prevented 214,000 deaths.
Corruption too has played a part – oil-rich Chad has been plagued by bribery, which has undermined faith in government at a time when child mortality has actually increased.
The charity says that the key to saving more lives is to focus on nutrition, sanitation and women's rights – noting that one to three years of maternal schooling would reduce child mortality by about 15%. There is also a need to provide universal health services to mothers – the report highlights innovative programmes in Indonesia and Bolivia. It calls on donors to provide the cash to enable the charity to implement such schemes.
However, some experts said Save the Children should be pressing governments to make equality targets the issue. Kevin Watkins, from Oxford University's global governance programme, said: "If a poor child is fives times more likely to die than a rich one, then that's a human rights issue. We need developing countries … to focus on spending on the poor, not just saying that more donor money is the answer. A country like Vietnam has a great record in cutting child deaths because it taxes and spends progressively."
http://www.guardian.co.uk/society/2010/sep/06/fairer-spending-could-save-4m-children