A FAIR CHANCE AT LIFE Equity and Inclusion to reduce child mortality

1. A FAIR CHANCE AT LIFE Equity and Inclusion to reduce child mortality December 8, 2010 Aboubacry Tall Regional Director for West and Central Africa

2. A Few Reminders We are not on track to achieve MDG 4 Averages hide disparities, gloss over inequities and create slower progress. The world’s poorest suffer the highest mortality MDG measurement encourage a focus on low hanging fruit – the most easily accessible. Every child – irrespective of the circumstances of their birth or the socio-economic of their parents – has the same right to good health and to life

3. WHERE WE ARE NOW • Since 1990, the child mortality rate has globally been reduced by 28%. • Of the 68 “Countdown to 2015” priority countries, only 19 are on track to meet MDG 4. • Five others have even seen an increase in their child mortality rate. • 1 out of every 7 children still dies in Sub Saharan African before his 5th birthday • PROGRESS is often concentrated among the wealthiest fifth of the population • Corruption and lack of transparency worsens the situation for the poorest .…

4. WHY EQUITY MATTERS IN TACKLING CHILD MORTALITY • Equity makes good common sense • Combating extreme inequities is a great tool to reach the MDG4. It would: • -draw attention to the country's social fabric flaws and therefore act as an early warning system • -good for economic development because redistribution would be a great tool to reduce poverty. • -create a virtuous circle of accountable government and equitable public policy

5. How to make equitable progress on child survival:4 key lessons to make equitable progress on child survival • We owe it to our children to do the right thing • The right thing makes sense: ethical, economic and political • Based on the experience of 7 countries (Ghana, Mozambique, Niger, Egypt, Indonesia, Bolivia, Zambia), Save the Children has identified 4 policy lessons for faster and equitable progress for MDG 4. • Comprehensive approach • Universal approach • Equitable distribution of resources • Transparent and accountable governments

6. LESSON 1: MDG4 require a comprehensive strategy Complicated and costly measures are not always the best. Such actions can only lead to success if they’re are combined with a policy in the 4 following areas: • Nutrition:1/3 child death is due to under nutrition. • Sanitation: basic hygiene can significantly reduce child death. In fact, 45% of the cases could have been prevented by simple hand washing with soap. • Empowering women: gender inequalities can be devastating on children survival. • Access to social protection programs (including social a health assurance) is often part of the reduction strategy of the successful countries e.g. Ghana, Rwanda, South Africa. .

7. Lesson 2: the need for a universal approach to service delivery • Countries that have managed to reduce child mortality generally promote a universal approach, instead of targeting specific groups (which can be more costly and imply specific administrative needs). Since 2006 Ghana has adopted the High Impact Rapid Delivery (HIRD) approach as a national strategy in order to provide health and nutrition services to rural communities. • Considering the fact that 40% of countries making slow progress can be considered as fragile, universal approach can contribute to political stability and may actually help to stabilize the fragile economic or political situation of those countries.

8. Lesson 3: the need for an equitable distribution of resources • Countries that have made equitable reduction generally practice a more equitable distribution of resources: 23% of the health expenditures covered by social security vs. 3% in countries with static mortality rates. • Public recognition of disadvantaged groups along with redress measures.

9. Lesson 4: the need for governments to be transparent and accountable • Countries making slow progress on MDG4 generally have breaks between budget allocation and actual resource transfers to the poorest ones. • For instance, the lack of transparency in Kenya’s budget may have contributed to widespread abuses and inconsistencies in the application of programs that were meant to benefit to the poor. • It’s also the case in Cameroon or Chad where corruption has been particularly damaging for the poorest children, as in such situations the resources are often captured by the better off.

10. Holding Governments Accountable • Localize MDG 4: governments, donors and international institutions must take into account local realities and disparities and commit to achieving the MDG4 for all income groups • Monitoring progress against equity objectives: governments, donors and international institutions should start reporting routinely on MDG progress and on any relevant source of inequity in order to enable countries to strengthen their data • Fostering demand for action on equity: UN institutions should ensure that the priorities of the poorest are emphasized in policy debates and decisions with their civil partners.

11. Conclusion • The true test of how well we do against MDG 4 is not just whether we meet the global target of 2/3 reduction in child mortality. • The true measure of success will be whether we do so everywhere, in every country and in every community.