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Efforts to lower maternal and child deaths fall short, USAID targets 24 high-risk countries

Source: Thomson Reuters Foundation - Wed, 25 Jun 2014 10:58 GMT
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Somali refugee Sahro Asad Hassan, 19, holds her newborn infant in the maternity ward at Dagahaley camp in Dadaab, Kenya REUTERS/Finbarr O'Reilly
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WASHINGTON (Thomson Reuters Foundation) – Countries are falling short in meeting the global goal to end preventable child and maternal deaths by 2035, despite a U.S.-led plan launched two years ago to accelerate progress, a report released on Wednesday said.

The findings have prompted the U.S. Agency for International Development (USAID) to refocus its child and maternal health programmes. The agency is directing $2.9 billion in funds over two years to 24 countries where mortality is highest, dropping projects in 19 countries and streamlining its programmes to prevent overlap with other donors.

Rajiv Shah, head of USAID, said he is confident these changes will help save the lives of up to half a million children over three years.

"We set for ourselves the target of getting child mortality down below 20 over 1,000 by 2035 for every country in the world, and we believe we are on track to achieve that goal," Shah said at a news briefing.

In its report "Acting on the Call: Ending Preventable Child and Maternal Deaths", a blue ribbon panel led by the United Nations' special envoy for health finance Ray Chambers reported that promising gains have been made in some countries with highly targeted programmes. 

Uganda and Zambia for example have reduced maternal mortality by at least 30 percent by pouring resources into high-risk areas. USAID also has driven results by increasing the treatment of drinking water, helping in malaria prevention and raising the delivery of contraceptives to lessen the frequency of pregnancies. 

"Despite these successes, on our current trajectory, we will not achieve the global goal of ending preventable child and maternal deaths by 2035," the report concluded. It recommended focusing resources on the 24 countries that account for 70 percent of the global mortality rate and scaling up projects that are proven successes. 

SUB-SAHARAN AFRICA

By 2013, maternal death rates were down 45 percent from 1990 levels but well shy of the 2015 Millennium Development Goalfor a 75 percent reduction. In Sub-Saharan Africa, the number of women dying in pregnancy and child birth stands at one in every 38 compared with one in every 3,700 in developed countries, according to  World Health Organisation

Most of these deaths are because mothers lack access to skilled routine healthcare or to basic emergency services, health experts said.  

"We know how to save these lives, we haven't put the momentum behind it, and unfortunately there is no silver bullet. There is a multiplicity of ways to prevent child and maternal death, and we just haven't got the services to all the right places on a district-by-district basis," said Erin Thornton, executive director of Every Mother Counts.

She welcomed the plans announced by USAID although she cautioned that more details on resource allocation were necessary to ensure would be no negative impact on the other 19 countries.

To that end, USAID said a number of joint partnerships with the private sector are due to be announced on Wednesday. 

Among them will be a $30 million programme from Johnson & Johnson, $500 million from Johns Hopkins University. Additionally, at least $4 million will be pledged by public and private partners for the USAID-led programme called Survive and Thrive, which partners child clinicians in the United States with their counterparts in high-risk countries to share knowledge and improve training, said Lily Kak, USAID senior adviser for new-born health. 

USAID did not identify the 19 countries where projects would be dropped, nor provided figures on whether its overall funding for child and maternal mortality is increasing in the years ahead. In fiscal year 2013 USAID spent $2.1 billion on all its child and maternal health programmes.

Programmes that have proven successful include the use of in Nepal of chlorohexidine ointment on the umbilical cord, which has reduced neo-natal infections and death by 23 percent and now will be produced in other countries such as Nigeria, Shah said.

The 24 countries identified as high risk, where maternal mortality averages 310 per 100,000, are Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, Ghana, Haiti, India, Indonesia, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Nepal, Nigeria, Pakistan, Rwanda, Senegal, South Sudan, Tanzania, Uganda, Yemen and Zambia.  Many global health experts want to reduce the maternal mortality rate to 50 deaths per 100,000 live births.   

The United States on Wednesday is hosting a conference in Washington of over 500 leaders in global health to review progress over the past two years ahead of a global meeting in child and maternal mortality in Johannesburg at the end of the month.

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