Editor’s Note: Chelsea Clinton is an adjunct assistant professor at Columbia University’s Mailman School of Public Health and vice chairwoman of the Clinton Foundation. Devi Sridhar is a professor of global public health at University of Edinburgh’s Medical School and on the board of Save the Children UK. The opinions expressed in this commentary are solely those of the authors.
Chelsea Clinton, Devi Sridhar: Helping infants survive remains the greatest challenge in global health
Outbreaks such Ebola and MERS, tragic as they are, draw resources away from core health work, they write
Sometimes, when we look around, it can seem that our world is worse off than it’s ever been. But despite intractable problems, there is good news: Untold millions of people are living healthier, more productive and more secure lives than ever before.
One of the most important areas where tremendous progress has been made is child survival. With vaccination and better management of pneumonia, diarrhea and measles, the global community has reduced child deaths by half in little over 10 years.
Even skeptics of international development efforts like economists Dambisa Moyo and Bill Easterly recognize these gains. But we cannot equate progress with success, particularly given how tenuous the progress is.
If we look at the data, the risk of death among children under 5 is highest closest to the time of birth. This is true all over the world, not only in low-income countries. Of all the children who die before age 5, 15% die on their first day and 44% die during the first 28 days of life.
Helping babies survive the first day, the first week and the first month of life remains the greatest challenge in global health. Parents who live in poor parts of the world sigh with relief when their child has “made it” to the first birthday.
But there’s a part of this story that is less well told.
Emergency infectious disease outbreaks like Ebola and MERS, as serious as they are, have become black holes, sucking the necessary ingredients from health systems that could be allocated toward saving babies.
While these outbreaks are tragic and scary, and need resources to be contained effectively, inadvertently they draw billions of dollars from domestic budgets and external donors away from core health work. They claim the attention of political leaders and researchers alike, who suddenly find themselves developing the requisite policies and expertise to manage the crises, rather than staying the course on improving general public health and increasing the chance that a baby born today will survive tomorrow and in the months ahead.
Most crucially, they take the time of on-the-ground health workers – doctors, nurses, community health workers – as well as civil servants in ministries of health.
Tragically, Ebola took the lives of many of health workers – more than 500 across Liberia, Sierra Leone and Guinea. It also indirectly took the lives of infants and children who, because of the terrible strain placed on already fragile health systems, died from easily treatable conditions. They are the “uncounted” dead of the Ebola outbreak.
The key interventions for child survival are well-known and not expensive. But they require dedicated investment and attention, coupled with stronger health systems and sufficient health care workers.
The efforts of governments around the world are often supported by international organizations such as Gavi and The Global Fund, NGOs such as Save the Children and the Clinton Health Access Initiative, and philanthropies such as the Bill & Melinda Gates Foundation and the Wellcome Trust.
As Bill and Melinda Gates have said in describing the evolution of their foundation from a focus on technology to systems, providing vaccinations and key medicines does not happen in a vacuum. You need trained personnel to use a basic antiseptic for cleaning the umbilical cord or to provide steroids to help premature babies breathe, and infrastructure to support the delivery.
This is also why the Clinton Health Access Initiative, Partners in Health and other organizations are working with the World Bank to support Liberia’s health workforce program so that when the next outbreak occurs – whether it’s Ebola or something else – it does not become an epidemic.
Even before the Ebola outbreak, Sierra Leone had the fourth-highest first-day death rates in the world for newborn babies. In contrast, Liberia was highlighted as one of the success stories in child health. UNICEF recently announced that an estimated 70,000 births in Liberia have not even been registered since the Ebola outbreak began.
It will be devastating to look at what has happened to child survival over the past year in a half in West Africa, and how an outbreak that has led to tens of thousands in direct deaths can also result in hundreds of thousands of infants left on their own.
There is no simple solution. And all health problems – whether it’s Ebola or child mortality – need resources. We will do well to keep focusing on strengthening health systems and improving health workforces so that we can prevent future emergency infectious disease outbreaks as well as provide the basic care that will help babies survive their critical first weeks.
The Ebola epidemic
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