It is estimated that in 2012 approximately 6.6 million children, 18,000 children per day, died before reaching their fifth birthday. This represents a reduction of almost half the number of under-fives who died in 1990, when more than 12 million children died. The average annual rate of reduction in under-five mortality accelerated from 1.2% a year for the period 1990-1995 to 3.9% for 2005-2012. While significant, this remains insufficient to reach MDG 4 which aims to reduce the under-five mortality rate by two thirds between 1990 and 2015. As the region with the highest child mortality rates in the world, sub-Saharan Africa faces huge challenges. A rate of 98 deaths per 1000 live births has meant that a child born in the region faces more than 16 times the risk of dying before their fifth birthday than a child born in a high income country.
Of the 2012 figures, close to 75% of the deaths are attributable to just six conditions: pneumonia, diarrhoea, neonatal infection, measles, malaria and HIV/AIDS. These conditions are all preventable or manageable with adequate treatment. Malnutrition and a lack of safe water and sanitation contribute to half of these deaths. The impact of poor living standards upon health can be profound. For those living in poverty such issues are exacerbated by a lack of access to affordable and good quality healthcare.
Global support and continued investments are essential to strengthen health systems in developing nations so that all children are able to receive the care they need. Developing health systems are however faced with a variety of issues which must be challenged and overcome if effective and equitable services for children are to emerge. Expanding the scale and scope of health interventions is crucial, as is tackling barriers which may hinder advances.
A lack of funding at a macro-level and low heath system capacity can constrain positive developments. Critically many developing countries are facing a health worker crisis. It is estimated that sub-Saharan Africa will require an additional 860,000 workers to scale up its healthcare provision to meet the health related MDG targets. Efforts are already under-way to promote and increase the number of community health workers who operate at a local level, improving the scale and distribution of coverage.
Access to healthcare remains a key issue. Proven cost-effective interventions for deadly diseases such as malaria, diarrhoea and measles exist but can fail to reach vulnerable groups. Weak health services at a district level can create inequalities between regions. Strengthening district health services can contribute to the delivery of primary care services to marginalised children and families at a community level.
The chart below indicates under-five mortality rates from 1990-2012 set against MDG 4 targets for all African countries in the Commonwealth, it also includes Pakistan, India and Bangladesh.
Developing Commonwealth countries have seen variable degrees of success in reducing child mortality. India and Nigeria, who together account for more than a third of all under-five deaths, have seen significant reductions, though neither has reached its MDG target. Nigeria has not yet halved its child mortality rate from 1990 while India is also unlikely to reach its target despite a greater level of reduction. Sierra Leone, long considered one of the worst countries in the world for child mortality is yet to reduce its 1990 rate by a third. A combination of chronic underinvestment in health programmes, malnutrition and harmful cultural practices in a post-conflict setting have acted to keep mortality rates high. Scaling existing programmes up has been noted as a particular area of difficulty. Botswana, Lesotho and Swaziland have all witnessed a small increase in child mortality for the period 1990-2012. Poor sanitation, dirty drinking water, malnutrition and the HIV/AIDS epidemic have been indicated as key factors for the increases. By contrast Malawi, Tanzania and Bangladesh have taken huge strides in reducing their child mortality rates. All three countries have met their MDG 4 target.
The need to prevent and treat the conditions which contribute to child mortality has been accepted as a global imperative. Regular immunisations, vitamin A supplements, rehydration for children suffering from severe diarrhoea and use of bed-nets by women and children to protect them from malarial mosquitoes have all been proven to be simple and effective ways of keeping children alive. Ensuring access to these life-saving interventions is crucial.
As the 2015 MDG deadline approaches numerous initiatives have emerged to tackle these issues. The Global Vaccine Action Plan is working towards universal access to immunisation by 2020. A strong immunisation programme is an integral part of a well functioning health system. The WHO and UNICEF have joined other partners in establishing a new Global Action Plan for Pneumonia and Diarrhoea which aims to have proven preventative and treatment measures in place for all children by 2025. Such a focus is encouraging. It is vital that these developments are matched by a strengthening in the capacity of emerging national healthcare systems, so that they can provide access and quality care for all citizens.
Written by Michael Cavanagh
It is widely accepted that corruption is detrimental to the interests of society, particularly the poor. The pervasive view is that corruption impedes social and economic development, eroding the public's trust, hurting investment and undermining democracy and the rule of law. Over the past decades a growing body of work has emerged highlighting the malign impact corruption can have on a society. There is compelling evidence which suggests corruption can fuel poverty by subverting the normal means of distributing economic gains, enriching the grafter while negatively impacting public spending programmes which benefit the poor. On this basis development agencies have placed anti-corruption strategies at the heart of their efforts to strengthen governance.
A renewed focus on challenging corruption and its negative impacts is welcome, but should it have received top billing alongside civil war and property rights when David Cameron announced his vision for the development agenda? One could argue there are a range of other issues which hold more overt linkages to both stalling the development process and fuelling poverty. It has been suggested that corruption has been given a central role because westerners care about corruption far out of proportion to its impacts on poverty alleviation and economic growth.
This is not to say corruption is unimportant. Corruption clearly matters, it can hurt poor people, increase inequality and lower the returns on development investment. However, varying forms of corruption have different effects, some can be very harmful in certain political and social contexts, while other impacts may be relatively benign.
(Red: Low HDI / Orange: Medium HDI / Yellow: High HDI / Green: Very High HDI
The above chart highlights the relationship between the Human Development Index (HDI) and Transparency Internationals Corruption Perception Index (CPI) for Commonwealth countries in 2013. The chart indicates a correlation between low levels of HDI and higher perceived levels of corruption. Conversely those with high levels of HDI are seen to have low levels of corruption. This pattern is indicative of the relationship between corruption and development, there are however a number of points which must be considered.
It is difficult to prove the direct causal impact of corruption levels on economic growth and other development outcomes. Rather than acting as a cause of poverty and slow development, corruption should be seen as a symptom of underlying problems which are often political in nature. Continuing patronage and a lack of checks and balances on politicians and civil servants who without incentive to change their behaviour, continue to act in the interest of themselves and the elites who support them.
Though progress has been made, attempts to tackle corruption have not been entirely successful. Strengthening accountability and the formation of anti-corruption commissions have had limited success. There is still no accepted approach among governments and development agencies for fighting corruption. The rise of civil society groups offer another potential means with which to combat the issue, though these are subject to the political freedoms afforded to such groups in a given nation. Recently in Kampala, Uganda, the Black Monday Movement – a coalition of local NGO's and civil society groups – marched “to mourn the loss of Uganda's public money through corruption”. The catalyst for the coalitions formation was a corruption scandal which rocked the country in 2012. Prime Minister Amama Mbabazi was forced to concede “massive theft” had taken place of $15 million intended for development projects in the conflict affected northern region.
The growing number of civil society organisations willing to stand against corruption in Africa is a positive development. A wave of recent anti-corruption protests have been at the centre of a wider mobilisation of civil society, which has unsurprisingly followed democratisation efforts. Such examples can be seen in Uganda, Senegal, Democratic Republic of Congo and Tunisia. Many of these groups have reported “judicial harassment” by the authorities. Ultimately, combating corruption in this way requires engagement with governments and the support of watchdogs and justice systems, which can often be lacking.
As the post-2015 development agenda emerges a key focus could aim to tackle the underlying causes of corruption, such as the nature of political systems and the funding of political parties. Anti-corruption efforts could be placed within the wider context of other struggles, such as attempts to reduce constraints to effective service delivery. This would require an evaluation of the complex incentives which shape individual choices of decision makers. Further, the success of anti-corruption strategies will be dependent on the answers to a number of questions. Who are anti-corruption efforts being undertaken by? Is leadership provided from the highest levels of government? Does the state have the capacity to implement a strategy through detection, investigation and ultimately prosecution?
Written by Michael Cavanagh