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Policy Insights Policy Insights OECD DEVELOPMENT CENTRE www.oecd.org/dev/insights PolicyPolicy InsightsInsights No. 65 April 2008 Combating Under-five Mortality in Africa (based on the African Economic Outlook 2008*) by Audrey Verdier-Chouchane ♦ Reducing under-five mortality rates in Africa by two-thirds is urgent. ♦ HIV-AIDS, malaria, lack of basic health services and conflict are hampering progress. ♦ Preventable diseases take a heavy toll on the under-fives. ♦ Preventing the deaths of children is a matter of political will. Where there has been progress towards the Millennium Figure 1. Under-five Mortality Rates in Selected Development Goals (MDGs), including towards MDG No. 4 Southern African countries which aims to “Reduce by two thirds the mortality rate among children under five”, it has been when strong government leadership and good policies are combined with adequate financial and technical support. 200 180182 It can be done. 180 160 William Easterly’s 20071 argument that a one-dimensional 160 interpretation of the MDGs gives an unfairly bleak portrait 140 132 132 of Africa is right. He says that the MDGs are poorly and 120 arbitrarily designed and that the relative performance of 120 110 101 African countries looks worse because of the particular 100 1990 way in which the targets are set. Africa already had very 80 80 2005 high child mortality levels when the goals were established, 68 58 60 rendering a two-thirds reduction less likely. In 1990, on 60 average, the under-five mortality rate of Africa was around 40 154 per 1 000. That would mean reducing it to 51 per 1 000 by 2015 in order to reach the goal. By 2005, the 20 under-five mortality rate on the continent had reached 0 137 per 1 000, a decrease of only 9.3 per cent instead of Botswana Lesotho SouthAfrica Swaziland Zambia Zimbabwe the 40 per cent required to be on track. Source: Author based on data from the World Bank (on line) World HIV/AIDS, malaria, lack of basic health services and Development Indicators, Washington, D.C. continuing conflict are the main reasons for the shortfall and the very slow average progress. Southern African countries where the HIV/AIDS pandemic is high, This is a very bad performance by anyone’s standards, © OECD 2008 registered higher mortality rates in 2005 than in the 1990s and it calls for urgent measures. Some countries have (Figure 1). responded and adopted appropriate policies that are _____________________ beginning to work, even if not all of them are back on 1. Easterly, William (2007) “How the Millennium Development Goals track. They have proved that substantial improvements are unfair to Africa”, Global Economy and Development, Working are possible. Paper 14, November 2007. Policy Insights No. 65 No. Insights Policy The opinions expressed in this paper are those of the authors and do not necessarily reflect those of the OECD, the Development Centre or their member countries. 1 In Africa overall, only 17 per cent of the countries have So, which African countries are advancing towards achieved or are on track to achieve the goal. The figure is MDG 4 and how have they done it? much lower, 7.5 per cent, when the better-performing North According to Save the Children2, three countries deserve African countries are taken out of the calculation. Egypt praise for saving the lives of children younger than five. has already achieved the target and Algeria, Cape Verde, Despite their very low per capita GDP, Madagascar, Comoros, Eritrea, Libya, Malawi, Morocco and Tunisia Malawi and Tanzania registered respectively, a 32, 46, are likely to reach it (Figure 2). As might be expected, and 27 per cent decline in under-five mortality between wealthier households, urban areas and households where 1990 and 2006. Governments played a major role. The mothers have some education are those that are most reduction was achieved through health-sector reforms and likely to see a reduction in child mortality. community-based programmes. In Malawi and Tanzania, Another important factor in child mortality is vaccination progress was partly the result of an increase of skilled against measles. In 2005, in Africa as a whole, only health-care workers and better care during pregnancy. In 64 per cent of children of 12-23 months received at least addition, children from 5 to 59 months received at least one dose of measles vaccine (95 per cent in Northern one annual vitamin A supplement to combat malnutrition. Africa). The continent can do better. In Madagascar, the principal strategy was to prevent malnutrition through breastfeeding. The case of Egypt demonstrates even more forcefully Figure 2. Main performers in reaching MDG No. 4 that political will is the key to success. Egypt is the only (Percentage changes of under-five mortality rates) African country which had already achieved MDG 4 by 2006. The government launched a major initiative in Niger Senegal 1992 called “healthy mother, healthy child” to improve Guinea-Bissau Djibouti health conditions in poverty areas. The effort focused on Tanzania Sudan improving care for pregnant women, and providing skilled Namibia Madagascar assistance during childbirth and access to family planning Seychelles Guinea information and services. Mauritius Ethiopia Mozambique Examples such as these prove that reducing child mortality Comoros is within the reach of African countries. Five, simple CapeVerde Malawi measures, recommended, among others, by Save the Algeria Eritrea Children can help: training doctors and nurses to provide Libya Tunisia safe childbirth; encouraging breast feeding for the first six Morocco Egypt,ArabRep. months of a baby’s life; providing measles vaccinations; -120% -100% -80% -60% -40% -20% 0% promoting oral rehydration to fight diarrhoea; and training health workers to recognise pneumonia and how to treat Source: Author based on data from the World Bank (on line) World it with antibiotics. Development Indicators, Washington, D.C. It can be done. 2 Save the Children (2007) State of the World’s Mothers Index: Save the Lives of Children under 5, available at: www.savethechildren.org * published jointly by the African Development Bank and the OECD Development Centre with the United Nations Economic Commission for Africa with financial support from the European Commission. OECD Development Centre © OECD 2008 Readers are encouraged to quote or reproduce material from OECD 2, rue André-Pascal, Development Centre Policy Insights for their own publications. In return, 75775 Paris Cedex 16, France the Development Centre requests due acknowledgement and a copy of Tel.: +33-(0)1 45.24.82.00 the publication. Full text of Policy Insights and more information on the Fax: +33-(0)1 44 30 61 49 Centre and its work are available on its web site: www.oecd.org/dev E-mail: [email protected] www.oecd.org/dev/insights Policy Insights No. 65, April 2008 Policy Insights No. 65, No. Insights Policy 1.
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