WEST AFRICA: Why is child development stalled?

DAKAR, 28 January 2008 (IRIN) - Experts put the lack of progress on children’s development in West Africa down to pervasive poverty, chronic malnutrition in many countries, piecemeal aid responses, and health systems broken by protracted conflicts.

Nine of the 12 countries with the world’s highest rate of child deaths are in the region, according to the UN Children’s Fund (UNICEF) State of the World’s Children 2008 which was released on 22 January.

According to the report, the region is the only one in the world showing “no progress” on reaching the Millennium Development Goal to reduce under-five mortality by two thirds by 2015.

While the number of children dying before their fifth birthday has declined by almost a quarter globally since 1990, in West and Central Africa it dropped by only 1.2 percent, the report showed. On average 18.6 percent of children in West Africa die before their fifth birthday, while one in 10 will die by their first.

The reasons for such slow progress are complex, but some factors stand out according to UNICEF’s Dr. Genevieve Bagkoyian, UNICEF’s regional adviser on child survival and development.

High death rates among children are largely a result of chronic poverty and the legacy of conflict in Chad, Liberia and Sierra Leone; poor management of health systems in some of the wealthier states such as Nigeria; and chronic malnutrition in parts of Sahel countries of Mali, Mauritania, Burkina Faso, Niger and Chad, Bagkoyian said.

“Throughout the region, how many governments do we have that are stable, have adequate funds and good governance to tackle change?” she asked.
Leading cause

Malnutrition is a leading cause of death in the region, killing half of all children under five, according to UNICEF. This is because it weakens children’s ability to fight other diseases, such as malaria or pneumonia.

"Poor nutrition in the first five years of a child’s life combined with high levels of disease will lead to high death levels," Greg Ramm, West Africa regional director of Save the Children, told IRIN.

According to a previous UNICEF report, malnutrition-related death rates in West Africa are double the global average.

Malnutrition also affects reproductive health, leading to low birth weights and in some cases, premature births.

In Niger, of the 19 percent of children who die by their first birthday, a quarter die on the day they are born, mainly because of these factors, combined with a lack of access to skilled doctors or midwives, according to Bagkoyian who estimated that across the region 60 percent of women give birth at home without a doctor present.

Mothers

But giving birth also leads to death for simpler reasons that are easier to rectify, such as the lack of a clean blade to cut umbilical cords and cultural behaviours such as an avoidance of breastfeeding Bagkoyian said.

“In many of these countries, if we changed a number of taboo behaviours, we could save a lot of children even if they are born at home,” she said.

The lack of trained medical staff points to a need for stronger health systems that prioritises the health of mother and child, she said, adding that aid agencies and donors have not had as much impact as they could because they have not coordinated themselves to tackle root problems.

‘’In the past we had one agency working on a polio campaign, another on measles, when what is needed is commitment from agencies and donors to come up with joint solutions to these problems, rather than one by one.’’

She added that prevention efforts are crucial. “Simple preventive actions, if expanded to reach higher numbers, could reduce child mortality by 5 percent per year,” she estimated, pointing to mass immunisation campaigns, working with donors to provide children with Vitamin A and mosquito nets and spreading simple reproductive health messages as good examples.

''...What is needed is commitment from agencies and donors to come up with joint solutions to these problems...''
Government role

But building better health systems also depends on governments, Save the Children’s Ramm said. Poverty can create a major barrier to achieving this, because it leaves such a small tax base for governments to invest.

“In many of these places, even when governments have prioritised healthcare within their available budget resources, there would still not be enough money to get the job done, because there’s simply no tax base to fund it.”

“When addressing if it’s a question of poverty or of priorities, the answer is both, but ultimately you can’t prioritise what you don’t have,” he said.

But while some West African governments channel a relatively generous proportion of their annual income to health, some of the most marginalised give the least, including Chad, which according to UNICEF allocated just 3 percent of its annual gross domestic product (GDP) to health in 2007.

To reverse the situation in West Africa, Ramm said, aid agencies and governments need to tackle change at different levels: working on prevention efforts at the community level, working with governments to set up stronger health systems, and lobbying donors to meet their aid commitments.

But donors also have a responsibility to increase the proportion of their aid budgets that goes to healthcare and nutrition, he said, starting with meeting the UN target of committing 0.7 percent of their GDP to official development assistance. To date only five countries – Norway, Sweden, Denmark, the Netherlands and Luxembourg – have done so.

“Even among donors who are doing better at upping their aid levels, most of them not reaching these targets,” Ramm said.