Opinion: Now more than ever, DFID must lead efforts to end preventable child deaths

How should we view progress on child mortality?

From one perspective, the speed at which we have seen advances in child health in recent decades has been staggering. Child mortality numbers have fallen by more than half, from 12.5 million in 1990 to 5.3 million in 2018, even as the number of children being born has increased. It’s a story of progress that should embolden us all with optimism. A world where no child dies of preventable causes is within reach.

But viewed another way, there is a story of great inequality and of children left behind. While solutions are at our fingertips, they remain elusive for the poorest and most marginalized. Without radical action, 53 countries — predominantly in sub-Saharan Africa — are set to fall short of their SDG commitment to end preventable deaths of newborns and children under the age of 5.

The solutions are not complicated, and we have the tools and resources to change course. However, child health has been deprioritized on the global stage, and progress in the most challenging contexts has stalled. World leaders need to act with renewed urgency and ambition.

And who better to drive that change than the U.K. Department for International Development? The U.K. has long been a leader in global health, using aid to ensure children can survive and thrive, and the coming two years offer a fantastic opportunity to build on DFID’s technical expertise and leverage its soft power for good.

Encouragingly, the U.K.’s secretary of state for international development, Alok Sharma, has announced that U.K. aid will prioritize investments to end preventable deaths of mothers, newborns, and children by 2030.

But we continue to await details on how that will be done in practice.

To show how the U.K. can use the next two years to build on its long history of leadership in child health, Unicef UK’s new report, “Ending Preventable Child Deaths: How Britain Can Lead the Way,” sets a road map for action on five priority issues hindering progress on child mortality:

• Limited access to quality primary health care is a leading cause of the 7,000 newborn deaths every day and is closely linked with stalling progress on all aspects of child health.
• Unequal access to vaccines means 1.5 million children under 5 die from vaccine-preventable diseases every year.
• Pneumonia is the primary infectious disease cause of death among children under 5.
• Malnutrition contributes to nearly half of deaths for children under 5.
• Diarrhea is the fifth-leading cause of death among children under 5, and unsafe water, sanitation, and hygiene account for two-thirds of diarrheal disease.

Central to these issues are challenges with access and equity, as child deaths are concentrated among the poorest populations and health systems fail to respond to their specific needs. The key to expedite progress on child mortality lies with global investment in and prioritization of strong primary health care services to ensure equitable access to health care for the poorest and most vulnerable children.

So, what happens next? If the world is serious about delivering on the global goals in the next decade, we need to act now and invest in scaling up solutions to the biggest challenges. By 2030, 52 million children under 5 are estimated to die. To prevent these deaths and create transformative change for all children, the U.K. government must deliver on its promise to meet the Sustainable Development Goals by seizing the opportunities presented by the 2020-21 period:

• The Global Forum on Childhood Pneumonia in Barcelona. This week, national governments and global health partners are meeting to deliver concrete action to address the slow progress on tackling childhood pneumonia. As one of the founding members of the Advance Market Commitment for pneumococcal vaccines, the U.K. has helped accelerate the development of pneumococcal vaccines in developing countries, but the disease needs global attention.

The U.K. should use the pneumonia forum’s calls to action as an opportunity to ensure pneumonia reduction is a key success indicator in health system strengthening programs and to fortify partnerships with high-burden countries to provide targeted support for national pneumonia control strategies.

• The Sanitation and Water for All meetings in Washington. In April, Sanitation and Water for All, an international partnership of governments and development stakeholders, will convene high-level meetings with finance ministers to discuss actions for attracting attention and investment to the WASH sector. The U.K. recognizes the disproportionate effect of diarrheal diseases on children under 5 — and that much of this disease burden is a result of inadequate WASH services — and should support the provision of improved WASH in primary health care facilities as a core component of future programming to strengthen health systems.

Furthermore, the U.K. should use SWA to commit ongoing financing for sustainable WASH facilities while highlighting the social and financial impact of investments to secure international commitment to WASH.

• The Gavi replenishment conference in London. In June, Gavi, the Vaccine Alliance is due for reinvestment to ensure it can vaccinate an additional 300 million children from 2021-25. Gavi reaches almost 50% of the world’s children, including in the poorest countries. As a founding member and the next replenishment host, the U.K. has the important role of ensuring Gavi obtains the funding it needs to implement its new five-year strategy.

The U.K. should make an early and ambitious pledge to Gavi, in line with its current funding levels, and show diplomatic leadership by delivering strong pledges from partner countries.

• The Nutrition for Growth Summit in Tokyo. This global pledging moment to end malnutrition will be held in December. Given that the U.K.’s current commitments on malnutrition expire this year, the summit is a key event for the U.K. to restate and advance its leadership on malnutrition. At the first N4G Summit in 2013, DFID announced it would triple its nutrition investments. From 2015-19, DFID reached over 50 million women, adolescent girls, and children under 5 with nutrition programs.

The U.K.’s annual nutrition expenditure averaged £716 million ($885 million) between 2013 and 2017. To tackle the triple burden of malnutrition and facilitate increased collaboration between sectors to develop nutrition-sensitive approaches, the U.K. should make an early pledge of £800 million per year from 2021-25 for nutrition programming. This increase is justified by the need to drive nutrition improvements for the poorest children in the most fragile contexts and to address the growing demand for crosscutting and climate-resilient nutrition investments.

• The U.K.’s G-7 presidency. The U.K. can build on its momentum to prioritize child health in 2020 by focusing its G-7 presidency in 2021 on improving child health outcomes and placing strong primary health care systems as the foundation of such efforts.

As one of the largest donors of overseas aid with a record of advancing progress on child mortality, the U.K. is uniquely placed to use each of these key moments to show political leadership, spearhead the child health agenda, and influence other donors to make equally ambitious commitments.

With only 10 years to meet the SDGs, 2020 can represent the turning point for ending preventable deaths. This year will decide whether the world wins or loses the battle against child mortality.