Failure to focus on poorest has led to more than 2.8 million child deaths in Africa in ten years
More than 2.8 million children’s lives could have been saved in Africa over ten years if countries had made the same effort to help poor children as better-off ones, Save the Children said.

The aid agency says that while there has been important overall progress towards the UN goal of cutting child mortality, this has been coupled with a worrying trend in a number of African countries where efforts to reduce child mortality have left children from the most disadvantaged backgrounds behind. Save the Children argues that this trend threatens to undermine long term progress in reducing child mortality.

Save the Children says that while average global figures show child mortality has fallen 28% over the past decade, this masks an expansion of the child mortality gap between the richest and poorest families in many countries, including Nigeria, Madagascar, Benin, Burkina Faso and Guinea.

However, that it is possible for countries to reduce child mortality in an “equitable way” – so that the poorest communities are not discriminated against – and identifies seven countries including Ghana, Egypt, Mozambique and Niger where, in the period studied, child mortality fell and the gap between the richest and poorest income groups narrowed.

The report, entitled A Fair Chance at Life, also explodes the myth that the richer a country is the more children’s lives it is able to save, and shows that some of the world’s poorest countries, like Ghana, have reduced child mortality dramatically by focusing on the poorest families.

Ghana has done this by giving schools grants to ensure fee-free access for pupils and implementing a free maternal healthcare policy, a school feeding programme, a pilot cash-transfer programme and a national health insurance scheme.

A Fair Chance at Life also reveals:

-In Tanzania there has been a substantial fall in child mortality overall, but while the rate among the richest families fell by a third, the rate among the poorest families only decreased very slightly. This is down to the high cost of drugs, lack of rural health services and poor quality of care, among other things.

-In Burkina Faso there has been a fall in child mortality overall, but an increase in the child mortality rate among the poorest households.

• In Nigeria the poorest children are two-and-a-half times more likely to die before their fifth birthday than the richest. Households outside the wealthiest 10–20% of the population face mass deprivation, lacking access to the necessary range of health care and other related benefits.

• If Benin and Madagascar had reduced child mortality more equitably – making the same rate of reduction for all income groups as for the fastest improving income group - they would now be on track to meet MDG 4.

• The life expectancy rates in sub-Saharan Africa today have not been seen in Europe since the beginning of the 20th century. Someone born in sub-Saharan Africa can expect to live 52 years on average, while in Western Europe it is 80 years. Although the mortality rate has fallen, high fertility levels mean that the absolute number of child deaths in the region has increased since 1990, from 4.2 to 4.6 million.

With only five years to go, the goal to reduce child mortality by two-thirds (MDG4) is one of the most off-track as global child mortality has only fallen by 28% since 1990 – far short of its 67% target.

Aboubacry Tall, Regional Director for Save the Children in West and Central Africa based in Dakar, Senegal, said: "It is outrageous that children are dying from preventable causes because their parents are too poor to pay health care fees or buy drugs, but this is the sad reality for many people.

“It is a disgrace that some countries - while making progress towards reducing child mortality - are not ensuring that the poorest and most vulnerable children benefit in the same way that other children are.

"In West and Central Africa, the majority of the population live in poverty, and government’s administrative capacity is usually at a premium. In such circumstances, governments should be ensuring universal access to services. Without it, not only will the poorest be forgotten, but progress will remain slow and uneven.

“It is only by focussing on the issue of equity that governments are likely to reduce child mortality across all groups in society. Every child has a right to survival and every government has an obligation to protect them.”

A Fair Chance of Life highlights that more equitable reductions in child mortality would mean much faster overall progress towards MDG4. It reveals that if countries had made progress across all income groups at the same rate as the fastest-improving group, four million additional children’s lives could have been saved across 42 countries in ten years. Nigeria, for example, would have prevented an additional 892,000 child deaths.

Save the Children warns that unless world leaders take a radical new approach to cutting child mortality by focussing on equity and ensuring universal access to basic healthcare and other essential services, the MDGs will not be met.
The aid agency is also calling on governments and international donors to invest more in gathering data that tracks progress towards MDG4 for different groups, and not just in the aggregate.

Aboubacry Tall added: "This is not an impossible challenge. We know who these children are and we know what they die from. We also have the technology and resources to radically alter the life chances of millions of children. Even countries with very low incomes can save thousands of lives by making political choices that make sure the poorest families get the help they need. What is lacking is the political will to focus policy on reaching all children everywhere.

"When world leaders meet in New York later this month they will have a unique opportunity to decide that progress will be measured by the extent to which we are saving the lives of all children, wherever they live and no matter how poor their parents may be.”