My most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating “strep throats” with penicillin was better than operating. I didn’t need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.
Millions of children today are not so lucky. Over 7 million children under the age of 5 die each year; 70 percent of child deaths occur in sub-Saharan Africa and South-East Asia. The vast majority — over two-thirds — are entirely avoidable with existing safe, effective, low-cost prevention and treatment.
We’ve come a long way: reducing child mortality by nearly 70 percent in 50 years. But a child born in a low-income country is still about 18 times more likely to die before the age of five than a child born in a wealthy country. We know how to prevent most child deaths through low-cost, high-impact, close to home interventions such as community-case management and increasing access to quality medicines. We can and must do more to end preventable child deaths.
“Every Child Deserves a 5th Birthday,” a new child survival initiative, launched by USAID Administrator Dr. Rajiv Shah, is building this awareness across the country and the world. Join the global campaign to end preventable child deaths.
Prevention, treatment and care close to the home are keys to saving children’s lives
Improving access to quality, essential children’s medicines reduces preventable child deaths. Where do you take your child if they have a fever or diarrhea and the closest doctor is a day’s walk away? If you live in rural Tanzania or other low-income countries, it most likely is a community health shop, hours closer and much more convenient than the nearest health facility or pharmacy. Previously, these shops were staffed by unlicensed, untrained dispensers who sold medicines of questionable quality.
In response, MSH worked with the Tanzania Food and Drugs Authority to develop an accredited drug dispensing outlet (ADDO) program, with funding from The Bill & Melinda Gates Foundation. Through the ADDO program, nearly 10,500 dispensers have been trained and certified and over 3,800 shops accredited across 15 regions of Tanzania. The licensed dispensers at these accredited shops provide, for example, oral rehydration salts & zinc for diarrhea, and bednets & treatment for malaria; and they know the screening questions to provide appropriate medicines for treatment of acute-respiratory infection among children or, if necessary, make a referral to a clinic. The ADDOs are a sustainable enterprise, bringing life-saving prevention, treatment, and care for children closer to home. The ADDO program also empowers women, as nearly 40 % of shop owners and over 90% of trained dispensers are women.
Community case management saves children’s lives. In rural, low-income countries, health centers can be inaccessible to most of the population. Over half of the deaths of children under the age of five occur in the home. Training community health workers empowers the community, including the mothers, on prevention and treatment of basic needs for children under the age of five, such as malaria, diarrhea, pneumonia, and malnutrition.
The USAID-funded BASICS program in Benin, led by MSH, has helped local leaders implement a community-based, integrated management system for child health. Over a six-month duration, community health workers treated 27,060 cases of child illness, referred 1,043 cases to health centers, and made 14,822 home visits to increase awareness of child illness, immunization, and nutrition. Now, over 1,000 community health workers provide case management at the community level for child illness, covering over 200,000 children under the age of five in five health zones in Benin.
Empowering mothers, through community health workers, improves care for children’s common illnesses. In Afghanistan, under-five mortality and infant mortality rates have dropped dramatically, due in part to a combination of close-to-home interventions targeting mothers in the home. Over 20,000 trained community health workers serve nearly 45 percent of the country’s sick children, with health facilities serving 55 percent. Community health workers visit villages and households, teaching mothers, like Taj Bibi, how to care for common child illnesses, such as treating diarrhea with oral rehydration salts and zinc.
Together, we can, and must, reduce preventable child deaths.
Expanding access to quality health care closer to the home will improve child survival in low-income countries. Training and certifying rural medicine dispensers at a national scale, and providing community-based care by community health workers, will help empower rural communities and improve the health of children in these resource-poor areas. Through these cost-effective, high-impact interventions closer to the home, we can accelerate the reduction in child mortality and save millions of lives.
Every child deserves a 5th birthday.
- USAID’s 5th Birthday campaign
- [Video] Accredited Drug Dispensing Outlet (ADDO) Program: Improving Access to Medicines in Tanzania
- [Video] USAID: Why 5th Birthday?
Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.