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UNICEF Shifts Gears to Target Poorest of Children

Matthew O. Berger

NEW YORK, Sep 7 2010 (IPS) - A focus on the children at the very bottom of the economic ladder is the most effective and efficient way to help children and communities in need, concludes a new report from the United Nations children’s agency UNICEF released Tuesday.

The poorest of the poor are often said to be the hardest to reach and the most expensive to help – making it too impractical for an agency like UNICEF to focus on them. But what if new technology and methodologies make that reasoning outdated?

In May, researchers at UNICEF set out to see whether the benefits of helping those most in need might just outweigh the costs of getting them that help.

Through simulating the effects of an “equity-focused approach”, which would involve a greater focus on the poorest of poor children and increased support for community-based initiatives like training rural health workers, and a “current path approach”, which replicated the status-quo emphasis on training professional health workers and building modern facilities, in 60 different countries of various incomes, the study found that the first approach would be both more efficient and more successful.

Conceding that the findings challenge traditional thinking, UNICEF Executive Director Anthony Lake said he was “more than pleased – I’m excited by the results.”

“This equity-focused approach proved considerably more cost- effective and sustainable than the path we’re on,” he said. “It doesn’t just suggest change; it compels it.”


These results are expected to fundamentally alter the approach UNICEF taking is toward the Millennium Development Goals that relate to its work, namely MDGs four and five – to reduce child mortality and to improve maternal health.

Though there has been progress toward these goals, the poorest countries are lagging behind their middle-income and high-income counterparts. Among the 67 countries in which 40 or more children out of 1000 die before age five, for instance, only 10 are on track to reach the MDG four target of reducing under-five mortality by two-thirds between 1990 and 2015.

Every minute, 21 children under five die – or 29,000 a day – mainly from preventable causes. Lake noted that if this many children died in some sort of disaster, “no one would talk about anything else.” But since their deaths are attributable to diseases and malnutrition, they slip under most peoples’ radars.

Likewise, while there have been advances in getting care to women before, during and after birth, there is still a large gap between the provision of care in poorer regions, like southern Asia and sub-Saharan Africa, and other regions of the developing world.

Half of the half-million people who die in childbirth each year are in sub-Saharan Africa, said Carolyn Miles, chief operating officer of Save the Children, told reporters here Tuesday. “And that disparity is growing.”

In a report on the progress toward meeting the MDGs, also released Tuesday, UNICEF pointed out that children from the poorest 20 percent of developing-world households are more than twice as likely to die before turning five than children from the richest 20 percent of developing-world households.

The same holds true for the probability of children being underweight in the poorest and richest 20 percents.

The disparity is between genders as well as between income levels. Girls and young women in developing regions are at a considerable disadvantage in access to education, especially secondary education, than developing-world boys.

The report, “Narrowing the Gaps to Meet the Goals”, tries to address that disparity – one of the biggest factors limiting the success of efforts to reach the MDGs agreed at the U.N. in 2000. As the efforts in some poor countries progressed, the poorest of them were left behind. The report’s finding that an equity-focused approach will bring improved returns on investment in health, nutrition and education provides an economic case to complement the moral case that already existed.

An investment of one million dollars in reducing under-five deaths in a low-income country with high child mortality would avert 60 percent more deaths under the equity-focused approach than under the current approach, the report found.

“An equity-focused strategy will yield not only a moral victory – right in principle – but an even more exciting one: right in practice,” Lake said in statement.

One major reason why this investment in the poorest communities yields such larger results is that ill health and illiteracy are often so concentrated in those communities that investments go a lot further there.

Another factor in its potential for success is the new approach’s focus on supporting community-based programmes, which it says are much better equipped to deliver care in poor, often remote regions than professional health workers and modern hospitals or research facilities.

 
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