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New targets for child survival?

The first day of the Child Survival Call to Action here in Washington DC, felt, at times, like being at two different events. When we registered we were given two packs, one from USAID and one from UNICEF.

Throughout the day, tweeting was using either #5thBDay (USAID) or #Promise4Children (UNICEF) or – tweeters were pretty confused. There are even two websites.

It reflects some of the confusion about the purpose of this event, and the timing of it. It is fantastic to have these two organisations (together with the governments of India and Ethiopia) calling something on a topic which Save the Children thinks should be central to all global efforts.

The topline aim to end all preventable child mortality and to get the rates in poor countries as low as it is in rich countries, is wonderfully ambitious. And, with so many initiatives on vaccination, nutrition, family planning and health workers, bringing them all together to remind us that the overall aim is bigger than the sum of the parts.

However there are questions about whether the approach and the time is right. The Millennium Development Goals (MDGs), including to reduce child mortality by two-thirds by 2015, have three and half years left to run and attention should not get diverted.

There is a risk that a new target for 2035, which is being proposed, would let current world leaders off the hook. For many countries, this would be a less ambitious target. There are also questions about the one-size-fits-all of a target rate that applies to every country.

There are also key lessons from the MDGs which need to be learned and much fuller discussion about what might replace them after 2015. UNICEF has been the leader in pointing out that national average targets do not reduce and can even increase inequity within a country.

One of the most important contributions USAID makes is to fund DHS surveys that show that child mortality and health services are grossly inequitable, with the poorest, ethnic minorities and rural communities suffering most and excluded by wealth.

All this raises the question about why the proposed target has not adopted these lessons and is a national average of 20 under-five deaths per 1000 live births. Save the Children has been advocating strongly to try to avoid this mistake. We have said that the target should not be a national average and that a country would only succeed if it achieved in “in every segment of society”.

Today, discussion moves onto the detail. Hopefully we will be able to see this target adapted into one which could really drive change for the poorest.

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