Two studies from UNICEF, forming The Lancet Series on equity in child survival, health, and nutrition, provide compelling evidence for the strategic importance of focusing global health improvement efforts on the poorest and hardest to reach children.
The first study, led by Dr Mickey Chopra, UNICEF Chief of Health, outlines the most effective strategies which should be used to overcome the supply and demand bottlenecks which prevent deprived populations from receiving effective health care, such as lack of healthcare workers and medicines. The authors review existing evidence to provide a practical set of recommendations for improving the coverage of health strategies, identifying several key factors which lead to improved health coverage, including expanding roles for lay health workers, increasing geographical access to services, and making effective use of the private sector.
In the second Series paper, Carlos Carrera, UNICEF Health Specialist, and colleagues show that, contrary to widely-held opinion, there no longer has to be a trade-off between equity and efficiency in child health. In fact, the researchers find that prioritising services for the poorest and most marginalised is now more effective and more cost-efficient than more mainstream approaches.
In a Comment published alongside the papers, UNICEF's Executive Director, Anthony Lake refers to a new child mortality movement Committing to Child Survival: A Promise Renewed and remarks: "The analysis presented in these articles provides a strong case for proceeding with optimism. Great things can be achieved when the best possible science, sound strategies, adequate investment, and political will combine. A Promise Renewed provides the framework for such an integrated push on child survival. It is time to translate talk, data, and science related to equity in child survival, health, and nutrition into action to give the world's most vulnerable children a fair chance to survive and develop."
Last week, UNICEF and partners published new child mortality estimates showing that the global number of under-five deaths has fallen from around 12 million in 1990 to an estimated 6.9 million in 2011. All regions have experienced marked declines in their under-five mortality rate since 1990. However, while significant progress has been seen, there is still unfinished business. On average, around 19 000 children still die every day from largely preventable causes, and the economically poorest regions, least developed countries, most fragile nations, and most disadvantaged and marginalised populations continue to bear the heaviest burden of child deaths.