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Child Mortality Subject of Subcommittee Hearing

On March 13, the House Foreign Affairs Subcommittee on Africa and Global Health held a hearing, “Child Survival: The Unfinished Agenda to Reduce Global Child Mortality.” The hearing focused on the reauthorization of H.R. 2266, the Global Child Survival Act of 2007, sponsored by Reps. Betty McCollum (D-MN) and Chris Shays (R-CT).

Chair Donald Payne (D-NJ) said, “In May of 2007, [Reps. McCollum and Shays] introduced H.R. 2266, the United States Commitment to Global Child Survival Act of 2007…which directs the president to develop a comprehensive strategy to reduce child mortality and establishes the Interagency Task Force on Child Survival and Maternal Health in Developing Countries. The bill also authorizes ramped up annual funding starting at $600 million and ending at $1.6 billion in 2012, to save the lives of children around the world. The significant commitment of the United States to reducing child mortality in the developing world contributed to a 50 percent reduction in the mortality of children under the age of five between 1960 and 1990. However, over the past several years funding for child survival and maternal health programs have fluctuated, but have remained between $350 million and $450 million. In the FY2009 budget, the Administration has requested $369.5 million for child survival and maternal health programs, some $77 million less than FY2008 levels. Two weeks ago, this committee voted for a bill which will provide $50 billion in the reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) and this, once passed in both chambers, will be a great victory for the president and for the Congress…At the same time, we must take into account that, according to the US Coalition for Child Survival, more than 90 percent of child deaths are caused by preventable, treatable diseases and conditions other than HIV/AIDS and malaria. So as we ramp up PEPFAR, we must also increase funding for programs to address the basic health needs of children and pregnant mothers such as immunizations, nutrition assistance, and treatments for diarrhea and other infections.”

Ranking Member Chris Smith (R-NJ) said, “Four million infants die each year in the first month of life and two million die within 24 hours of birth. A baby is about 500 times more likely to die in the first day after birth than during [its] first month. A common factor in these newborn deaths is the health of the mother. The lack of prenatal care, lack of adequate nutrition during pregnancy, unassisted childbirth, lack of a sterile birthing environment, no access to clean blood, and lack of access to emergency obstetrical services all contribute to the deaths of women and their children. We must do more to save the lives of both. If we are to address newborn and maternal deaths, and go even further to ensure the healthy development of the baby through adolescence and the long-term health of the mother, the baby and the mother must be provided adequate nutrition and health care from the earliest stages of life, prior to birth. Birth is not the start of life it is a life event in the baby’s existence that began from the moment of conception. We need to recognize this biological fact in terms of policy, funding, and programming, and treat both mother and the unborn baby as two patients whose survival and well-being are mutually interdependent. This would significantly increase the baby’s chances of survival following birth, and also reduce the risk of maternal mortality and morbidity. The child survival revolution must recognize, embrace, protect, and tangibly assist unborn children from all threats including disease, trauma, and abortion.”

Dr. Kent Hill, assistant administrator for global health at the U.S. Agency for International Development (USAID), said, “When the U.S. Child Survival program began in the early 1980s, almost 15 million children died each year in the developing world. If the global community had done nothing, with the increasing number of children born each year, that number now would have reached 17 million. USAID and UNICEF [United Nation’s Children Fund], however, chose to launch the ‘Child Survival Revolution’ that has become a global collaboration with other donors, multilateral organizations, U.S. private voluntary organizations and NGOs [non-governmental organizations], researchers, the private sector, and, especially, country governments. As a result of all these efforts, UNICEF announced in 2007 that the estimated number of child deaths in the world had fallen below 10 million annually. That number is still far too high, but the drop does mean that our efforts have made a real difference. USAID works to address the ‘unmet need’ in child survival and maternal health through discovery, diffusion, and scale-up, and long-term sustainability of effective health interventions.” Dr. Hill cited several USAID efforts: “We support research to develop high impact, low cost interventions, for example, ways to treat low birth weight babies, prevent and treat life-threatening infections of newborns, and save mothers from bleeding to death after giving birth. We support countries to expand their use of new and existing high impact, cost-effective interventions, for example, vaccines, vitamin A treatments for sick children and mothers in pregnancy and childbirth, newborn care, breastfeeding and improved nutrition for children and pregnant women, and improved household water quality. We help countries build the essential elements of health systems and human capacity they will need to sustain progress in maternal and child health.”

Dr. Hill continued, “By 2013, we aim to achieve an average 25 percent reduction of maternal and under-five mortality in these 30 priority countries as well as an average 15 percent reduction of child malnutrition in at least ten of these countries. At the same time, we recognize the critical human resource constraints on progress in many countries. Therefore, as part of our plan, we are making a commitment to increase by at least 100,000 the number of trained, equipped, and supervised community health workers and volunteers serving at the primary care and community levels in these priority countries. This measurable health system change will provide and extend critical health services in the countries and communities, which need them most. The success of these community health workers and volunteers will depend upon a health system that can deliver the necessary interventions and commodities and also ensure quality of care and retention of these workers. In this work, we will continue the successful collaborations we have with other U.S. government agencies. This includes our work with CDC [Center for Disease Control] on family planning, water and sanitation, immunizations, and polio eradication, and our work with NIH [National Institutes of Health] and others on new vaccine development as well as our collaboration with PEPFAR and the President’s Malaria Initiative.”

Former U.S. Senate Majority Leader Bill Frist (R-TN), said, “For more than a decade I have participated in medical mission trips to Africa, and my firsthand experiences have led me to believe in the power of using medicine as a currency for peace. I have seen war-torn villages calmed and reunited through the establishment of health clinics. I have seen medicine dissolve hatred as hope filled voids long occupied by despair. And I have seen leery citizens in distant lands develop trust in America as our nation’s compassion and generosity provide a helping hand to those in need. This last point has convinced me that increased support for global child and newborn health is more than a compelling moral or humanitarian issue. It is a national security issue. Health diplomacy undermines the ideological support of terror by shining through hate-filled propaganda to show America’s true face. Medicine is truly a force that overpowers division and hatred because people do not go to war with those who have just saved their child. We should harness those truths to strengthen our image abroad and bolster our security for generations to come. It is important that we take a few moments to examine what is taking these young lives. The largest portion of preventable deaths is due to pneumonia, diarrhea, and a variety of newborn complications related to suboptimal pregnancy and delivery care. Malnutrition is an underlying condition contributing to more than one-third of these deaths. And defying common misperceptions, HIV/AIDS is associated with only three percent of under-five deaths globally while malaria accounts for only another eight percent. The health interventions to save these children are simple, inexpensive, wellknown, and readily available. Supplements such as vitamin A can for mere pennies reduce micronutrient deficiency. A basic antibiotic that costs only 30 cents can treat pneumonia. Oral rehydration therapy can help save the two million children who otherwise perish from dehydrating diarrhea each year. And together with other interventions, like immunizations, skilled care at delivery, and simple knit caps, we could save most newborn lives. These life-saving solutions do not require expensive investments in state of the art hospital facilities. They rely instead upon a network of community-level health services, an area in which U.S. government-supported programs can play a critical role in training and supporting community health workers to treat sick children and in teaching parents how to protect the health of their babies. In short, we know how to deliver these life-saving solutions. The challenge is to scale up our efforts in coordination with other donor nations and enlist the commitment of developing countries to ensure these proven, low-cost health interventions reach every village and each child in need.”

Dr. Pierre-Marie Metango, dean of Future Generations Graduate School of Community Change and Conservation (WV), said, “When I was a child growing up in the village of Bafou, Cameroon, as the first-born I had to accompany my mother twice a day to fetch water at the river half a mile away. The question I had then was, ‘Why didn’t the leaders build the village along the river side?’ And, after I graduated from medical school in France and went back home to work…I kept wondering why people couldn’t simply move to live closer to a hospital or health center for easy access to quality health services. It was not until much later that I had to switch my focus to the essential services moving to the people rather than the people moving to the services…Through the grassroots work of non-governmental organizations…working with governments and international donors, community-based primary health care programs are saving the lives of millions of children who otherwise would have died from pneumonia, diarrhea, measles, neonatal tetanus, and malnutrition…In my village in Cameroon, the number of child deaths has drastically decreased as a result of community-based health activities. Safe water is now provided by hand pumps from wells. Through the efforts of the local health center, children are regularly immunized, and diseases such as malaria and pneumonia are detected and treated earlier. Community health education has resulted in better sanitation and hygiene as well as more informed breastfeeding practices among women. For these village improvements impacting child health to occur, a three-way partnership has been essential involving the community, the local government administration, and external funding support. Another important element has been the training and support of local health workers…In order to reach the global goal of reducing under-five mortality by two-thirds by the year 2015, we will need to achieve the following: reach the hard-to-reach and the poorest-of-the-poor through programs that ensure equity; expand coverage of simple and effective child survival interventions on a much larger scale than is currently possible; and ensure that funding is available to make these programs sustainable in the long-term as poor countries and poor communities gradually absorb the cost of these programs.

Dr. Metango continued, “Achieving this will require a sustained and higher level of funding from the U.S. government and from other donor countries around the world than has been available to date. Achieving this will also require a stronger engagement of communities and their creativity and resources. It will require new partnerships and alliances. And it will require a higher level of commitment to first-class operations research to ensure the effectiveness of large-scale programs. Only these partnerships will ensure that more children in Africa, Asia, and Latin America live to their fifth birthdays and beyond. The world has the resources and the technical ‘know how’ to ensure that fewer and fewer children in the poorest countries of the world die from readily preventable or treatable conditions.”

Mr. David Oot, chair of the U.S. Coalition for Child Survival, and vice president for the Office of Health and Save the Children; Anne Peterson, director of the Global Health Centre at World Vision; and Dr. Robert Walley, board member of Matercare International, also testified.

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