Will the Agenda for Child Survival Survive?

Saving kids: Who doesn’t want to do that? Though relatively uncontroversial (say, compared to saving drug addicts and sex workers), the agenda for child survival is not new. In fact, it’s a (relatively) old agenda in global health, arguably dating back to the time of UNICEF's third Executive Director James Grant (1980-1995) who pushed to recognize the “global silent emergency” and to reduce preventable child deaths. But by the 1990s, the then-unfinished agenda in child survival took back stage to HIV/AIDS, a new and devastating disease. While priority to AIDS and later the so-called “big three” gained steam, particularly with the establishment of The Global Fund to Fight AIDS, Tuberculosis, and Malaria and PEPFAR, attention on child survival stagnated, if not waned…And thus history leads us to today. Donors of countries facing economic crisis have suddenly remembered that paying for treatment for people living with AIDS is a decades-long entitlement (on the order of $300 per person per year). Thus, in our faddish world, with ever-shortening attention spans, donors are taking interest in new and especially cheap things, including a “new” agenda for global health in child survival.  After all, saving the life of a child is remarkably cheap! Back in 1985, James Grant wrote that the four lifesaving interventions (growth monitoring; oral rehydration therapy; breastfeeding; vaccination) could be purchased at the affordable price of $10 per child. Today in our even richer world: Are there any excuses left to ignore the agenda on child survival?Last week in Washington, D.C., a coalition of global leaders and international organizations launched the Child Survival Call to Action in an effort to drive down the risk of preventable child deaths to roughly equivalent levels in all countries by 2035. Ministers of health and others made pledges to reduce child mortality (not “child morality”, as their Global Road Map says—3 times!) to 20 per 1000 live births by 2035, and there were 8 new partnerships announced. These pledges to meet a deadline plus new partnerships are supposed to mark the beginning of a veer from “business as usual” mode, and to paraphrase Raj Shah and others, to further “accelerate the progress” in reducing child mortality seen globally.But will the still-unfinished agenda of child survival survive beyond this year, or even to 2015, or (gasp) 2035? One wonders—if even the MDGs are not met, will this more ambitious (and laudable) goal be reached without addressing the causes of failing to reach the MDGs? And are new pledges and a new platter of partnerships enough? Is the agenda for child survival an indication of a deliberate shift of USAID’s global health policy, and if so do we need a comprehensive plan or initiative for child survival, not unlike PEPFAR or PMI to address it? Or will this be yet another global health fad which happens annually and is soon forgotten?Fast forward another quarter century: By 2035, we hope the world will be inhabited by those newly born people saved today, who will have entirely forgotten about this old agenda for child survival. Until then though, this “global silent emergency” has become a lot less silent, thanks to last week’s event and the smart leadership behind it. For this agenda to survive, the world will need not only renewed commitment on old things (to save new people, no less!), we’ll need unified strategies buttressed by new financial resources, not unlike on the response previously driven in fighting AIDS. We shall see.The author thanks Amanda Glassman and Orin Levine for helpful comments.