NGO "ANOTHER WAY" (STICHTING BAKENS VERZET), NETHERLANDS, SUSTAINABLE INTEGRATED SELF-FINANCING DEVELOPMENT PROJECTS AND ADVANCED DEVELOPMENT TECHNOLOGIES

The Millennium Project, commissioned by the Secretary-General of the United Nations, has produced a report called A practical plan to achieve the Millennium Development Goals – 2002-2006. With effect from 1 January 2007 reporting on the Millennium Development Goals was taken over by the United Nations Development Programme (UNDP) which brings out annual reports on progress made in achieving the Development Goals. The report referred to here is the Millennium Development Goals Report 2008. The most recent report published is The Millennium Development Goals Report 2010. Analysis of these documents is included in parts Goals 1-4 and Goals 5-8 in Section 8 of Block 5.

Millennium Goal 4 is about the reduction of child mortality and the percentage of children aged 1 vaccinated against measles.

It refers to child health.

On the issue of health, refer to section 1 of block 1 analysis : health and sanitation and in-depth review of health and sanitation of the course..

The UNDP Report on Human Development for 2007/2008 provides the following tables :

06 One year olds fully immunized against measles.

08 Infant mortality rate, and under-five mortality rate.

1. Opinion.

On one page explain on which information you think the UNDP statistics are based. Do you think they accurately represent the reality ? Why ?

The Millennium health goals are covered in articles 53-57 of Section VI : « Health and sustainable development », of the Plan of Implementation of the Millennium Goals.

Article 53 reads:

“ 53. …..The goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating diseases, while obtaining health gains for the whole population requires poverty eradication. There is an urgent need to address the causes of ill health, including environmental causes, and their impact on development, with particular emphasis on women and children, as well as vulnerable groups of society, such as people with disabilities, elderly persons and indigenous people.”

Paragraphs b) and g) of article 54 state:

“(b) Promote equitable and improved access to affordable and efficient health-care services, including prevention, at all levels of the health system, essential and safe drugs at affordable prices, immunization services and safe vaccines and medical technology;

…

(g) Target research efforts and apply research results to priority public health issues, in particular those affecting susceptible and vulnerable populations, through the development of new vaccines, reducing exposures to health risks, building on equal access to health-care services, education, training and medical treatment and technology and addressing the secondary effects of poor health; ”

According to article 53 sustainable development can be attained only in the absence of diseases. It is therefore necessary to “address the causes of ill health”.

To do this one has to promote the availability of “essential and safe [sic] drugs at affordable prices, immunization services and safe [sic] vaccines and medical technology.”

2. Opinion.

Write two pages. On the first page, you express your satisfaction with the articles as director of a pharmaceuticals multinational On the second page you are the representative of a developing country responsible for the negotiations for the Implementation Plan. Explain how and why articles 53 and 54 came to have the cited texts.

Millennium Goal 4 is reviewed in pages 87-97 of the UNIFEM report Making the MDGs Work for All .

Section A of the review is entitled : Issues for a gender-responsive rights-based analysis.

Point 5, on page 89, includes a reference to a study by Bryce et al (2003). It reads :

“5. Most children who do not survive to their fifth birthday die from preventable causes.

A 2005 study found that 73 percent of the 10.6 million child deaths worldwide each year are the result of six causes: pneumonia, diarrhoea, malaria, neonatal sepsis, preterm delivery and asphyxia at birth. The first four causes account for 54 percent of all child deaths globally. 94 percent of all child deaths due to malaria are in Africa.[121] While measles is not among the six leading causes of child deaths, it is responsible for almost half a million deaths of children each year and results in blindness or loss of hearing in many others. The proportion of one-year-old children immunised against measles—global indicator 4.3—may be regarded as an indicator of the effectiveness and efficiency of the preventive health system. However at country level, alternative indicators which reflect more directly the main causes of child mortality in that country may be more relevant.”

In their article (registration required to obtain free access) «Where and why are 10 million children dying every year » (The Lancet, Vol. 361, edition 9376, pp 2226-2234, June 2003) authors Black R.E., Morris S.S. and Bryce J. explain the consequences of inadequate nourishment, including lack of vitamin A and/or zinc, on child mortality :

“We used a prediction model to estimate the distribution of deaths in children younger than 5 years by cause for the 42 countries with 90% of all such deaths in 2000.[32 ] Estimates and uncertainty bounds were: 22% of deaths attributed to diarrhoea (14-30%), 21% to pneumonia (14-24%), 9% to malaria (6-13%), 1% to measles (1-9%), 3% to AIDS, 33% to neonatal causes (29-36%), 9% to other causes, and fewer than 1% to unknown causes (figure 3). ”

The percentage participation attributed to malnutrition is +/- 60%. In the case of malaria, +/- 50% of deaths are attributable to malnutrition. Much neonatal mortality is due to malnutrition, in particular to lack of breast-feeding.

Refer also to «Knowledge into action for child survival », The Bellagio Study Group on Child Survival, The Lancet, Vol. 363, edition 9380, pp. 323-327, July 2003.

According to the Lancet report, measles accounts for just 1% of the 10.000.000 (or 100.000) children who die. Of the 100.000 cases, at least 50% are caused by malnutrition. That gives a number of 50.000 deaths and not 500.000 deaths as cited above in the report Making the MDGs Work for All .

Point 7 on page 90 of the report Making the MDGs Work for All reads :

“The role of mothers is recognized as critical in improving child survival—it is mothers or grandmothers who are primarily responsible for the care of under-five children. However, they may lack the economic resources, time, and/or access to transport which is necessary to access health care for their children. They also often lack the power and authority to make critical decisions that may make the difference between a child living or dying.”

“Higher levels of mothers’ education result in a significant reduction in child mortality. Although mother’s education is not included as an indicator for Goal 4, the Millennium Development Goals Report 2006 notes that secondary or higher education for mothers doubles child survival.[122].”

And on page 92 :

“Eliminating extreme poverty, particularly its greater impact on women, and promoting women’s empowerment and gender equality are essential components of an integrated approach to Goal 4. ”

Updated and detailed information on the achievement of Millennium Goal 4 is available in the UNICEF report Committing to Child Survival : A Promise Renewed : Progress Report 2013, (UNICE New York, September 2013. ISBN 978-92-806-4706-8. The report tends to confirm the earlier analyses discussed above. “Globally nearly half of all deaths among children under 5 are attributable to under-nutrition.” (p. 19). Pneumonia and diarrhoea remaining leading causes with 5000 deaths per day, while 1200 deaths per day are attributable to malaria, AIDS 2% and measles just 1%. “Without faster progress reducing preventable diseases, the world will not meet its survival goal (MDG4) until 2028” (p. 3).

Figures 34 (highest malaria mortality) and 35 (children under 5 sleeping under insecticide-treated mosquito nets) of the report are not collated. Since some countries with high net use appear to be amongst the countries with the highest rates of mortality from malaria, the real benefits from the use of insecticide-treated nets should be subjected to further study.

3. Opinion.

Make a two-page analysis explaining on the first page the importance nutrition and the social conditions of women in the fight against child mortality. On the second page apply your observations and conclusions to your chosen area.

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◄ Second block : Problems to be solved.

◄ Index : Diploma in Integrated Development (Dip. Int. Dev)

◄ List of key words.

◄ List of references.

◄ Course chart.

◄ Technical aspects.

◄ Courses available.

◄ Homepage Bakens Verzet.

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