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Child mortality: aid works

Click to download the Unicef report on child mortality

The number of children dying before age 5 dropped from nearly 12 million in 1990 to around 6.9 million in 2011, according to new figures from UNICEF and the United Nations Inter-agency Group for Child Mortality Estimation. To put it another way, 14,000 fewer children under 5 die each day than was the case 21 years ago, chiefly because of progress in tackling polio, measles and malaria. The decline in under-five mortality has accelerated in the last decade — from 1.8% a year during the 1990s to 3.2% a year between 2000 and 2011. But 19,000 children under 5 still die every day from preventable diseases, notably pneumonia (18% of the deaths) and diarrhoea (11%).

We asked aid specialist Brenda Killen from the OECD Development Co-operation Directorate for her thoughts on what the UN report reveals.

Brenda Killen: It’s great news that child mortality has fallen, but every baby’s death is a tragedy and we have to reduce mortality even more by learning the lessons from this success, identifying the key success factors, then replicating them elsewhere – on a larger scale if possible. One lesson for me is that your chances of success are greatest when the goal is simple, clear, and widely shared.  Everyone wants to reduce child mortality – from global leaders to the poorest people in the least developed parts of the world.  So we can mobilize our efforts around it in a true partnership of governments, donors, NGOs, people. And we can raise funds around it so it has sustained and secure finance. Being able to plan your budget is important, especially for long-term efforts such as those targeting child mortality. Our research shows that the value of aid is reduced by 15% to 20% when it’s unpredictable and volatile.

We hear a lot of criticism about aid being a waste of money. How important was aid in reducing child mortality?

BK: Aid didn’t achieve the result on its own, but it was a vital factor. Experience from the field shows again and again that aid programmes work. For example, aid saves over 1 million children from death each year in six Commonwealth countries according to Oxfam Campaigns Director Ben Phillips. At the OECD, we’ve been studying what makes aid effective. Last year in Busan, Korea, donors from OECD and non-OECD countries, along with civil society, set out a number of principles to guide all development actors in making their cooperation work better. I mentioned the fact that the mortality goal was widely shared. In the Busan Partnership, this is described as “ownership”: countries receiving finance take charge of the process and so too do the various people and organisations involved at every level.

But what if the country can’t cope?

BK: Ownership doesn’t mean the country has to achieve everything on its own. The Busan principles emphasize that partnerships are important too, and we’re starting to see results from a number of innovative initiatives where we’ve used aid well. Aid can do things that other types of assistance can’t. A good example is the GAVI Alliance, the organisation that used to be called the “Global Alliance for Vaccines and Immunisation”. Aid was used to guarantee markets for life-saving vaccines so that the pharmaceutical companies would provide the products needed to tackle the leading killers of infants at an affordable price.  This would not have happened without aid.  The development of new partnerships such as the Global Fund to Fight Aids, TB and Malaria or the Partnership for Maternal, Newborn and Child Health are other examples.  They show that innovative thinking backed by aid can be a game-changer.  And that is the Busan principle on results.

Why do you need a “principle on results”? Shouldn’t it be obvious that policy makers need to produce evidence of results?

BK: Yes, but actually collecting reliable data, analysing it and drawing conclusions as to what works and doesn’t isn’t simple. Child mortality has always has been relatively well-reported when compared with other issues and efforts to tackle child mortality have gone hand-in-hand with improvements in data and knowledge.  Even so,  in 2009 the births of 50 million children went unrecorded and the deaths of 40 million people went un-noted except by family or friends, according to the World Bank. And there’s a long list of other areas where better information is needed, both to support the design of policies and programmes and to improve accountability. For instance, only 17 sub-Saharan African countries have collected data to measure changes in poverty over the past decade and 47% have not carried out household income or expenditure surveys in more than five years. Only one in four African countries report basic crop production data. Without reliable data, you can’t target your efforts, or demonstrate impact, or learn lessons as quickly and accurately as you should.  The Busan Action Plan for Statistics supports three principal objectives: fully integrating statistics in decision making; promoting open access to statistics; and increasing resources for statistical systems.

Finally, what would you say to people who argue that the government shouldn’t be giving taxpayers’ money to foreigners when times are tough at home?

BK: We’ve just been talking about statistics, so it’s worth recalling the actual data. In 2011, countries that are members of the Development Assistance Committee (DAC) of the OECD provided $133.5 billion of net official development assistance (ODA), representing 0.31% of their combined gross national income (GNI).  This was a 2.7 % drop in real terms compared to 2010, the first drop in 15 years. There are a number of reasons OECD countries should help others. Apart from the moral aspect, it’s in their own interest, for both positive and negative reasons. The big problems affecting the world with regard to the economy, security and conflict, the environment, or health don’t respect national boundaries. It’s cheaper to help a poor country tackle problems while they’re still local before they spill over to affect the wider global community. Let’s not forget that the public is fully committed to helping the less fortunate. A recent survey in crisis-hit Ireland found that 80% of those interviewed support the 0.7% target for aid. The public is also supporting important private giving. For example, Save the Children has over two million supporters worldwide and raised 1.6 billion dollars last year. What is often questioned is how aid money is spent – and that’s what the Busan commitments are all about. And as Korea and others have shown, aid plays a part in helping countries develop to become valuable partners in a number of different fields.

Useful links

OECD work on aid effectiveness

Who needs to know? Balancing quality and privacy in health care

Today’s post comes to us from Professor Niek Klazinga, Professor of Social Medicine  at the Academic Medical Center of the University of Amsterdam and contributor to the Health Care Quality Indicator Project, OECD Health Division

... but sharing data can save them

Quality has become a buzzword in health care, as in so many other sectors. Industrialized countries are shifting gradually from governance based on cost-control towards models that also take the quality of the health outcome and process into account.  

This makes sense for many reasons. Judging the “success” of health interventions – whether or not they meet certain quality objectives – is important to any decision on how health care dollars should be spent.  A whole new information industry has sprung up  to produce performance information for governments, patients, health care financers, managers and professionals alike, by measuring different aspects of quality.

Data about quality is needed if we are to improve systems, but collecting it can be controversial since it means keeping track of some aspects of health delivery that we used to consider “private”. The debate around the need to collect data versus the need to protect privacy is only starting.

For good comparisons on surgical complications, for example, we need to know whether the complaint existed at admission  (admission codes indicate this), whether the patient had diabetes or asthma (secondary diagnoses) or whether the patient has also been to another hospital or primary care physician with the same complaint (data linkage via unique patient identifiers).

Gathering this kind of information to improve quality in health care seems justifiable and not  the type of privacy invasion that data protection rules were originally designed for.  Yet the critical attitude towards government and overall concern about privacy currently limit the production of reliable and comparable information on quality and safety.

It is hoped that during the upcoming OECD ministerial conference, countries where these debates are farther along can be inspire those still in the middle of it seeking a balance between the quest for better comparative information and privacy concerns.

Useful links

The OECD Health Care Quality Indicator Project was launched in 2002 to produce reliable, valid and comparable information on the quality of health care in member states.

Results were published in Health at a Glance in 2007 and 2009, covering cancer care, care delivered for cardiovascular diseases, primary care, mental health care and care related to infectious diseases among others.

A working paper on patient safety indicators was published in November 2009.