Analysis: Saving children on a budget

WASHINGTON, March 28 (UPI) -- More should be invested in low-cost, low-tech interventions that save babies' lives, global health advocates said at a news conference Wednesday in Washington, D.C.

"Most of the 10 million children who die each year die from very common infectious diseases," said Peter Salama, chief of health at UNICEF.

"But most of that basket of diseases has no dedicated global fund," he told United Press International.

Of those 10 million children under age five who die, 4 million die in the first month of life, according to the World Health Organization. Many of those deaths are from preventable causes like malnutrition, malaria and diarrhea.

By allocating funding to interventions that give the most bang for the buck, two-thirds of all child deaths could be prevented, Salama said.

Funding for basic interventions -- with the exception of malaria -- lags behind resources devoted to higher-profile diseases like AIDS, Salama said. "Don't rob Peter to pay Paul, but give these interventions the attention they deserve."

"There is a need for a very massive global push on the agenda of reducing child deaths because it's an area where we could easily make a lot of progress."

Researchers at the World Health Organization have identified a package of interventions called Best Buys that phases in low-cost, easy-to-implement prevention of common causes of child death.

Many of the interventions are straightforward and simple like breastfeeding, vaccines and vitamin A supplements. Others include basic pre-natal care for the more than 50 million women each year who give birth at home without the help of a skilled attendant.

Currently, spending on Best Buys is $4.2 billion in the 42 countries that accounted for 90 percent of child deaths in 2000.

Increasing that funding by $5.1 billion annually would allow those countries to fully implement the Best Buys interventions, saving 6 million children, said Gary Darmstadt, an associate professor of international health at Johns Hopkins University.

"What we need is a concerted effort, backed by sufficient funding, to put into place what we know can work," Darmstadt told congressional staffers at a briefing on child health Wednesday, sponsored by the Global Health Council and the U.S. Coalition for Child Survival.

Instead of implementing public health interventions one at a time, it is more cost-effective to deliver them in a package during a specific time period, he said. A good example is having a day for checkups and vaccinations at a community-based clinic.

But that does not mean that all interventions must be implemented at once, Darmstadt added. A phased-in approach can start with the simplest and easiest changes, adding more difficult and costly interventions as delivery systems improve.

"Programs can provide increasing benefits ... and mature as time goes on."

Part of any rethinking of where funding goes must also look at where investments go within countries, said Zulfiqar Ahmed Bhutta, chairman of the child health department at the Aga Khan University in Karachi, Pakistan.

In Pakistan, only 15 percent of public health expenditures go to the local clinics where 90 percent of Pakistanis receive care, he said, while about 40 percent of spending goes to advanced care services at university hospitals.

As a result, the clinics are cash-strapped and many mothers "vote with their feet" by staying at home and foregoing care altogether, Bhutta said.

Politics can also get in the way of better funding allocation, he added. When he shared the results of his research with Pakistani officials "the results were a bit mixed."

But countries like Ethiopia that have invested in cadres of low-skilled health workers have already seen positive results of programs like administering oral rehydration and antibiotics, Salama of UNICEF said.

"A large majority of these interventions can be delivered by minimally trained workers," he said. "They are not faced by the same delivery bottlenecks as AIDS and other diseases that require more advanced delivery systems."