By Marwaan Macan-Markar
BANGKOK, Sep 21 , 2010 (IPS) - Cambodia’s partial success in reducing child mortality rates has exposed a fault line of inequity, one that underscores the advantage that the country’s urban population has had over the rural poor.
Yet the South-east Asian kingdom, 35 percent of whose 14 million population live below the poverty line, is not alone in having this mixed record of reducing child mortality, say child rights experts.
Some of the other countries in the region reflect a similar trend 10 years after world leaders committed to meet a set of eight targets to help the world’s poor by 2015. The fourth of the eight U.N. Millennium Development Goals (MDGs) seeks to achieve a two-thirds reduction in child mortality rates by 2015.
"To be fair to governments in South-east Asia, child mortality rates are going down everywhere," said Ben Phillips, director of strategy at the Asia office of Save the Children, a British-based humanitarian organisation. "But the rate of decline is less than the rate they committed in 2000."
"In South-east Asia, child mortality rates have almost halved from 2000 levels," he told IPS. "But the region is substantially behind from meeting the two-thirds target, which is five years away."
A recent report by Save the Children, entitled ‘A Fair Chance At Life’, shows that Cambodia has seen a 32 percent drop in child mortality figures among the country’s "richest 20 percent", but only an 18 percent reduction in child mortality among the "poorest 20 percent".
Indonesia, the region’s giant where 16 percent of its 225 million people live below the poverty line, has recorded "equitable progress," noted the 37-page report. The poorest 20 percent has seen child mortality figures drop by 29 percent, while the richest 20 percent has witnessed a nine percent decline.
Military-ruled Burma, also known as Myanmar, lags behind all with the worst child mortality figures. It reportedly has 104 children under five years dying for every 1,000 live births. Cambodia, by contrast, has 82 deaths of children under five years of age per 1,000 live births. Laos, the third of this region’s poorest countries, has 75 deaths per 1,000 live births.
Child rights groups have hailed Thailand, Malaysia and Vietnam as being well on course to meeting the 2015 targets. The region’s richest country, the city-state of Singapore, has been singled out in a study by ‘The Lancet’, a British medical journal, as leading all countries in the world in child mortality rates, having reduced it by 75 percent since 1990.
The inequity in child mortality rates in countries like Cambodia and the Philippines, which has 32 deaths per 1,000 live births, is "partly an urban-rural divide," said Phillips. "There is no conscious discrimination, but a natural tendency for nurses and doctors to work in cities."
At times, the distance to a health care is a day away, making it costly and time consuming for a family to take a newborn to treat illnesses that lead to child deaths, such as pneumonia, diarrhoea and sepsis.
"If you live more distant from a health centre, you will be reached later unlike those who live closer to health care workers," said Basil Rodriques, regional adviser for your child survival and development at the Asia office of the United Nations Children’s Fund (UNICEF). "The MDGs saw the ‘low hanging fruits’ reached first."
To address this trend, countries in the region are being urged to strengthen community health initiatives in rural areas, including by tapping trained midwives who live in the villages they grew up in. "This is what is going to make the difference," Rodriques said in an interview. "Governments are looking at how to train workers who grow up and return to live in their communities."
Early diagnosis of diseases like pneumonia is key to saving a child’s life, adds Rodriques, pointing to achievements in Indonesia. "There is a growing recognition of a community-focused approach, since community health workers are trained to see the problem and offer prompt care."
Vietnam’s success with a similar community health care programme across its rural regions is also being held up as another model for the region. Its record of child mortality is 17 deaths for 1,000 live births.
"It is really hard to divorce equity from the development paradigm," said Rodriques. "The MDGs have, in a sense, acted as accelerator for governments in South-east Asia to invest more."
Save the Children’s Phillips estimates that the entire Asian region needs two million health workers, ranging from midwives, nurses and obstetricians, to meet the 2015 targets on child mortality. "India will need one million of them and South-east Asia will need a third," he said.
"This requires a dramatic shift in policy and resources made available to strengthen rural health care systems," he explained. "If you are not focused on equity, the outcome will be inequitable."
"Health workers don’t just cure; they also prevent," he said. "Governments need to be putting more people through nursing schools."