DR. KENT HILL
ASSISTANT ADMINISTRATOR FOR GLOBAL
HEALTH
BEFORE THE
SUBCOMMITTEE ON
COMMITTEE ON FOREIGN AFFAIRS
HOUSE OF REPRESENTATIVES
MARCH 13, 2008
“Child Survival: The Unfinished Agenda to Reduce Global Child
Mortality”
Chairman Payne, Congressman
Smith, and other distinguished members of the Committee, I
would like to thank you for convening this important hearing. I especially thank you and the Congress for
the sustained support provided through the years for our Child Survival and
Maternal Health programs. That support
has enabled USAID to play a leadership role in an international effort that has
made significant improvements in maternal and child health. And, we greatly appreciate your recognition
of USAID’s contribution to this effort.
I first want to acknowledge
the importance of the theme that you have set for this hearing, the “unmet need”
for progress in child survival. I will
tell you about some of the important successes of USAID’s child survival and
maternal health programs because these successes are what give us confidence
that we can meet this “unmet need.” I then
will briefly discuss why this is a good time to hold this hearing and the special
opportunities that exist to accelerate progress in child survival. In closing, I will describe our strategic
approach to achieving the greatest impact on maternal and child mortality with
the resources we have. Our goal is for
our programs to build sustainability.
Despite significant progress
in reducing child deaths, almost 10 million pre-school children die each year,
almost all of them in poor countries.
What is particularly tragic is that most of these deaths are preventable. Almost four million deaths are newborn
infants who do not survive beyond the first week or month of life. By the time many children reach school age,
the effects of illness and malnutrition have reduced permanently their
potential to learn, grow, and be productive citizens of their countries.
We appreciate your
recognition of the urgent need to improve the survival and well-being of
mothers. USAID’s approach to child
survival and maternal health is integrated because we know that the survival
and health of young children, especially newborns, starts with the health of
their mothers and the care those mothers receive during pregnancy and
childbirth. Each year, half a million
mothers still make the ultimate sacrifice, losing their lives in the process of
giving birth. Millions more suffer
complications that produce lifelong disability.
For a quarter of a decade, with
the support of Congress, USAID has been working to improve the survival of
mothers and children. When the U.S.
Child Survival program began in the early 1980s, almost 15 million children
died each year in the developing world.
If the global community had done nothing, with the increasing number of
children born each year, that number now would have reached 17 million. USAID and UNICEF, however, chose to launch
the “Child Survival Revolution” that has
become a global collaboration with other donors, multilateral organizations,
U.S. private voluntary organizations and NGOs, researchers, the private sector,
and, especially, country governments. As
a result of all these efforts UNICEF announced in 2007 that the estimated
number of child deaths in the world had fallen below 10 million annually. That number is still far too high, but the
drop does mean that our efforts have made a real difference.
USAID works to address the “unmet
need” in child survival and maternal health through discovery, diffusion and scale-up,
and long term sustainability of effective health interventions.
·
We support
research to develop high impact, low cost interventions, for example, ways to
treat low birth weight babies, prevent and treat life-threatening infections of
newborns, and save mothers from bleeding to death after giving birth.
·
We support
countries to expand their use of new and existing high impact, cost-effective
interventions, for example, vaccines, vitamin A, treatments for sick children
and mothers in pregnancy and childbirth, newborn care, breastfeeding and
improved nutrition for children and pregnant women, and improved household
water quality.
·
We help countries
build the essential elements of health systems and human capacity they will need
to sustain progress in maternal and child health.
I would like to provide some successful
examples of USAID’s programs.
1.
In
2.
In
3.
In
4.
In
5.
In
6.
After
the fall of the Taliban in 2001,
These countries demonstrate that
it is possible to make real progress despite continuing poverty, instability,
and sometimes conflict. As shown in the
displayed chart, this progress also is occurring more broadly in USAID-assisted
countries throughout the world. The 15 countries
show an average 33 percent reduction in under-five child deaths.
15 USAID- Assisted Countries Achieving 20-50% Reductions in U5 MR in the Last Ten Years:
Country |
Under-5
Mortality (deaths/1,000 births) |
Year |
To |
Under-5
Mortality (deaths/1,000 births) |
Year |
Percent
Reduction |
|
106 |
1998 |
à |
69 |
2006 |
35 % |
|
85 |
1998 |
à |
61 |
2006 |
28 % |
|
163 |
1998 |
à |
82 |
2006 |
50 % |
|
173 |
1998 |
à |
123 |
2006 |
29 % |
|
52 |
1998 |
à |
41 |
2006 |
21 % |
|
130 |
1998 |
à |
80 |
2006 |
39 % |
|
105 |
1998 |
à |
76 |
2006 |
28 % |
|
56 |
1998 |
à |
34 |
2006 |
39 % |
|
157 |
1998 |
à |
115 |
2006 |
27 % |
|
213 |
1998 |
à |
120 |
2006 |
44 % |
|
206 |
1998 |
à |
138 |
2006 |
33 % |
|
100 |
1998 |
à |
59 |
2006 |
41 % |
|
136 |
1998 |
à |
97 |
2006 |
29 % |
|
44 |
1998 |
à |
32 |
2006 |
27 % |
|
115 |
1998 |
à |
89 |
2006 |
23 % |
Source: State of the World’s Children reports, 2000 & 2008
Similarly, this graph shows
that within relatively short periods of time maternal mortality has declined on
average 32 percent in 10 USAID-assisted countries.
10 USAID- Assisted Countries Achieving 20-50% Reductions in Maternal Mortality
This progress is the result
of USAID working hand-in-hand with many partners, including the private sector
and civil society, other international bilateral partners, and the country
governments. Nevertheless, much remains to
be done. In countries where infant and child mortality
has declined, newborn mortality still remains high. Globally, newborn mortality now accounts for
almost 40 percent of under-five mortality.
Some countries, particularly
in
We at USAID believe it is
possible to reach more newborns, children, and mothers and accelerate progress
toward the respective MDGs. In the past
few years, new resources and commitments have appeared, which we believe can
lead to a “second wave” of global efforts to increase child survival:
·
New resources are
available from private sector partners like the Bill and Melinda Gates
Foundation, bilateral donors such as the
·
The MDGs are
stimulating increased international and country-level attention to the need for
accelerated progress to reach the child and maternal survival goals.
·
This attention is
producing new international cooperation such as the inter-agency “Countdown
2015,” which will monitor and report on progress toward these goals in 60
priority countries.
·
The African Union
recently approved a new “Framework for Accelerated Progress in Child Survival.”
Work on a similar regional collaboration
for maternal and child health is beginning in
·
In response to
these MDGs and countries’ commitment to accelerate social development, some
countries are substantially increasing their own investments in maternal and
child health.
These new developments and
resources provide an important opportunity for USAID to leverage non-USAID
resources to provide more assistance. We
have a recognized leadership role in the global child survival and maternal
health effort. USAID is unique among
international partners in child survival and maternal health:
·
We have the
technical expertise to support ground-breaking research and to guide
development of solid, evidence-based programming;
·
We have Missions
on the ground that can adapt this evidence to each country’s situation and
coordinate our support with other donors and with government strategies, and
·
We have the strong
partnerships with NGOs, faith-based and other civil society organizations, and
the private sector at both international and country levels.
We
see USAID’s approach as supportive of the recently endorsed Paris Declaration
principles that promote:
·
leadership in
development activities by countries themselves;
·
alignment of
foreign assistance with countries’ own priorities, systems, and approaches;
·
harmonization
among external partners to reduce the complex burden of assessments, plans,
monitoring approaches, and reporting; and
·
results-oriented
investments by both countries and their donor partners.
Now with the support of
Congress, we have additional resources to apply these strengths. USAID focuses its strategic approach in child
survival and maternal health to achieve the greatest possible health and
development impact with our maternal and child health resources.
We plan to use the major
share of those resources in approximately 30 USAID-assisted countries that
represent at least 50 percent of maternal and child deaths worldwide. These countries are characterized by:
·
the highest numbers
and rates of child deaths;
·
commitment of the
host country government to work with partners and civil society for accelerated
reduction of maternal and under-five mortality;
·
capacity of the
USAID mission and the country to manage and program increased resources, and
·
opportunities to
interact with other resources, including other USG investments such as PL 480 Title
II, the President’s Malaria Initiative, the President’s Emergency Plan for AIDS
Relief (PEPFAR), and our own emergency programs as well as the investments of
other donors, multilateral agencies, the Global Fund, and others.
Given the political,
cultural, and epidemiological context as well as the available resources and
infrastructure, a deliberate process to determine the best mix of key
interventions must occur for each priority country. Through our Missions and Regional Bureaus, we
will work with these priority countries to achieve and sustain the greatest
possible reduction of maternal and child mortality and malnutrition with programs
that:
·
identify and
scale up the high impact interventions most relevant to the country;
·
strengthen health
systems and the human capacity to support and sustain improved child and maternal
health outcomes;
·
link water and
sanitation investments to improved children’s health;
·
complement other
USG, donor, and host country resources, and
·
in post-conflict
settings such as
By 2013, we aim to achieve an
average 25 percent reduction of maternal and under-five mortality in these 30
priority countries as well as an average 15 percent reduction of child
malnutrition in at least ten of these countries.
At the same time, we
recognize the critical human resource constraints on progress in many
countries. Therefore, as part of our
plan, we are making a commitment to increase by at least 100,000 the number of
trained, equipped, and supervised community health workers and volunteers
serving at the primary care and community levels in these priority
countries. This measurable health system
change will provide and extend critical health services in the countries and
communities which need them most. The
success of these community health workers and volunteers will depend upon a
health system that can deliver the necessary interventions and commodities and also
ensure quality of care and retention of these workers.
In this work we will continue
the successful collaborations we have with other USG agencies. This includes our work with CDC on family
planning, water and sanitation, immunizations, and polio eradication, and our
work with NIH and others on new vaccine development as well as our
collaboration with PEPFAR and the President’s Malaria Initiative.
Thank you again for this opportunity. We at USAID share the commitment you have demonstrated to the continuing needs of children and families in poor countries.