TESTIMONY ON CHILD SURVIVAL BEFORE THE HOUSE COMMITTEE ON FOREIGN AFFAIRS, SUBCOMMITTEE ON AFRICA AND GLOBAL HEALTH

March 13, 2008

David Oot, Chair of the US Coalition for Child Survival, and Associate Vice President, Office of Health, Save the Children/US

On behalf of the US Coalition for Child Survival, as well as Save the Children, let me also begin by thanking Chairman Payne and Ranking Member Smith for holding this important hearing. First, let me say a word about the Coalition. Our Coalition believes it is simply unacceptable that nearly 10 million children die each year of highly preventable causes – largely unnoticed both here and abroad. Our Coalition is committed to educating and advocating for increased attention to this issue, and specifically dedicated to mobilizing U.S. and global leadership and resources to save these lives.

Our Coalition membership of 40 organizations is diverse - and includes representatives of academic and other technical institutions, student groups, faith-based and other non-governmental organizations. Collectively, our Coalition members represent literally hundreds of years of experience working in developing countries delivering life-saving maternal, newborn, and child health services.

Many of our members represent grassroots American constituents who care deeply about this issue. And, how do we know they care? When told by Save the Children that a simple knitted cap could help prevent hypothermia in a newborn (an often fatal condition due to loss of body heat), over 20,000 knitters from every State in the Union got out their knitting needles and produced nearly 300,000 caps. In New Jersey, for example, nearly a thousand people knitted over 13,000 caps. We literally had to vacate an entire floor in our Save the Children headquarters to receive these hats – and the heartfelt notes that were attached asking the President and our policymakers to do more to save newborn lives.

So, what have we learned?

First, these programs work. When we hear about the suffering and death of children in developing countries, many assume that is the way it has always been, that little can really be done about it. That perspective is just wrong. Something can be done. Thanks to the efforts of host governments, non-governmental organizations, donors, and the private sector, progress in reducing these needless deaths has been made. The truth is that if there had been no change in under-five mortality rates since 1985, nearly 17 million children would still be dying each year. Instead, that number is now less than 10 million.

Based on four decades of personal experience – and nearly 20 years living and working in Asia and Africa – I have had a chance to see firsthand the difference that these life-saving programs make. During the early 1990s, I lived and worked in Nepal. At that time, no one could have imagined that a country as poor as Nepal – mired in a widespread internal conflict – could find itself on track to meet the Millennium Development Goal 4 of a two-thirds reduction in under-five mortality by 2015. But it is. As noted by Senator First, since 1990, under-five mortality has declined by nearly 50 percent. By focusing on a package of proven, low-cost interventions – delivered through local health facilities and community health workers – and especially through a national cadre of Female Community Health Volunteers (FCHVs), immunization coverage has increased from 43 to 83 percent since 1996, more than 90 percent of children under-five receive vitamin A supplements, and children who previously had little or no access to treatment for pneumonia are seen and treated in or near their homes. Indeed, semi-literate FCHVs currently deliver more than half of all pneumonia treatments in 42 districts.

Second, proven, low-cost solutions won’t save lives if they don’t reach those most in need. The basics must be in place – trained and skilled staff, equipment, supplies, and critical operating budgets – to support the delivery of services. In many countries – especially in South Asia and sub-Saharan Africa – millions, and especially the poor, have yet to benefit from these life-saving solutions. We must close that gap.

Third, we need to deliver a package of critical services for mothers, newborns, and children – and extend these services beyond health centers to households and communities. We cannot succeed if we do not reach those households and communities where most of these deaths occur – in villages and homes that are often far from any health facility.

Lastly, we need to focus more attention on newborns since nearly 40 percent of deaths of children under five occur in that first month of life. In India, (where I began my career as a Peace Corps volunteer in the 1960’s) nearly one million deaths to children under-five occur in the first month of life. Most of these newborns are born and die at home. Until recently, it was thought there was little that could be done to prevent these deaths. Working with local non-governmental organizations, Save the Children and our partners have learned that a basic package of home-based newborn care delivered by community health workers can prevent as many as half of these deaths. A local non-governmental organization called SEARCH trained community health workers to promote basic preventive health practices, including warming and drying the newborn, assisting a newborn that was not breathing at the time of delivery, using a clean blade to cut the umbilical cord, promoting immediate breastfeeding, and recognizing and treating common neonatal infections. Collectively, these interventions reduced deaths in the first month of life by more than 60 percent, and the Government of India now plans to replicate home-based newborn care throughout India.

Clearly, these programs work – and more lives – 6 million more each year - can be saved. But, “business as usual” will not save these lives. We must do much more. Thanks to Chairman Payne, and other co-sponsors of the United States Commitment to Global Child Survival Act, we have an unprecedented opportunity to provide the leadership and resources needed to make this happen.

Together with other developed and developing countries partners, the US has a critical role to play. Our Coalition strongly believes that the proposed Child Survival legislation is a critical step in re-establishing our leadership and increased investments that are urgently needed to save the lives of babies and young children. We believe that the proposed creation of an inter-agency Task Force will help ensure that this effort gets the high-level policy attention that is needed, and that this initiative will focus on those countries where the need is great and on those proven interventions we know can save lives.

We also applaud the recognition that this is a partnership involving governments, civil society, and other donor countries. In part due to the USAID-funded Child Survival Grants Programs, there are now more than 45 US non-governmental organizations poised to deliver these life-saving programs to those most in need. Bilateral donors, such as Canada, Norway, and the United Kingdom, and multilateral donors, such as UNICEF, have recently made a major commitment to supporting the expansion of these programs. It will take all of us working together to get these services to those in need.

Finally, the Act authorizes increased funding needed to expand access to these life-saving programs, and the establishment of a system of accountability so that Congress and the American people will know the difference we are making. We want to commend USAID for the recent steps taken to focus on those countries where the need is great and on those interventions we know can save lives. We also want to acknowledge USAID’s commitment to building a transparent system to monitor and measure the results we know are possible.

What It Will Achieve

Using data from a recent expert analysis published in the Lancet medical journal, it is estimated that it would cost about $44 to deliver a package of life-saving interventions to one child each year. Therefore, if we doubled our assistance from $450 million in FY 08 to $900 million in FY 09, we could deliver these services to over 20 million children – and save more than one million young lives. With renewed, strong American leadership, our increased investment would help leverage greater efforts by other donor governments and host governments, thus saving a much larger number of young lives.

To quote Bill Foege, Senior Fellow at the Bill & Melinda Gates Foundation, and former Director of the U.S. Centers for Disease Control and Prevention (CDC), we need to “change the social norm so that we all recognize that it is simply wrong for only the few to have access to the tools for survival because of where they live.” When we have the tools and resources to prevent these needless deaths, and fail to act, we are not only failing those we know we can help, we are failing to live up to the values that we know we cherish as Americans. We know that these programs will be good for those children – and the parents of those children – who survive, but we firmly believe that it will also be good for America. In closing, I want to inform the Chair that 30 organizations committed to this cause have submitted written testimony to be included in the record. Again, thank you for the opportunity to speak to this committee.