DR. KENT HILL

ASSISTANT ADMINISTRATOR FOR GLOBAL HEALTH

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

BEFORE THE

SUBCOMMITTEE ON AFRICA AND GLOBAL HEALTH

COMMITTEE ON FOREIGN AFFAIRS

HOUSE OF REPRESENTATIVES

WASHINGTON, DC

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 Indonesia, USAID has a long history of supporting the Government of Indonesia’s maternal health program, focusing primarily on strengthening the capacity of skilled birth attendants to provide basic essential obstetric care, including prevention of bleeding immediately after birth, the leading cause of maternal mortality. According to a global survey, Indonesia had the highest use of active management of the third stage of labor to prevent bleeding.  From 1992 to 2000, maternal mortality dropped by 21 percent.

2. In Bolivia, as the government implemented a national health insurance system that covered maternity services, USAID trained health care providers in obstetric care and promoted culturally appropriate birth practices and 24-hour-a-day quality care of women. From 1990 to 2004, maternal mortality dropped by 44 percent.

3. In Bangladesh, home-based essential newborn care, coupled with successful identification and treatment or referral of newborn infections by trained community health workers, reduced newborn mortality by 33 percent in a pilot program supported by USAID. The Government of Bangladesh now has developed a newborn health strategy to scale up lessons learned from this pilot. USAID has replicated this low-cost, high impact approach of reducing newborn mortality in several other countries.

4. In Ethiopia, we are supporting the government in extending access to basic maternal and child health care through training and deployment of thousands of new community health workers. At the same time, we are helping to strengthen Ethiopia’s health system through a new national drug logistic system, an improved health information system, and a strengthened ability to estimate costs and budget for basic health services. Ethiopia has seen under-five deaths decline by almost 30 percent since 1998, supported by these changes.

5. In Nepal, we have been developing and scaling up a program that links female community health volunteers with the health system to bring vitamin A, immunization, and treatment of child illness to villages that in the past had no health care. This program now reaches more than half the population of Nepal. Nepal has recorded a decline in under-five child mortality of 41 percent since 1998.

6. After the fall of the Taliban in 2001, Afghanistan registered some of the worst health statistics in the world: 1 in 4 children died before his/her first birthday and 1 in 6 women died in childbirth in her lifetime. USAID and its partners started immediately with measles immunizations and then launched a program that provided a basic package of health services to mothers and children in rural Afghanistan.  The program also paid attention to rebuilding key elements of the health system, including management, drug supply, and training. Since then, under harsh and insecure conditions, skilled attendance at birth has tripled and under-five mortality has been reduced by 26 percent, saving the lives of 80,000 children per year. 

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
Bangladesh	106	1998	à	69	2006	35 %
Bolivia	85	1998	à	61	2006	28 %
Cambodia	163	1998	à	82	2006	50 %
Ethiopia	173	1998	à	123	2006	29 %
Guatemala	52	1998	à	41	2006	21 %
Haiti	130	1998	à	80	2006	39 %
India	105	1998	à	76	2006	28 %
Indonesia