Investing in the poorest children
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WILL little Penina survive to see her 5th birthday? Her parents are poor – so maybe she will survive, maybe not. The odds are not in her favour.

Data has shown that children growing up in poverty are nearly twice as likely to die before reaching their fifth birthday compared to children growing up in better circumstances.

This has to be among the most fundamental injustices in our world. The fate of children from poor families does not have to be this way. Most child deaths can be prevented with proven, high-impact, and, for the most part, low cost interventions.

When today a mother delivers a baby in Tanzania there is a 36% chance that she will not have a skilled attendant supporting and helping her during childbirth. The likelihood of not receiving skilled care increases to 58% if the mother happens to be from a poor family.

The absence of a skilled birth attendant during delivery putsa baby at risk and together with inadequate services such as ante-natal care and immunization it is one of the main factors associated with maternal and child mortality.

Despite major strides over the past 10 years, today,67 children out of every 1,000 live births in Tanzania die before their fifth birthday. Access to critical services remains particularly problematic for mothers and children from poor households.

Anew UNICEF report, Narrowing the Gaps: The power of investing in the poorest children, shows that an equity approach that deliberately invests in the poor not only provides greater results in terms of lives saved but is also cost-effective.

Data analysed from 51 countries, including Tanzania, show that while investments to improve key interventions for poor children are greater than those needed to reach the non-poor, the number of deaths averted per USD 1 million spent is 1.8 times higher among the poor than among the non-poor.

The study looked at access to six key health interventions:antenatal care, the presence of a skilled birth attendant during delivery, early initiation of breastfeeding, full vaccination, useof insecticide treated nets, and seeking care for children with diarrhoea, fever or pneumonia and linked the coverage of these to child mortality.

Specifically, the study found that: In the 51 countries studies access to high-impact health and nutrition interventions has improved most rapidly among poor groups in recent years Under-five mortality rates fell almost three times faster in poor communities than in non-poor communities between 2003 and 2016 as a result of increased coverage of high impact interventions Increasing coverage of high impact interventions for the poor is value for money.

These findings have important implications as governments work to achieve the Sustainable Development Goals (SDGs), which put strong emphasis on the reduction of inequalities.

The SDG child mortality target is ambitious. The aim is to end all preventable new-born and child deaths by 2030. This universal goal demands urgent action to reach the still unreached children, families and communities.

Tanzania has made significant progress in reducing child mortality. The Tanzania Demographic and Health Survey shows that the number of children under five who die fell from 147 per 1,000 live births in 1999 to 67 in 201516.

The survey also showed that the country has disparities. Rural areas fare worse (86 deaths per 1,000 live births) and the child mortality rate in the southwestern highlands is much higher at 95.

It is precisely in these areas where children and their families do not have the same access to quality services that we need to focus. Tanzania is on the verge of reaching middle-income status with a strong political will to achieve rapid industrialization.

A significant share of the future workforce that is required to achieve this vision – i.e. today’s children – continues to be affected by multiple deprivations and vulnerabilities.

Over the next 10-15 years, the largest ever youth population in the country will enter their economically productive years. Identifying the most disadvantaged children, making the investments needed so that they too have a good start to life can only be a win-win proposition.

These children can grow up to be the healthy, skilled, and productive workforce required for sustained social and economic development. As I think about Penina – and the many more Peninas and Ahmeds that I have met in my travels to the southern highlands, western regions and Zanzibar – I hope that we will accelerate our efforts to reach the most disadvantaged children.

A girl or a boy born to a poor family need not start off with a compromised future. On the basis of compelling evidence, Narrowing the Gapsurges Governments to invest in proven, high impact interventions and promote innovations to reach the hardest-to-reach, in particular children and mothers in poor households.

Tanzania has various programmes and services in place, not only for mother and child health but also in the domain of poverty reduction. And while it is true that resources are never enough to simultaneously address all needs, Narrowing the Gaps is calling upon the Governments to“leave no one behind”, enhance the equity-focus of its investments and to provide adequate guidelines to local governments to do the same.

UNICEF will continue to support the Government and partners to travel that last mile to reach the hardest to reach children. Penina and Ahmed deserve our dedicated attention and support even if the circumstances of their birth have labelled them “poor”.

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