Saving six million children each year is affordable

June 23, 2005

Extra funding amounting to as little as US$1.23 per head in the 42 countries* with the highest rates of child mortality is needed to save 6 million children, concludes a study published in this week's issue of THE LANCET. The cost is affordable for governments of even the poorest nations, if outside donors provide funds to build-up the health systems of these countries, state the authors.

In 2003, a study published in The Lancet (Lancet 2003; 362: 65-71), estimated that the lives of 6 million children could be saved each year if 23 proven interventions** were universally available in the 42 countries that had 90% of child deaths in 2000. In the latest study, Robert Black (Johns Hopkins Bloomberg School of Public Health, Maryland, USA) and colleagues, assessed the cost of delivering these interventions at universal coverage by calculating the sum of unit costs for drugs and materials, delivery costs, and programme management and support cost, including supervision. They found an additional US$5.1 billion in new resources is needed annually. Although the figure does not include the cost of scaling-up health systems to universal coverage, which will require extra outside donations, the findings suggest that the 42 countries in the analysis will be able to sustain these achievements once they are attained. Without the extra investment of US$5.1 billion to save the lives of 6 million children the Millennium Development Goal for child survival--where nations pledged to ensure reduction of two-thirds in child mortality between 1990 and 2015--will not be met, state the authors.

Jennifer Bryce, the lead author of the study, concludes: "...$5 billion is about 6% of expenditures for tobacco products in the USA for 2003. For public-health decision makers, the $5 billion needed to save 6 million child lives annually might be compared with the estimates of $12-20 billion now committed annually to the fight against HIV/AIDS. These examples suggest that $5 billion is affordable, and reflects a choice being made by policy makers and donors - a choice that allows 6 million children to die each year, over 16,000 each day."

In an accompanying comment Barbara McPake (The London School of Hygiene and Tropical Medicine, London, UK) states that, though finances are only one barrier to saving the lives of vulnerable children, " is unquestionably a shameful indictment of our global society that when known effective interventions have been developed and could be financed at a cost of this order, millions of children are denied access to them."

In an accompanying editorial The Lancet comments: "These estimates provide compelling evidence, in absolute or comparative terms, of the affordable target required to achieve the Millennium Development Goal (MDG) for child health by 2015, and also a sobering reminder of how little a life costs in some parts of the world."
Contact: Professor Robert E Black, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E8527, Baltimore MD 21205-2179, USA. +1 410 955 3934

Dr Jennifer Bryce, 2081 Danby Road, Ithaca, NY 14850, USA. T) +1 607 277 9731

Comment: Dr Barbara McPake, Department of Public Health & Policy, Health Policy Unit, London School of Hygiene & Tropical Medicine London, WC1 7HT, UK. T) +44 207 927 2681

Contact: The Lancet press office 0207 424 4949/ 4249

Notes to editors

  • The countries are primarily in sub-Saharan Africa and south east Asia.

  • The 23 interventions include:
    • breastfeeding and other nutrition interventions, which are effective in reducing deaths from diarrhoea, pneumonia, malaria and measles
    • antibiotics for the treatment of pneumonia and other infections
    • zinc, for the prevention of diarrhoea and pneumonia and the treatment of diarrhoea
    • insecticide-treated nets for the prevention of malaria


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