In the year 2008, the world is half way to the target set for achieving Millennium Development Goals (MDGs) by 2015. One of the 8 MDGs is to reduce the child mortality rate by two third of what it was in 1990, by 2015(1). For the reasons of strengthening the activities in this direction, UNICEF has chosen ‘child survival’ as the theme for the recently released ‘The State of the World’s Children 2008’ (SOWC 2008) report(2).

This 164 page document starts with the chapter titled "Child survival: where we stand" informing that the under-five child deaths in 2006 had fallen to 9.7 million which is less than half of 20 million deaths reported to have occurred in 1960s. Out of these deaths, almost half (4.8 million) occurred in Sub Saharan Africa and another one-third (3.1 million) in South Asia. How-ever, the world is unlikely to achieve the goal of reducing it to less than 5 million by 2015. The chapter also highlights gross disparities in under-five mortality rate (U5MR) which ranges from 6/1000 in industrialized countries to 186/1000 in West and Central Africa. A total of 129 countries are reported to be on track to achieve MDGs, whereas 60 countries including India are off the course. These off-track countries, where the burden of child deaths is highest, are now being termed as priority countries for child survival.

The report also discusses role of community based strategies in reducing neonatal and childhood mortality and outlines the progress in realigning the programs, scaling up services and system and obtaining political commitment. The statement calls for international cooperation for the child survival in form of the fund flow and commitment of industrialized countries towards underprivileged nations. At the end, the SOWC provides an extensive statistical annexure on the performance indicators (child health status, nutrition, health, HIV, education, demography, economic performance, status of the women, child protection etc.) for all countries and gives them a ranking based upon U5MR. Country with the worst U5MR is given the first ranking and the country with the best, the last. Sierra Leone, Angola and Afghanistan are ranked at first three positions with U5MR of 270, 260 and 257, respectively. India occupies 49th position with U5MR of 76/1000 live births. Unfortunately, India’s ranking has worsened a bit in comparison to last two years (Rank 52 in 2006 and 54 in 2007) meaning that the progress has been slower in comparison to some other countries. Singapore and Sweden jointly are placed at last (189th) position with U5MR at 3/1000.

The ‘State of the World’s Children 2008’ (SWOC) is a timely publication to bring the focus on child survival, especially in the countries where the progress is not up to the mark. The report mentions some successful case studies to be replicated in other similar settings. However, it is a bit disappointing that major focus in this report is on technical information with insufficient attention to practical implementation and experiences. Case studies should have been discussed in depth with analysis on their strength and weaknesses and lesson learned from these initiatives.

It appears that main focus of SWOC is to provide the data on the status of the children in the world. The practical and applicable information and in-depth analysis of this data is missing from this report. This is contrary to the World Health Organization’s annual flagship publication known as ‘The World Health Report’ (WHR)(3). Over last few years, these WHRs have become authoritative documents on the relevant issues such as health systems, mental health, non-communicable diseases and international health security. Similarly, in the current decade, Lancet has published in-depth analysis and practicable solutions in the series(4) on child and maternal health which attracted lot of citations and quotations. UNICEF too should make the efforts to appropriately balance the statistical information and practicable solutions on the basis of analysis of data and case studies in these reports. This exercise will increase the utility of these reports for the decision making and implementation.

The SOWC 2008 notes that the U5MR in India has declined from 115 in 1990 to 76 in 2006. The Infant mortality rate has also declined from 82 to 57 during the same period. The MDGs mandate that India should achieve an U5MR of 38/1000 by 2015. At present rate, it appears to be a mammoth task and India has rightly been included in the list of 60 countries in the priority list for the need to strengthen their efforts to achieve this goal. It is time that International fraternity focuses its attention on theses high priority countries to reduce child mortality and achieve the goal. This report starts with "What is a life worth? The most of us would sacrifice a lot to save a child."(1) However, the question remains "Are we doing enough?"

Funding: None.

Competing interests: None stated.

Chandrakant Lahariya,
Assistant Professor, Community Medicine,
G R Medical College and Associated Hospitals,
Gwalior 474 009, MP, India.
E-mail: [email protected] ; [email protected]