29 May 2012

Namibia: Save Our Children From Unnecessary Death

Photo: Stuart Price/UN Photo
More than 75 percent of newborn deaths can be prevented by scaling up interventions like Kangaroo Mother Care - wrapping newborns in skin-to-skin contact with their mothers.

THE death of Juliana Kleopas and her newborn baby at the Katutura State Hospital on May 13 2012 occasioned angst and soul searching among Namibians not only about nursing care in particular, but also about the public health service generally.

Authorities have, in the meantime, announced that an investigation has been commissioned to get to the bottom of the incident. We can only hope that the report will be available as a public document for lessons learnt all round. Staying with the theme of adolescent health, we write this morning on a report by The Economist reproduced in The Namibian of Thursday, May 24.

The report we refer to deals with under-five or child mortality rate per 1 000 live births. The report is quite shocking and unsettling in respect of our country. In the table accompanying the report, our country is jostling for the bottom spot with Liberia -a country which has only recently escaped decades old civil strife and war. How can this be the case for a country, such as ours, which spends a small fortune compared to most on health? A country which has recently moved upwards to a plush neighbourhood of upper middle income countries?

A good place, as any other, to start in interrogating this, may be the Millennium Development Goals (MDGs). There are eight MDGs. Reducing child mortality rates by 2015 is one of them.

For Namibians, the report card on this particular MDG is a curate's egg. This is because whereas the global trend, partly as a consequence of the MDGs, moves downward, ours is contrarian.

In the most recent MDG report Namibia submitted to the UN in 2010, the authorities report that infant mortality rate decreased from 56.6 deaths per 1 000 live births to 46 in 2006/07.

Significantly however, they continue to say "Namibia is unlikely to reduce infant mortality to attain the 2015 target of 19 infant deaths per 1 000 births." Concomitantly, the number of under-five children that were malnourished and stunted in fact increased from 28.4% in 1993/4 to 29% in 2006/ 07.

Perhaps there are little surprises here, because at the time of the release of the second report in 2008, Prime Minister Nahas Angula already made known that Namibia was not likely to reach the MDG targets for maternal and infant mortality.

"Something must be done. Even if it means training young people to train their fellow young women on prenatal and Traditional Birth Attendant to assist with deliveries, we should do it," Angula said at the time.

It is this something which as a nation, we fail to grasp that accounts for our ignominious score on the health of our children. It is not only unsafe delivery, which led to the death of mother Juliana Kleopas and her baby which account for our unacceptable and disgraceful mortality rate. The causes are multiple and include, among others, malnutrition, the relative high incidence of HIV-AIDS and other infections sensu lato.

Therefore, our horrendous under-5 mortality rate is far from being a health problem. The evidence is growing that our children are malnourished and stunted. These are not medical conditions that speak to the inadequacy of our broader policies of equity and social cohesion.

We can give the children as many Panado's as we wish, but if they have little or nothing to eat these will show up in our under-five mortality rates and other measures of poverty.

As if speaking to our huge health bill, Dr Margaret Chan, WHO Director General, said in our parliament recently "money alone does not buy better health. Good policies that promote equity have a better chance."

A glance at the accompanying table produced by The Economist shows that most of the others are low income countries.

Also (economic) growth per se is not the silver bullet. However, as the article by The Economist puts it "an increase in national income should reduce mortality not just because it is usually associated with lower poverty and better nutrition but also because growth can be a proxy for other good things: more sensible economic policies; more democratic, accountable governments; and a greater commitment to improving people's living standards."

So the causality between growth and reduction in mortality is tenuous. But more equitable distribution of assets and income; and a health delivery system, in the ethos and high morals of Florence Nightingale, may begin to eat into our stubbornly high child mortality rate.

It is the children who are, after all, the future of a country. As the recently concluded national census will bear out, ours is typically a youthful population. But a tree which receives little or no water is most likely to die. Our under-5 mortality rate says that inequity remains stark. It says families have no wherewithal and are struggling to feed their children. It says our social and welfare policies have marginal impact. And it is also a record of spectacular failure of governance that our under-five mortality rate moves in the wrong direction from the generally upbeat progress in even the poorest countries. It is a record that Government's policies of laissez-faire and cronyism have not served our children and Namibians generally, well.

As our country embarks on National Development Plan IV, there may be a need for introspection on the priorities of the country; and to craft a plan and programmes at the centre of which will be the welfare of the people, and in particular the young.

In the new order of things, Government would need to bring on board the broadest coalition of partners from the civil society, the faith based organizations and others to interrogate both the content and delivery of programmes for our children.

The recent adoption as government policy, of pre-primary education is but an important element in this policy renewal and revival in the interest of the child. To be sure, parents, community and government, at all levels, need to come on board and pull in the same direction. Whilst we are mindful of the substantial resources currently committed to education, it remains important that we re-examine our welfare spend to ensure that it reaches those for whom it is intended in order to make the difference.

Unlike countries of the developed world, we are essentially a country where the predominant segment of our population is significantly young. It is them who are the country's ultimate insurance policy. It is premiums paid today, by way of investments, which will bear fruit for us all round, to secure our country in the League of Nations.

It is by investing in them, that we shall not be at the bottom of the league as we currently are with the under-five mortality rate. This is a call which we are sure speaks to all parents. We must make government policies and expenditure plans to reflect this call.

We shall anxiously wait to see where the next table places the health of our children.

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