Cambridge — Thirty years ago, I was a young physician practicing family medicine in rural Talihina, Oklahoma. We saw unusual cases, including snakebites and a man who survived a gunshot through the heart. But what I loved most was delivering babies - bringing new lives into the world and great joy to parents. Sadly, my most vivid memory from those years is of a baby girl who didn't make it. Her parents, first-time pregnant, didn't recognize the warning signs. When they reached the hospital, our team was too slow. Too late.
Around the world, 6.6 million kids under 5 die each year - more than 90 times the capacity of the Superdome. The vast majority of these deaths are preventable. The Millennium Development Goals, adopted in 2000 as the world's report card on international development through 2015, have catalyzed progress and helped save millions of children's lives. But most developing countries won't meet the MDG target of a two-thirds reduction in childhood mortality.
Still, eliminating preventable child mortality is within our power. The post-2015 development framework - which United Nations member states discuss next week in New York - needs to redouble efforts on health, including a specific focus on child mortality.
Among prospective health targets, universal health coverage (UHC) is essential for child survival in the post-2015 era. UHC is about affordable access to quality healthcare services: It's the goal that everyone receives the care they need without suffering financial hardship. No one would benefit more from this goal than kids, who often die without seeing a health worker.
With scores of low- and middle-income countries already well along the path to universal coverage, the UHC movement has surged in the last few years. A widely-supported 2012 UN resolution endorsed UHC. Margaret Chan, head of the World Health Organization, calls UHC "the single most powerful concept" in public health. Jim Kim, President of the World Bank, says "we must be the generation" to deliver UHC.
Yet as the conversation has moved from this technical crowd to broader audiences, there's been confusion. To many, especially in the U.S., a UHC goal sounds like the unrealistic expectation that developing countries provide a "Cadillac plan" to everybody. To others, universal health coverage can sound like a vague abstraction--focused on enrollment alone, as if holding an insurance card worked as a talisman against ill health. And it might seem that UHC, promising a more comprehensive, integrated approach to healthcare, will divert resources from priorities like child mortality.
In fact, UHC is the single best health strategy for ending child mortality. The first expectation for a UHC program is to deliver an essential package of low-cost, high-impact services to everybody. A health worker with basic training and equipment can prevent most deaths from the major culprits of pneumonia, diarrhea and malaria. WHO estimates that these and other basic interventions would reduce child deaths by more than half in high-mortality settings. Healthy spacing and timing of pregnancies through universal family planning access will also help reduce under-5 deaths.
The key to impact is making this care truly available--what we call effective coverage. That's the acid test of UHC. Where child mortality is high, healthcare access is low, often related to geography and/or political instability. Community health workers (CHW) are an example of an affordable, scalable solution which UHC systems can build around.
CHWs are usually members of the community, trained to provide primary care in poor and rural settings. For kids in particular, CHWs can be a lifesaver.
Finally, we've seen UHC efforts markedly reduce financial barriers to healthcare. This is vital for young children, who sadly, in many settings, are low priority for household spending. Leaders have rallied constituents around the goal of health for all, often increasing health funding through new taxes and other sources. The reform process gives leaders power to reshape how healthcare is delivered. For example: organizing a national health system around community-based primary care.
This model has excelled in post-conflict settings like Rwanda and Afghanistan. In both countries, leaders established a vision emphasizing equity, access and affordability. At reasonable cost, Rwanda made basic services available to practically everyone, using a delivery system in which patients go to CHWs and community health centers first. In 2011, Rwanda joined the small group of countries on pace to achieve the MDG for reducing child mortality. In Afghanistan, while progress has been less dramatic, child deaths have decreased, with CHWs recognized for effectively reaching underserved populations despite poor infrastructure and cultural obstacles to women's healthcare.
I'll never forget the despair of those parents in Oklahoma who lost their daughter--the terrible human cost of failing to respond quickly enough. With 2015 approaching, we've got to think big and act fast. For too many kids, healthcare comes too slow, too late, too far from home.
Universal health coverage can deliver the affordable access to quality care that children and their families need. It can give all kids the opportunity for a healthy life. It can mean more health workers, on the front lines, helping to save kids' lives. Just in time.