Eritrean in 19th century Germany every second child


Eritrean remarkable
achievement of MDGs in reducing child mortality

General overview

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At the start of the new millennium, world leaders assembled
at the United Nations to outline a broad vision to fight poverty in its many
dimensions. That vision, which was converted into eight Millennium Development
Goals (MDGs), has remained the principal development agenda for the world for
the previous 15 years.

As we are reaching the termination of the MDG period, the
world community have many reasons to celebrate. Thanks to determined global,
regional, national and local efforts, as a result the MDGs have saved millions
of lives and improved living environments for many more. The data and analysis
presented in this report prove that, with targeted interventions, sound
strategies, adequate resources and political will, even the poorest countries
can make dramatic and unprecedented progress. The report also acknowledges
uneven achievements and shortfalls in many areas. The work is not complete, and
it must continue in the new development era which is Sustainable Development
Goals (SDGs)

Disastrous events with
high death tolls always make the headlines, and rightfully so. Yet there are
many daily, recurring tragedies in the world which create as much or more
suffering and often go unnoticed.

 In early-modern times, child mortality was very high; in
18th century Sweden every third child died, and in 19th century Germany every
second child died. With declining poverty and increasing knowledge and service
in the health sector, child mortality around the world is declining very
rapidly: Global child mortality fell from 18.2% in 1960 to 4.3% in 2015; while
4.3% is still too high, this is a substantial achievement.

One reason why we do not hear about how global living conditions
are improving in the media is that these are the slow processes that never make
the headlines: In 1990 7.6 million children died before they were five years
old, in 2013 the number of children dying in childhood was down
to 3.7 million.1 This
happened at a time when the number of children being born increased
globally. Unfortunately, the media is overly obsessed with reporting
single events and with things that go wrong and does not nearly pay enough
attention to the slow developments like these that reshape our world.
A media that would report global development could have had the
headline “The number of children dying globally fell by 455 since
yesterday” and they wouldn’t have this headline once, but every single day over
these more than 2 decades.2

Big countries like Brazil and China reduced their child mortality
rates 10-fold over the last 4 decades. Other countries – especially in Africa –
still have high child mortality rates, but it’s not true that these
countries are not making progress. In Sub-Saharan Africa, child mortality has
been continuously falling for the last 50 years (1 in 4 children died in
the early 60s – today it is less than 1 in 10). Over the last decade this
improvement has been happening faster than ever before. Rising prosperity,
rising education and the spread of health care around the globe are the major
drivers of this progress.

Goal 4: Reduce
child mortality target

The Target

Reduce by two thirds, between 1990 and 2015,
the under-five mortality rate.

The dramatic decline in preventable child deaths over the
past quarter of a century is one of the most significant achievements in human
history. Substantial progress in reducing child mortality has been made, but
more children can be saved from death due to preventable causes


• The global under-five mortality rate has declined by
more than half, dropping from 90 to 43 deaths per 1,000 live births between
1990 and 2015.

 • Despite
population growth in the developing regions, the number of deaths of children
under five has declined from 12.7 million in 1990 to almost 6 million in 2015

 • Since the early
1990s, the rate of reduction of under-five mortality has more than tripled

• In sub-Saharan Africa, the annual rate of reduction of
under-five mortality was over five times faster during 2005–2013 than it was
during 1990–1995.

 • Measles
vaccination helped prevent nearly 15.6 million deaths between 2000 and 2013.
The number of globally reported measles cases declined by 67 per cent for the
same period.

 • About 84 per
cent of children worldwide received at least one dose of measles containing
vaccine in 2013, up from 73 per cent in 2000.

Sub Saharan Africa
child mortality rate

Despite the impressive improvements in most regions,
current trends are not sufficient to meet the MDG target. At today’s rate of
progress, it will take about 10 more years to reach the global target. The
global advance in child survival continues to elude many of the world’s
youngest children and children in the most vulnerable situations. About 16,000
children under five continue to die every day in 2015. Most of them will perish
from preventable causes, such as pneumonia, diarrhea and malaria. Though sub-Saharan
Africa has the world’s highest child mortality rate, the absolute decline in
child mortality has been the largest over the past two decades. The under-five
mortality rate has fallen from 179 deaths per 1,000 live births in 1990 to 86
in 2015. Yet the region still faces an urgent need to accelerate progress. Not
only does sub-Saharan Africa carry about half of the burden of the world’s
under-five deaths—3 million in 2015—but it is also the only region where both
the number of live births and the under-five population are expected to rise
substantially over the next decades. This means that the number of under-five
deaths will increase unless progress in reducing the under-five mortality rate
is enough to outpace population growth.

showcase towards achieving MDGs

Eritrea has a positive a unique story to tell about health related
millennium development goals (MDGs). Eritrea was among the few an expected
country to achieve the MDGs in health due its poor economic condition. Nevertheless,
Eritrea has now achieved all the three health related MDGs namely MDG-4, reduce
child mortality, MDG-5, improve maternal health and MDG-6, combat HIV/AIDS,
malaria and other diseases.

Based on the latest data available and through an analysis of the
trends of the 8 MDGs, as well as current supportive policy and political
environment in Eritrea, this report is going to tell about the experience in
achieving MDG-4 which is reducing child mortality.

Specifically, this report will highlight innovations, best
practices as well as challenges and bottlenecks that need to overcome in order
to sustain the gains achieved so far.



set target for this MDG is “reduce by two-thirds, between 1990 and 2015, the
under-five mortality rate.” Indicators designed to assess its progress are:

Under five mortality rate;
Infant mortality rate (per 1,000);
Proportion of one-year old children
immunized against measles.

under-five mortality rate was 49.5% in 2013, which already surpasses 50% target
set for 2015; infant mortality was 42% in 2010 and is projected to meet the
target of 20% by 2015; and the proportion of one-year children immunized
against measles was 99% in 2013, which surpasses the target of 98% set for
2015. From available statistics as reported, it is evident that Eritrea has
already achieved MDG 4. However, this achievement needs to be maintained and
even improved, and the Eritrea authorities are prepared not look back but
continue the path of improving the status of this MDG in the coming years


3.1. Goal 4: Reduce Child Mortality MDG 4 calls for the
reduction of the under-five mortality rate by two-thirds between 1990 and 2015.
The global annual rate of reduction has steadily accelerated since the 1990–1995
period, more than tripling from 1.2 per cent to 4.0 per cent in the 2005–2013
period. Despite these gains, child survival remains an urgent global concern.
Eritrea has witnessed an unprecedented reduction in infant mortality rates per
1,000 live births, from 92 in 1990, to 58 in 2000, to 37 in 2012 (WHO, 2014).
As illustrated in figure 1, during the same period, the under-five mortality
rate per 1,000 live births was reduced from 150 in 1990, to 89 in 2000, to 50
in 2013 (UNICEF, 2014). Eritrea has therefore achieved MDG 4 as of 2013.

The Integrated Management of Childhood Illness (IMCI)
program was formally launched in 2000, and by 2010, all facilities had at least
one health worker trained to manage childhood illnesses in line with IMCI
guidelines. Although there are no current statistics, a recent evaluation of
IMCI implementation confirmed improvements in the use of antibiotics, the
quality of care and the level of knowledge and skills of health staff, as well
as a reduced case fatality rate. To complement the IMCI program, Eritrea
introduced Community IMCI (C-IMCI) in 2005. As revealed in figure 2,
immunization coverage for the third dose of the diphtheria, tetanus toxoids and
pertussis (DPT) vaccine (and since 1998 with the third dose of the hepatitis B
vaccine) increased from 10 per cent in 1991 to 98 per cent in 2013.

As a result of its strong routine immunization program,
Eritrea was certified as a polio-free country by the World Health Organization
(WHO) in 2008. Eritrea has maintained its polio-free status, despite its
proximity to countries where polio has not yet been contained. Since 2004,
neonatal tetanus has been virtually eliminated, as certified by WHO in 2007.
Measles also no longer pose a major threat to children with virtually all children
taking their doses according to schedule. In recognition of Eritrea’s strong
immunization program, the Global Alliance for Vaccine Initiative awarded the
country for high and sustained immunization coverage on October 17, 2009 in
Hanoi, Vietnam.




4.2. Efforts towards universal health coverage in the
Eritrean health care planning and delivery process, the drive for equity calls
for universal coverage, with care provided according to need. In principle, no one
should be left out, no matter how poor or how remote they are. If all cannot be
served, those most in need should have priority. Here lies the “all” in the
health for all mantra. Here also is the basis for planning services for defined
populations, and for determining differential needs in all administrative

4.3. Integrated health service provision in Eritrea The 2010
Overseas Development Institute study of Eritrea’s progress towards the
health-related MDGs concluded that the success of the Eritrean experience was
particularly due to the cost-effective inter-sectoral interventions and the
Government’s long-term approach to tackling the country’s health issues.2 The
Government runs a coordinated and stratified three-tier health care delivery system
that has also proven capable of meeting the needs of communities at all levels.
The diagram below attempts to depict how this health care delivery system
works. (i) Primary level of service consists of community-based health services
with coverage of an estimated 2,000 to 3,000 people. This level provides the
basic health care package (BHCP) services by empowering communities and
mobilizing and maximizing resources. The key delivery agent is the community
health worker led by the Village Health Committee; (ii) Health Stations offer
facility-based primary health care services to a catchment population of
approximately 5,000-10,000; (iii)The Community Hospital is the referral
facility for the primary health care level of service delivery, serving a community
of approximately 50,000-100,000 people. Community hospitals provide all
services available at lower level facilities, and also deliver obstetric and
general surgical services with the aim of providing vital life-saving surgical,
medical and other interventions.

4.4. Strategy of comprehensive service delivery

4.4.1. Community involvement Eritrean communities have a
long-standing culture of being actively involved in all issues. Their
investment in the country’s political, social and economic issues is one of key
drivers of the made towards the health-related MDGs. Studies have shown that
one of the key success stories of Eritrea’s development process is its ability
to mobilize and motivate communities to participate in the design, development
and utilization of program, including those related to health.

4.4.3. Political commitment and leadership The Government
emphasizes the importance of communities developing self-reliance and
inter-sectoral approaches to health, as well as the affordability and sustainability
of all interventions and program. The National Health Policy and the Health
Sector Strategic Development Plan (2011-2015) were formulated with a clear
understanding of the principles and imperatives of the above-discussed
strategies. Organizational structures and capacities are also set to extend
services and support this well acculturated development process and agenda in


5.1. Need for more money for health No country, no matter
how rich, has been able to ensure that everyone has immediate access to every
technology and intervention that may improve their health or prolong their
lives. Universal coverage should articulate who is covered for what, what
services are covered, and how much of the cost is covered. Health financing is
much more than a matter of raising money. It is also a matter of who is asked
to pay, when they pay, and how the money raised is spent. This is one area in
which Eritrea would benefit from learning about the experiences of others.

5.3. Maternal and child health as previously mentioned,
while more than 90 per cent of pregnant women attend antenatal care (ANC), only
about half are delivered by skilled professional attendants. In addition, while
there has been drastic reduction in the maternal mortality ratio since 1990 (77
per cent), it is still high at 380 per 100,000 live births. There remains the
even more pressing need to reduce neonatal mortality, which currently accounts
for close to half of infant mortality. Tuberculosis control is also a remaining
challenge that requires the expansion of existing interventions with special
emphasis on the DOTS Strategy in order to improve overall coverage. Despite
commendable achievements in the control and prevention of malaria, the threat
of resurgence due to climatic changes, cross border transmission and the
national strategy on irrigation expansion for food security, remains a real
threat in the foreseeable future. The remarkable progress in this area should
not lead to complacency.

5.5. Human resources for health The rapid expansion of the
health infrastructure since independence to cater to national health needs led
to a high demand for health personnel. The adoption of primary health care as a
policy priority was effectively implemented with the necessary re-orientation
of health workers, including re-training of staff to standardize the skills of
the different categories of health cadres that existed. Newer reform
initiatives such as decentralization to the zobas have also introduced new
health resource requirements and further challenges for the sector. With the
increase of non-communicable diseases combined with the burden of communicable
diseases, the sector is faced with the challenge of providing specialized
services that require a higher level of skilled staff. In essence, the current
issue is not only numbers but also competency and the right mix of the health
professionals that are able to respond to current, emerging or re-emerging
health conditions in Eritrea. 5.6. Health care financing Considering the desire
to improve the quality of care in health facilities for a growing population
with an increasing burden of non-communicable diseases, there is need to
transform the financing framework that has been in existence since
independence. The aim should be to reduce, the economic risks to individuals
and households

Ensure healthy lives and
promote well-being for all

the creation of the Millennium Development Goals there have been historic
achievements in reducing child mortality, improving maternal health and
fighting HIV/AIDS, Malaria and other diseases. Since 1990, there has been an
over 50 percent decline in preventable child deaths globally. Maternal
mortality also fell by 45 percent worldwide. New HIV/AIDS infections fell by 30
percent between 2000 and 2013, and over 6.2 million lives were saved from

this incredible progress, more than 6 million children still die before their
fifth birthday every year. 16,000 children die each day from preventable
diseases such as measles and tuberculosis. Every day hundreds of women die
during pregnancy or from child-birth related complications, and, in developing
regions, only 56% of births in rural areas are attended by skilled professionals.
AIDS is now the leading cause of death among adolescents in sub-Saharan Africa,
a region still severely devastated by the HIV epidemic.

deaths can be avoided through prevention and treatment, education, immunization
campaigns, and sexual and reproductive healthcare. The Sustainable Development
Goals make a bold commitment to end the epidemics of AIDS, tuberculosis,
malaria and other communicable diseases by 2030. The aim is to achieve
universal health coverage, and provide access to safe and effective medicines
and vaccines for all. Supporting research and development for vaccines is an
essential part of this process as well as providing access to affordable

health and well-being is one of 17 Global Goals that make up the 2030 Agenda for Sustainable Development. An integrated approach is crucial for
progress across the multiple goals.












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