Nations meet, children's lives in the balance

That is the alarm being sounded by Save the Children, as the nations of the world prepare for the Second Global Forum on Human Resources for Health, which will take place in Bangkok, Thailand, from January 25 to 29.

Children are continuing to die in huge numbers because they don't have access to a health worker. Doctors, midwives, nurses and community health workers are the backbone of health services. Without them, life-saving measures cannot be put in place, said David Melody, lead health adviser for Save the Children, the international nonprofit that address the issues of children in need.

In September, 2010, the United Nations established the Millennium Development Goals, a series of social and economic targets agreed to by member nations with a 2015 deadline. The MDGs include a number of global health objectives, such as reducing the mortality rate for children under the age of five by two thirds from its 1990 level and maternal mortality rates by three quarters, also from 1990.

The 21st century must be and will be different for every woman and every child, UN Secretary-General Ban Ki-moon said at the time.

Ban launched the Global Strategy for Women's and Children's Health, part of the MDGs, with over $40 billion in commitments from nations to improve health services to the world's most underserved populations.

These commitments will ensure more health for the money, and more money for health, Ban said.

But Save the Children said this week that the Millennium Development Goal on child survival will not be possible without millions more nurses, midwives and other health staff.

Melody said that the World Health organization estimated a critical shortage of 3.5 million health workers, which figure should be seen as a floor rather than a ceiling.

We need to reduce child mortality at four times the current rates if the Millennium Development Goal on child survival is to be reached, he said.

The UN admits that the MDG on child health is slipping further out of reach, reporting that, of the 67 countries defined as having high child mortality rates, only 10 are currently on track to meet the MDG target.

The UN noted that the number of children in developing countries who died before the age of five dropped from 100 to 72 deaths per 1,000 live births between 1990 and 2008.

But almost nine million children still die each year before they reach their fifth birthday, with the highest rates of child mortality continuing  to be found in sub-Saharan Africa, where, in 2008, one in seven children died before age five, the UN said.

This week, according to published reports, Canadian Prime Minister Stephen Harper traveled to Geneva, Switzerland, to co-chair a commission that aims to establish benchmarks for the U.N.'s $40 billion maternal and child health initiative.

The UN, in December, appointed Harper and Tanzanian President Jakaya Kikwete to head an information and accountability commission and establish by May 2011 a framework to help countries improve the way they collect and share information about the state of women's and children's health, and to track the money and how it is used.

Dmitri Soudas, a spokesperson for Harper said the prime minister's goal is to see that countries deliver on their pledges and that the money is spent responsibly.

His main objective is accountability and delivery of commitments, Soudas said, according to reports. The important thing here is delivering results. The end objective is to save the lives of mothers and children.

Ben Phillips, also of Save the Children, said that, among the  major donor countries, Norway is the most generous. Conversely, Italy's support is low and getting lower.

Developing countries, governments and donors need to invest more so that millions more health workers can be recruited, trained and deployed, and so that existing health workers are properly supported, Save the Children's Melody said, adding that donors and International Monetary Fund policies need to support decent pay for all delivering health services.

Phillips explained that the IMF's use of wage and recruitment ceilings and freezes, especially in Africa, can prevent poor countries operating under IMF regulations from hiring the nurses and midwives that mothers and children need.

The IMF needs to be more flexible and ensure its rules do not harm children, Phillips said.

Save the Children gave Sierra Leone as a prime example of the health worker crisis.

The nation currently has less than 10 percent of the health workers it needs to meet the UN's minimum threshold - a shortfall of over 11,000 nurses, midwives and doctors. Two million people in the capital, Freetown, are served by just six obstetricians and gynecologists - in a country where women face a one in seven risk of death during childbirth, the organization said.

The country is determined to rise to the challenge, and has already managed to double the number of hospital-based births by making healthcare free for small children and pregnant mothers. It will need expanded, long-term, predictable aid to help it address its health worker gap, Melody said.

Phillips said India presents another example.

Among developing countries, India has for decades underinvested in health, and the government acknowledges it now needs to triple health spending and hire hundreds of thousands of nurses and midwives, he said. By contrast, Sri Lanka and Thailand have both built strong public health systems.

We know how to save children's lives. We know that millions more health workers are needed. We know that this will need specific and time-bound targets for health workforce expansion, more money to pay for this, and more effective use of those funds, Phillips said.

He said governments and donors who have not yet made a commitment on health workers should do so this week at the Bangkok meeting.

Time is running out, and children are dying who could be saved, he said.