Child Mortality in Brazil - Essay Example

?Running Head: MDG 4: BRAZIL MDG 4: BRAZIL By Introduction At the turn of the millennium, the United Nations conducted one of the largestgatherings ever in its history with an attendance of about 150 world leaders. Held at the UN headquarters in New York, the so-called Millennium Summit paved the way for the setting of goals that were targeted to be achieved come 2015 and for the first the international community reached a consensus on eight specific goals and eighteen targets. These goals, dubbed the Millennium Development Goals (hereafter MDGs), were meant to underscore UN’s directions for the new century, which are development and reduction of poverty (Moore and Pubantz, 2006, pp. 296-297). The MDGs are deemed to be significant not only as a moral obligation of the world to help those who are suffering from abject poverty and sub-human conditions, but also as a means to establish a more secure and stable world order. A connection between general poverty and civil war had been found by some research. Moreover, an increasing prosperity for poorer countries means a wider market for commerce and trade that could benefit more people than those alleviated from it (Claessens & Feijen, 2008, p.1). Despite its current progress which is foreseen to fail its goals by 2015, MDG4 is achievable as illustrated by the case of Brazil and similar other countries. The roots of the MDGs can be traced back to the International Development Goals, which were the products of international conferences and summits prior to 2000 (Claessens & Feijen, 2008, p.2). Currently, the MDGs range from the eradication of poverty and hunger, basic universal education, gender equality, improvement of maternal health, the eradication and reduction of certain diseases, environmental sustainability, the establishment of global partnership for development and MDG 4, the reduction of child mortality (UN 2000), which is the primary subject of this paper. Table 1 shows all the eight MDGs and the various targets Table 1 the 8 MDGs (WHO 2005) MDG 4 in Action: The Case of Brazil The fourth of the MDGs is known as the reduction of child mortality and its timetable is set at, like all the other MDGs, in 2015. Specifically, the MDG4 has three specific goals: the reduction, by two-thirds, of the mortality rate of children under five years old; the reduction, by two-thirds, of infant mortality rate, and; the reduction, by two-thirds, of the proportion of children immunised against measles (Reduce Child Mortality, 2007). According to Alderman and Behrman, “Infant mortality rate (IMR), a measure of child survival, is considered to be one of the strongest indicators of a country’s wellbeing, as it reflects social, economic and environmental conditions in which children (and others in society) live, including their health care” (cited UNFPA & IPEA, 2007, p. 250). Thus, it is not surprising that in countries with low income one out every ten children dies before reaching the age of five as compared to high income countries which has a comparative ratio of under-five mortality rate of 1 in every 143. Notwithstanding the better statistics in high income countries, the more than 11 million children under-five who die every year is a staggering figure that needed to be solved (EndPoverty2015). In the mid-2000, the Countdown to 2015: Tracking Progress in Maternal, Newborn and Child Mortality, identified 60 priority countries with the highest rate of child mortality under five. The identification of these countries was underpinned by two criteria: those with 50,000 deaths under-five per annum, and; those with under-five deaths of more than 90 per 1,000 live births every year (UNICEF, 2008, pp.18-19). Among the 60 countries so identified is Brazil, a South American republic. In 1990, Brazil’s annual under-five mortality rate almost reached 60 per 1,000 live births (UNICEF 2007). Figure 1 shows Brazil’s statistics of under-five mortality rate from 1990 up to 2010 indicating a potential ‘on track’ record that could very well result in a 75% reduction of its 1990 under-five mortality figure by 2015. Thus, the 60/100,000 deaths in 1990 was reduced to 34/100,000 under-five deaths in 2004 indicating an annual rate of reduction of 4.1/100,000 live births. From 2004 onwards, Brazil needed to have an annual rate of reduction of 4.8/100,000 live births, an attainable figure judging from its present course, to attain the 20/100,000 live births under-five mortality rate by 2015 (UNICEF 2007). The Brazil case is complex because its under-five mortality rate is multi-faceted. Statistics show that there is an uneven distribution of under-five mortality rates in Brazil with respect to regions and racial or ethnic origin. In 2006, the national estimates showed that the Northeast Region has twice as much incidence of these deaths than in other parts of the country. The province of Alagoas, for example, had 68/100,000 under-five mortality rate in 2006 even as the national figure was already placed at 30/100,000 live births. In addition, children born of mothers who are of indigenous or African decent are at higher risk of IMR than those born of white mothers. Thus, while the country struggles to meet a national goal of 75% reduction of under-five mortality rate, it is also faced with the challenge of solving specific problems not experienced on the national level (UNICEF, 2008, p.25). One of the factors ascribed to Brazil’s comparative success in reducing its under-five mortality rate is the introduction of the community health worker programme. The programme was created in 1991 with the support of the UNICEF and entailed the selection of a Community Health Worker from amongst those living in the community. The functions of a worker include visiting families in the community to disseminate information regarding health, hygiene and childcare, whilst keeping an eye on pregnant women and children less than six years. In 1994, four Community Health Workers were integrated into the family health team, which also included a family doctor, nurse and assistant nurses and other health personnel under the Family Health Programme of the government, serving up to 1,000 families. Today, more than 220,000 community health workers serve the Brazilian people, the largest in the world and their presence is believed to have contributed to Brazil’s success in the MDG4 (UNICEF, 2008, p.25). Another strategy used in Brazil that is the implementation of diarrhoea-control programme. According to the World Health Organization (WHO) report in 2005, 17% of under-five mortality rate can be attributed to diarrhoea. This means 1.9 million under-five children deaths per annum. Diarrhoea is caused by the ingestion of diarrhoea-causing germs and often afflicts areas that have no safe drinking water and lack hygiene and sanitation. It is noted however, that infants who are breast-fed are immune, to an extent, from this illness (UNICEF 2007). Since the 1980s, Brazil had been promoting the use of Oral Rehydration Therapy (ORT) to combat diarrhoea through the help of health workers. Its impact was to decrease infant mortality rates. For example, the 41% the Northeast region’s IMR was attributed to diarrhoea, but in 1989, after the introduction of the ORT, the figure climbed down to 25% and further dropped down to 15% by 1995-1997 (Sastry & Burgard, 2008, pp. 5-6). A comparative study between 1990-2008 of five countries, viz. India, the US, China, Indonesia and Brazil, show that Brazil fared better than the four others when it comes to the reduction of under-five mortality rate due to pneumonia. Although the US and China had lower incidences of under-five deaths due to pneumonia per day in 1990 with 11 and 46 as compared to Brazil’s 56, the 2006 statistics show that Brazil was able to whittle down this figure to 22 which was more than a 100% reduction as compared to the US’ 8 and China’s 21. A report in Jornal de Pedetria cites a reduction of mortality rates for infants between the periods of 1990 and 2008 by 74% and 46% for 1-4 years old (Axelsson & Silfverdal, 2011, pp. 85-86). Brazil’s success in under-five reduction of death mortality due to pneumonia is underpinned by the implementation of the Integrated Management and Childhood Illness (IMCI), national clinical guidelines and vaccinations against Haemophilus influenzae group B (Hib) and Streptococcus pneumoniae (pneumococci) (Axelsson & Silfverdal 2011). Figure 2 also indicates that many of the children suspected to be suffering from pneumonia between 1990 and 2006 were brought to appropriate health providers for treatment (Country Profiles 2010). MDG 4: Analysis of the Concept As can be gleaned from the Brazil case, as well as the cases of such countries such as Bangladesh, Egypt, Indonesia, Mexico, Nepal and the Philippines, MDG4 is achievable. Nonetheless, considering that these countries constitute only 7 out of the 60 priority cases identified by the Countdown to 2015 in 2004, it can be concluded that its path is not an easy one. Haines and Cassels (2004, p.394) describe the result as a ‘mixed picture at half time’ seven years ago and it seems that the same picture remains to this day. The UNICEF itself has predicted a result that will be way off the goal by about 47/100,000 live births in 2015. The 2003 Human Development Report had put it more negatively by predicting that the goal of MDG4 can only be reached by 2165. One of the causes of pessimistic perception as to achievability of the MDG4 is sub-Saharan Africa, whose under-five mortality rate is being pulled down by the HIV/AIDS pandemic (Haines & Cassel 2004, p. 394.). Nevertheless, if the Brazil case is any indication, there is reason to believe that the goals of MDG can be achieved. It is no coincidence that the biggest network of community health workers is in Brazil, which can extensively penetrate the masses, especially in the poverty-stricken areas to bring health information and education as well as monitor and supervise pregnant women and children under-five years old. The Brazil case implies that the ability to bring organised health personnel to the doorsteps of the masses to bring about immediate intervention is important in the same way that the political will of the government to resolve its health issues is. According to Haines and Cassels, there is no absence of knowledge in the prevention and treatment of illnesses that primarily cause the high mortality rate of under-five children. What is lacking according to them is that effective interventions often fail to reach those who have need of them (2004, p. 394). The Brazil case also highlights that resources play a big role in achieving the goals of MDG4. It is no secret that Brazil is an upper middle income country (Axelsson & Silfverdal, 2011, pp.85-86) and has therefore the resources to establish well-organised health personnel and finance its own health programmes, such as providing cash benefits to almost half of the participants under the Family Health Strategy in the northeast provinces, which is the most critical of its areas as far as under-five mortality is concerned. Claessens & Feijen (2007, p. 2) moreover, believes that the development of financial services, especially in developing countries, is intertwined with the goals of the MDGs. They advocate the establishment of financial sector development that will ease the access of financial aid to poorer households and even smaller firms that use it to lend money to poor households. Financial stability, accordingly, has a ripple effect because it can improve health and education, which are the essence of the MDGs, including MDG4 (Claessens & Feijen, 2007, p. 2). The cash transfer programme of Brazil, for example, to the impoverished sector that had been identified to have high under-five mortality rate seems to echo this position. The implementation of well-planned, well-assessed public health programmes is also essential in success stories with respect to the MDG4. This has been illustrated by Brazil as well as in other case such as in Egypt, Mexico and the Philippines – all of which had put in place effective diarrhoea-control programmes and ORT that greatly caused the reduction of under-five mortality in these respective countries. In Latin America, an effective programme was able to eradicate polio and measles, two of the causes of under-five mortality rates, and the KINET project in two districts in Tanzania, where insecticide-treated mosquito nets were made available to the public causing the 27% reduction of under-five mortality due in those areas (Bryce et al, 2003, p. 161). Conclusion Although the MDG4 goal is already foreseen to fail by 2015, with majority of the countries unable to meet their 75% reduction goals, the existence of a few countries whose present course is foreseen to make them meet the same goals, proves that MDG4 is achievable. This paper has illustrated the example of Brazil and although Brazil’s economy is on the upswing and better than that of sub-Saharan Africa which is expected to miserably fail in its goals by 2015, there are other countries that are not as economically sound as Brazil that are succeeding such as Nepal and Bangladesh. The implication is that either these countries have found a better way of resolving their health issues to reduce under-five mortality rates or are receiving more support from international institutions in achieving their goals. The more acceptable answer is that these countries, such as Brazil, have properly assessed their health-related problems and have accordingly thought out well-crafted health programmes that meet their health-related problems head on. Although resources are pivotal, the appropriate programme that reaches into the target masses and allows immediate and timely appropriate health interventions are really indispensable and serves as the core factor in reducing under-five mortality rates. Underpinning these factors is a parallel resolve on the part of the governments to solve their health problems and meet the goals of MDG4. References (2007). Reduce Child Mortality. MDGMonitor. Retrieved August 23, 2011, from http.// http://www.mdgmonitor.org/goal4.cfm. (2010). Country profiles. Retrieved August 23, 2011, http://www.countdown2015mnch.org/documents/2010report/CountdownProfilesA-I.pdf. Axelsson, I. & S.A. Silfverdal S.A. (2011). ‘Pneumonia mortality among children in brazil: a success story.’ Jornal de Pedetria. Retrieved August 24, 2011, http://www.scielo.br/pdf/jped/v87n2/en_v87n2a01.pdf. Bryce, J., el Arifeen, S., Pariyo, G., Lanata, C., Gwatkin, D. and Habicht, J. (2003). 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