South Africa has reason to celebrate


This week governments and Health Ministers from around the world will congregate in Astana, Kazakhstan to create a renewed commitment to primary health care, universal health coverage and the SDGs targets for health.

According to new mortality estimates released by Unicef, the World Health Organization (WHO), the United Nations Population Division and the World Bank Group, mortality rate for children under five declined by 53 percent over the last seven years – going from 78 deaths per 1 000 live births in 2000 to 37 deaths per 1 000 live births in 2017.

South Africa made much faster progress in reducing under-five mortality rates between 2000 and 2017 than they did in the 1990s. These figures are very encouraging  as the country is among 84 others that made particularly solid progress over the last 18 years.

This achievement will add momentum to the effort to end preventable child deaths and achieve the health-related Sustainable Development Goals (SDG ) particularly Goal Three which talks of reducing the mortality of young children to less than 25 per 1 000 live births by 2030.

In addition to the decline over the years, South Africa has already achieved the SDG target of a neonatal mortality rate of 12 deaths or fewer per 1 000 live births, and based on current trends, would achieve the SDG target on under-five mortality by 2030.

The trend in SA goes hand in hand with all the events around the worldwide as now fewer children are dying each year. Across the world, the number of children under five who have perished from diseases deemed to have been preventable has declined dramatically from the 12.6 million in 1990 to 5.4 million in 2017.

Even with these steady achievements we simply cannot be complacent. There is still far much too much to be done. This is because an estimated 43,000 children under five died in this country.

Up to 13,000 of these children were newborns. The neonatal mortality rate has in particular remained stubbornly stagnant over the last few years. The vast majority of newborn deaths results from complications due to prematurity, birth complications including lack of oxygen at birth (asphyxia), and neonatal infections–preventable and treatable conditions. These deaths are inextricably linked to the health and nutrition of the mother and to the care she receives in the antenatal period, in labour and delivery, and immediately after that in the postpartum period.

Achieving the ambitious child survival goals requires an understanding of the levels and trends in child mortality, systematically gathering data and evidence on what works and what doesn’t and making sure that these lessons from experiences can be applied at scale.

Beyond achieving the SDG target, efforts to reduce inequity in mortality within country should be intensified.. To further accelerate progress, we must end all preventable child deaths, we need a new emphasis on districts and communities where child mortality is increasingly concentrated, as well as the multiple deprivations and comorbidities that contribute to preventable child deaths. South Africa, as a high-HIV prevalence country where hard-won gains in child survival were undermined by the spread of HIV and AIDS in the 1990s and early 2000s, needs to be vigilant and continue prevention efforts.

Achieving the ambitious child survival goals also requires ensuring universal health coverage (UHC). The most strategic route to achieving universal health coverage (UHC) is to invest in primary health care as an effective platform for the delivery of integrated services through robust, well-resourced health systems that respond to local contexts and needs and which reach down to the community level.  As this great meeting in Astana on October 25 and 26, governments and officials need to create a renewed commitment to primary health care, universal health coverage and the SDGs targets for health and now is the time to call for progress on ending preventable child deaths.

Ending preventable newborn and child deaths is no fantasy. In fact, it is achievable in our lifetime. Dramatic progress has already been made over the past two decades. But we are failing the youngest citizens on the planet, and with millions of young lives at stake, time is of the essence.

We must all commit to giving every child a fair chance at the start of life.

Sanjay Wijesekera is the Chief of the Water, Sanitation and Hygiene Division at UNICEF South Africa.