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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?
In July, Zambia unveiled a new vaccine campaign to protect against pneumonia, intensifying a national response to the single leading cause of death for children under 5 around the world. Still, treatment challenges persist.
The reality, observers here say, is that the government cannot yet fully support the integrated community case management effort – or the health system writ large. Some of the Lufwanyama health centers, which are responsible for ordering drugs for the community health workers, get half of the medicines they ask for from the district government, according to Save the Children. On top of these shortages, the district pharmacist orders 300 100-ml bottles of liquid amoxicillin for children every month, and nearly just as often, the bottles do not come.
For medicine, supplies, training, and more, Lufwanyama relies on nongovernmental partners to make up the difference. (Save the Children does not, however, buy drugs.)
But the sustainability of donor support is uncertain. Officials from the Zambian government, UNICEF, and WHO all commended Save the Children’s work in Lufwanyama and stressed the importance of case management at the community level. But LINCHPIN is scheduled to end in 2014. No new funding has come in and no transition plan has been outlined, although Save the Children wants to continue related work in the district.
“Five years isn’t a very long time for a project,” Waltensperger said. “There’s a lot of things that have changed and gotten much better under LINCHPIN, so we would want to make a plan to build on that.”
It is a hope, but not a guarantee. Nearly 250 miles south, at a clinic in Lusaka, a CHW said she was trained by one international nonprofit from 2004 through 2008 on how to identify, prevent, and treat child diseases. The woman, Christine Ndapisha, said she had not received training since, and it was evident. She saw that “PCV10” was printed on the new national immunization cards, but she had no idea what that stood for. She had heard little about the new vaccine for pneumonia.
'I DON'T LIKE BABIES DYING'
In a new national storage facility for vaccines in Lusaka, Vichael Salavwe recalled a formative experience that led him here in the first place. He was at a hospital, seeing patients, he said, when a mother came over, moaning, and grabbed his legs.
“Can you please bring back my child?” she begged of him.
Salavwenot had not yet been able to see the child on his rounds, but already the child had died.
“I don’t like babies dying,” he said.
Salavwe is the chief officer of integrated management of childhood illness in the Ministry of Community Development and Maternal and Child Health, a government arm focused on community public health that spun off, rather abruptly, from Zambia’s Ministry of Health this past March.
Salavwe said the bulk of his ministry’s budget goes to immunization. He proudly showed off five large vaccine refrigerators that the Zambian government recently acquired with donor support.
A 2011 country assessment found that Zambia fell short of WHO targets in nearly every indicator for effective vaccine management, including proper temperature and vaccine distribution.
But in the last few years, Zambia has made a concerted effort to improve that. Since 2010, according to UNICEF’s Rodgers Mwale, Zambia has invested $1.35 million and achieved about 70 to 80 percent of the expansion. Following Zambia’s summer rollout of the pneumococcal vaccine, the Japanese government announced that it would grant the country another $2.34 million to close the gap, so that it could reach greater cold-chain capacity, particularly at the district level.
The increase in coverage parallels Zambia’s rising investment in health. It is one of six African countries to have met a pledge to spend at least 15 percent of its annual budget on health.
“We have fully owned the program,” Salavwe said of prioritizing child health. The government is helping to pay for vaccines, he said. It is working to provide better health services to rural areas. It has developed new plans to address maternal and child health.
“All we are getting from partners … is support to augment what is already existing,” he said.
THE ULTIMATE PREVENTION
At the University Teaching Hospital pediatric ward, Jess glanced at Holly. The child was swaddled in blankets, one a secondhand University of Michigan fleece that Jess had bought at a local shop. Jess blamed the cold weather for causing Holly’s illness. It’s a common belief, although studies show that the relationship is more correlative than causative.
Jess said she was grateful that Holly was feeling better. The little girl was even sitting up.
Under the watch of nurses and doctors who visit daily, Holly had received an abundant mixture of medicines, including intravenous penicillin. Her fever had come down, and while she still had the IV tube taped atop her hand, her mother was hopeful that they would both leave soon, nearly a week after they first arrived.
“It’s gratifying when people come early, and when cases are referred to this place,” said Mary-Cheer Sinyinda, a nurse who has seen the ebb and flow of patients at the hospital for years. She now spends her days at the hospital monitoring the sickest children, those with severe pneumonia, who are part of a multisite study funded by the Bill & Melinda Gates Foundation.
Outside, a well-regarded pediatrician who has worked at the hospital for 40 years contemplated the state of his country’s child health.
“Immunization has done a good deal” in reducing child deaths, said the doctor, Chifumbe Chintu. “We’re not seeing polio now. This was a big problem. We’re not seeing tetanus. It was rampant during my days.”
The pneumococcal vaccine follows in this same vein. But it is not a panacea.
“You know what he tells me?” said his colleague, James Chipeta, the assistant dean of research at the hospital and a collaborator on the Gates-funded pneumonia study.
Chipeta nodded to Chintu, who, in turn, broadly smiled with recognition.
“He says,” Chipeta continued, if only there was “a vaccination against poverty.”
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