The study contends that providing services to the world’s poorest children in the most impoverished communities is not only just, it is also more cost-effective than the current policy of mainly helping the less poor in areas that are easier to reach.
The conventional wisdom among development specialists has long held that more lives are saved in poor countries — and the cost is cheaper — by focusing on the easiest people to reach. That usually means those in cities, where there are hospitals and transportation.
Unicef, whose core mission is helping the most deprived and vulnerable children, decided to challenge that assumption by examining statistical data from 26 countries. It developed a computer model and had the results vetted by outside experts.
Agency officials say they can now document that $1 million spent helping children 5 years old and younger in the most remote, disadvantaged areas of poor countries would prevent 60 percent more deaths than their current approach — a stunningly higher return on investment.
The logic appears sound. If the goal is to significantly reduce child deaths, providing more health services to regions where far larger numbers of children are dying — even if the delivery is more expensive — should show greater, more cost-effective results.
Unicef is recommending several new policies for itself and other agencies: Train and deploy more community health care workers who, working with simplified modern technologies, can deliver basic health services directly to remote villages. Use mass communications to encourage the poor to seek care, then eliminate user fees and cover transportation costs. Build maternal “waiting homes” near urban hospitals where rural women can stay before delivery.
In the decade since the United Nations adopted the Millennium Development Goals, there has been real progress. But while national averages are improving, disparities within many countries and among regions are getting worse. In all 26 countries that Unicef examined, the national under-5 mortality rate has declined by 10 percent or more since 1990. Yet in 18 of those countries, the gaps between child mortality rates in the richest and poorest segments of the population has either grown or remained unchanged.
Unicef officials do not want to completely abandon the old approach. They are arguing that the new data proves that there is a better chance of reaching the Millennium Challenge goals — the deadline is 2015 — if more of that aid is invested in desperately poorer areas.
Source: The New York Times, September 19th 2010
