The new inclusive “Global Partnership for Effective Development Cooperation” resulting from the 4th high level forum on aid effectiveness in Busan, South Korea, issued on 1st December does not include children or newborn babies.
This “exclusion” in the new global partnership may be gauged relative to the aid “pie” of about US $130 billion every year. This amount is 16 times more than the UN secretary general has been pledged by donors for each of the next five years for the Global Strategy for Women’s and Children’s Health. It is over 32 times more than the Global Fund had annually to fight AIDS, tuberculosis, and malaria (three diseases which increase the risk of low birth weight. Low birth weight may in turn predispose infants to increased risk of infection with the three infectious diseases).
The Busan declaration confirmed that “poverty and inequality remain the central challenge.” The declaration did not mention that the most recent WHO statistics show large inequities in the ratio between rich and poor for the millennium development goal indicator 17 which is, “% of births attended by skilled health personnel.” In over one third of the countries with a high proportion of low birth weight infants, the inequity in access to skilled health personnel at birth is over tenfold. In Ethiopia, a country highly favoured by many aid donors, the inequities in access are thirty fold, a bright red flashing sentinel of “aid ineffectiveness.” These inequities in health and healthcare are masked beneath country level aid effectiveness indicators allowing vested interests on both donor and recipient sides to cream off aid.
Disadvantaged groups in at risk areas below the country level, what UNICEF calls the development “gaps,” have few skilled health personnel to attend births, provide midwifery care, register births, or to record pre-term/low birth weights as a prospective outcome indicator of economic development.
Over three decades ago, WHO and SAREC showed that birth weights provided an indicator of social inequality. Two decades ago, the BMJ disseminated the concept that birth weight and the intrauterine growth rate (the quintessential inter-generational sustainability measure) have health implications throughout the entire life cycle. In the last decade, welfare economists have consistently shown that pre-term/low birth weight is a harbinger of deleterious work force participation and restricted economic development.
The Busan declaration does recognise that gender equality and women’s empowerment are critical to achieving development results. Improved maternal health and nutrition will certainly improve birth weights. The final section in the Busan declaration emphasises, “investing in resilience and risk reduction increases the value of our development efforts.” Investing in improved birth weights and reducing the risks of low birth weights will strengthen: the resilience of a person throughout her or his life cycle; the resilience of a health system that promotes and cares for the well being of that person; and the resilience of the national economic development or the global development within which each person dwells and health system(s) function(s). The birth weights of children thus constitute an integrated Management for Development Results (MfDR) outcome metric for the resilience of all three systems. Birth weights provide a prospective metric for aid effectiveness.
Nepal, China, Bangladesh, Cameroon, and Bolivia have already been working throughout the global crises to empower disadvantaged groups such as ethnic minorities, or people living in at risk areas, e.g. areas affected by climate change. Collaboration among such innovative groups and knowledge sharing networks of disadvantaged communities should reduce the risks of pre-term/low birth weight as part of appropriate health work force capacity building and then be scaled up to meet the needs of millions of poor mothers and their children rather than donor agendas.
The Busan presentation is available at:
http://www.unige.ch/medecine/imsp/institut/publications/busan-conference.html)
Philippe Chastonnay, Beat Stoll, Bruce Currey work at “Villa Friedheim” the home of the Institute of Social and Preventive Medicine (IMSP), University of Geneva, facilitating health work force capacity building in support of community driven health changes among disadvantaged groups in at risk areas for the last three decades.