- Email: [email protected]
Training is key to improve child health globally
Correspondence
In their Global Burden of Disease Study (Sept 13, p 957),1 Haidong Wang and colleagues quaintly conclude, after their thorough analysis of mortality in children younger than 5 years old during 1990–2013, that secular trends account for most of the mortality reduction. They incorrectly attribute this reduction to new drugs (specifically antiretroviral therapy), new vaccines (specifically rotavirus and pneumococcal vaccines), and the “dominant role of new technologies”.1 Disappointingly, the contribution of old vaccines, particularly the measles vaccine, is not mentioned in the study. The increase in global coverage with the measles vaccine has made a profound contribution to the reduction in childhood mortality, with a 74% reduction in childhood deaths attributed to measles from 535 300 in 2000 to 139 300 in 2010.2 Furthermore, reductions in measles mortality accounted for 23% of the estimated decrease in all-cause child mortality from 1990 to 2008.3 The call for further technology innovation is welcomed, but this should not be at the cost of achievable and sustainable universal coverage with well proven life-saving methods, particularly the measles vaccine. Insufficient investment, poor political commitment, and inadequate healthsystem effort in the delivery of two doses of measles vaccine to every child will jeopardise the encouraging progress towards reaching Millennium Development Goal 4 and will cost many young children’s lives. We declare no competing interests.
*David N Durrheim, Peter M Strebel [email protected] University of Newcastle, Wallsend, NSW 2287, Australia (DND); and World Health Organization, Geneva, Switzerland (PMS) 1
Wang H, Liddell CA, Coates MM, et al. Global, regional and national levels of neonatal, infant and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79.
www.thelancet.com Vol 385 January 24, 2015
2
3
Simons E, Ferrari M, Fricks J, et al. Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data. Lancet 2012; 379: 2173–78. van den Ent MM, Brown DW, Hoekstra EJ, et al. Measles mortality reduction contributes substantially to reduction of all cause mortality among children less than five years of age, 1990–2008. J Infect Dis 2011; 204: S18–23.
Training is key to improve child health globally An important moral dilemma of our age is the appalling rates of early childhood mortality, best summarised by Millennium Development Goal (MDG) 4.1 Substantial improvements have been reported; mortality in children younger than 5 years old has reduced from 12·2 million deaths per year in 2000 to about 6·3 million in 2014. 2 Although this reduction is impressive, more than 6 million children still die annually, raising concerns that progress in mortality reduction might stall after 2015.3 The areas with the highest child mortality are sub-Saharan Africa and southern Asia; these areas not only have the highest child disease burdens but also the lowest number of medical schools and very low health workforce numbers per population.4 The number of people trained to become health-care workers needs to increase, and this should be a local priority. Provision of educational support to those in training and those already trained to ensure optimum health-care skills is both a local and global responsibility and opportunity. Unfortunately, education and training is least available where it is needed the most, and without a trained health-care workforce, child mortality and morbidity will remain high. WHO’s Global Health Workforce Alliance 4 has identified that the shortage of doctors, nurses, and midwives is highest in the worst performing areas globally for MDG 4. At present, a global deficit of 7·2 million
health-care workers exists; this deficit is predicted to worsen to 12·9 million by 2035.5 WHO agrees that training of the health-care workforce must be the top priority but recognises that major political and technical leadership at country or regional and global levels and coordination of effort is needed.4 The Lancet Commission about health education5 documented that less than 2% of global health-care budgets are provided for education of its workforce. In a knowledge-rich and human-intensive profession, this underfunding is risky and unwise. Julio Frenk and colleagues5 concluded that there is a need to build global consortia of educational institutions, to leverage their resources, work together, and transform education opportunities into global public benefits. Leadership and coordination of linkages between the health and education sectors for the child health workforce is needed. Such leadership will coordinate key health professional groups and academic centres in educational resource production, ensure local engagement to meet local training needs, set measurable targets, build assessment into new developments, and provide support to local trainers and supervisors. Such actions can support those in training and those already trained and equip them with greater skills to manage mortality and morbidity in children younger than 5 years old.
David Snyder/ZUMA Press/Corbis
Measles vaccine still saves children’s lives
I declare no competing interests.
Kevin D Forsyth kevin.forsyth@flinders.edu.au Flinders University, Adelaide, SA 5042, Australia 1 2 3 4
5
UN. The Millennium Development Goals Report 2014. New York: United Nations, 2014. The Lancet. Women, children, and adolescents: the post-2015 agenda. Lancet 2014; 384: 1159. Lawn, JE. The child survival revolution: what next? Lancet 2014; 384: 931–33. Global Health Workforce Alliance. Stategy 2013–2016 Advancing the health workforce agenda within universal health coverage. http://www.who.int/workforcealliance/en/ (accessed Oct 20, 2014). Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58.
327
In their Global Burden of Disease Study (Sept 13, p 957),1 Haidong Wang and colleagues quaintly conclude, after their thorough analysis of mortality in children younger than 5 years old during 1990–2013, that secular trends account for most of the mortality reduction. They incorrectly attribute this reduction to new drugs (specifically antiretroviral therapy), new vaccines (specifically rotavirus and pneumococcal vaccines), and the “dominant role of new technologies”.1 Disappointingly, the contribution of old vaccines, particularly the measles vaccine, is not mentioned in the study. The increase in global coverage with the measles vaccine has made a profound contribution to the reduction in childhood mortality, with a 74% reduction in childhood deaths attributed to measles from 535 300 in 2000 to 139 300 in 2010.2 Furthermore, reductions in measles mortality accounted for 23% of the estimated decrease in all-cause child mortality from 1990 to 2008.3 The call for further technology innovation is welcomed, but this should not be at the cost of achievable and sustainable universal coverage with well proven life-saving methods, particularly the measles vaccine. Insufficient investment, poor political commitment, and inadequate healthsystem effort in the delivery of two doses of measles vaccine to every child will jeopardise the encouraging progress towards reaching Millennium Development Goal 4 and will cost many young children’s lives. We declare no competing interests.
*David N Durrheim, Peter M Strebel [email protected] University of Newcastle, Wallsend, NSW 2287, Australia (DND); and World Health Organization, Geneva, Switzerland (PMS) 1
Wang H, Liddell CA, Coates MM, et al. Global, regional and national levels of neonatal, infant and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79.
www.thelancet.com Vol 385 January 24, 2015
2
3
Simons E, Ferrari M, Fricks J, et al. Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data. Lancet 2012; 379: 2173–78. van den Ent MM, Brown DW, Hoekstra EJ, et al. Measles mortality reduction contributes substantially to reduction of all cause mortality among children less than five years of age, 1990–2008. J Infect Dis 2011; 204: S18–23.
Training is key to improve child health globally An important moral dilemma of our age is the appalling rates of early childhood mortality, best summarised by Millennium Development Goal (MDG) 4.1 Substantial improvements have been reported; mortality in children younger than 5 years old has reduced from 12·2 million deaths per year in 2000 to about 6·3 million in 2014. 2 Although this reduction is impressive, more than 6 million children still die annually, raising concerns that progress in mortality reduction might stall after 2015.3 The areas with the highest child mortality are sub-Saharan Africa and southern Asia; these areas not only have the highest child disease burdens but also the lowest number of medical schools and very low health workforce numbers per population.4 The number of people trained to become health-care workers needs to increase, and this should be a local priority. Provision of educational support to those in training and those already trained to ensure optimum health-care skills is both a local and global responsibility and opportunity. Unfortunately, education and training is least available where it is needed the most, and without a trained health-care workforce, child mortality and morbidity will remain high. WHO’s Global Health Workforce Alliance 4 has identified that the shortage of doctors, nurses, and midwives is highest in the worst performing areas globally for MDG 4. At present, a global deficit of 7·2 million
health-care workers exists; this deficit is predicted to worsen to 12·9 million by 2035.5 WHO agrees that training of the health-care workforce must be the top priority but recognises that major political and technical leadership at country or regional and global levels and coordination of effort is needed.4 The Lancet Commission about health education5 documented that less than 2% of global health-care budgets are provided for education of its workforce. In a knowledge-rich and human-intensive profession, this underfunding is risky and unwise. Julio Frenk and colleagues5 concluded that there is a need to build global consortia of educational institutions, to leverage their resources, work together, and transform education opportunities into global public benefits. Leadership and coordination of linkages between the health and education sectors for the child health workforce is needed. Such leadership will coordinate key health professional groups and academic centres in educational resource production, ensure local engagement to meet local training needs, set measurable targets, build assessment into new developments, and provide support to local trainers and supervisors. Such actions can support those in training and those already trained and equip them with greater skills to manage mortality and morbidity in children younger than 5 years old.
David Snyder/ZUMA Press/Corbis
Measles vaccine still saves children’s lives
I declare no competing interests.
Kevin D Forsyth kevin.forsyth@flinders.edu.au Flinders University, Adelaide, SA 5042, Australia 1 2 3 4
5
UN. The Millennium Development Goals Report 2014. New York: United Nations, 2014. The Lancet. Women, children, and adolescents: the post-2015 agenda. Lancet 2014; 384: 1159. Lawn, JE. The child survival revolution: what next? Lancet 2014; 384: 931–33. Global Health Workforce Alliance. Stategy 2013–2016 Advancing the health workforce agenda within universal health coverage. http://www.who.int/workforcealliance/en/ (accessed Oct 20, 2014). Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58.
327