Fatal neglect

WaterAid, in its 2009 report “Fatal Neglect: How Health Systems are Failing to Comprehensively Address Child Mortality”, says that:

The aid system is not responding to the causes of child mortality in a targeted manner. The Millennium Development Goal to reduce by two-thirds the number of children dying before their fifth birthday by 2015 is seriously off-track. In Sub-Saharan Africa, on current trends, it will not be met until 2064.

and notes that:

The World Health Organization estimates that 28% of under-five deaths are attributable to poor sanitation and unsafe water.

Clearly much more needs to be done! But is this lack of action on MDG4 (not to mention the MDG WatSan targets) because the donors are spending too much on AIDS? Well, Mr Rajalakshmi (who is a correspondent for the Indian newsmagazine Frontline) thinks so – see Is HIV/AIDS skewing the priorities of the public health system? (dated January 2008) (and thanks to Dave Trouba of WSSCC for bringing this to my attention).

Mr Rajalakshmi may be right as far as India is concerned − he writes:

The government does not seem to be terribly bothered about the continuing burden of other communicable diseases. According to the WHO, approximately 988,000 Indians die of all causes, annually. About 462,000 of these die from communicable, maternal and perinatal diseases. An estimated 34,000 die of AIDS according to this report (though the source of this estimate may be debated). Respiratory infections account for 107,000 deaths. Take the example of tuberculosis. India ranks first among the 22 high-burden countries in the world, with some 364,000 deaths annually. According to the WHO’s Global TB Report 2006, there were 1.8 million new cases in 2004, of which 5% were in people with HIV and 2.4% were multi-drug resistant (MDR) requiring very expensive treatment. The government’s revised national tuberculosis programme does not provide free treatment for MDR TB. More than one-fifth of the burden of communicable disease is related to the basic problem of clean drinking water. Look at the impact of diarrhoea which, the WHO estimates, killed an estimated 700,000 Indians in 1999 – over 1,600 deaths each day.

Such diseases are mainly an outcome of an inaccessible and unaffordable health system and a debilitating socio-economic environment. But these diseases are not on the international radar of any funding agency or government. There were 1.8 million reported cases of malaria last year. And this is an underestimation, as blood tests were carried out on less than 10% of people with suspected malaria. It is estimated that four people die due to malaria every day in the country. There are also the scourges of Japanese encephalitis, chikungunya and dengue. As many as 1,000 children died from Japanese encephalitis in Uttar Pradesh in two years, but these figures did not make the headlines or grab national or international attention in the way HIV/AIDS does. [Chikungunya? Similar to dengue − some details here.]

Globally I’m not so sure: diarrhoea kills 1.6−2.5 million children under 5 (details here, for example), but compare this (which is terrible enough) with deaths due to AIDS, as given in the 2005 report “HIV/AIDS, Tuberculosis and Malaria: The Status of the Three Diseases” by the Global Fund to Fight AIDS, Tuberculosis and Malaria: 3.1 million AIDS deaths in 2004 [and 2 million TB deaths and at least 1 million malaria deaths (possibly as many as 3 million)].

So I think the world needs to fight AIDS, TB & malaria, and also, through access to adequate WatSan, diarrhoea. But clearly what we need is very good WatSan advocacy!