The Worst Place in the World to be Sick?

06/09/2011 - According to a new index constructed by Save the Children, the worst places in the world in which a child could be sick are Chad and Somalia. In Somalia, children are bearing the brunt of the refugee crisis caused by the famine.

A new index composed by Save the Children measures how many health workers a country has in addition to their reach and impact in the region they serve. The index, unsurprisingly, found that the worst countries for a child to be sick in are Chad and Somalia. Children in other countries, such as Ethiopia, Nigeria and Sierra Leone also face increased mortality because of the lack of trained health care workers. The best countries to be sick in are Finland and Switzerland.

The Health Workers Reach Index is tripartite, considering health worker density in 161 countries as well as vaccination coverage for diphtheria, pertussis and tetanus and as skilled birth attendants for pregnant women.

Most of Latin American shows an "adequate reach," according to the index. Most of sub-Saharan Africa (as well as South Asia and the areas of Oceania), on the other hand, shows a "poor" or "critical" reach.

The index further shows that the risk of death among children living in the bottom 20 countries is five times higher than those countries higher up on the index. The 20 lowest countries are those that fall beneath the World Health Organization's (WHO) minimum threshold of only 2.3 doctors, nurses and midwives per 1,000 people. Of these bottommost counties, only Bangladesh has achieved a 90 per cent vaccination coverage rate for the three vaccines. Only Papua New Guinea and Equatorial Guinea have skilled birth attendant indicators above 50 per cent.

Save the Children's index is a useful tool when determining how countries fare with regard to achieving the Millennium Development Goals (MDGs) by 2015. Bangladesh and Nepal, for instance, have made great strides when it comes to improving child survival. These two are among the few low-income countries that are "on-track" to meeting the fourth MDG on child health by 2015. Measles vaccination is an indicator for the fourth MDG, while the rate of skilled attendants at birth is an indicator for the fifth MDG on maternal health.

The fourth MDG calls on countries to reduce child mortality (under-five mortality) by two-thirds of the 1990 level. Health professionals are vital, not only to undertake birth attendance and spearhead vaccination campaigns, but to address children's illnesses such as diarrhoea, pneumonia, malaria and more. Such diseases are major killers of children under the age of five in the developing world.

The index was published just two weeks in advance of an upcoming United Nations (UN) meeting on non-communicable diseases. It is hoped that this will help to launch a campaign for more doctors and nurses in the developing world, which is short some 3.5 million health professionals.

Even before the displacement caused by the Somali famine, only 33 per cent of  births in Somalia were attended by a skilled professional (2005-2009). Among the poorest quintile, this figure fell to only 11 per cent. According to the latest report by the UN refugee agency, Somali children are bearing the largest share of the burden in the East African refugee crisis. Overall, children under the age of 18 account for 80 per cent of 121,000 refugees living in four camps in southeastern Ethiopia.

Yesterday, the UN announced that the famine has spread to a sixth region in the country, affecting another 350,000 people. The UN warned that 750,000 people may die unless emergency relief operations are bolstered. Before the famine, Somalia was on track to meet many of the MDGs, including the fourth one on child health. Today, a total of about 12 million people remains in need of food aid.

"A child’s survival depends on where he or she is born in the world. No mother should have to watch helplessly as her child grows sick and dies, simply because there is no one trained to help," affirmed Save the Children chief, Justin Forsyth.