Right in Principle, Right in Practice

As someone who has welcomed children and grandchildren into the world, I know what it's like to peer in at ten infants through the glass walls of a new-born nursery, imagining the bright futures ahead in the 80 years of life they can expect.

The future for ten newborns in, for example, sub-Saharan Africa, is very different. By the age of five, one or two will die from something as preventable as a mosquito bite. About four will suffer the irreversible stunted growth that results from malnutrition. Three will never spend a single day in school.

Life expectancy? Not eighty. It's about fifty.

A decade ago, the world set eight Millennium Development Goals (MDGs) aimed at improving these terrible numbers by 2015. We've made progress. But in many areas, a close look at the numbers shows us that with progress have come widening disparities between the most and least deprived -- for child mortality, sometimes by more than 10 percent.

This week world leaders are convening at the UN to review the MDGs. The question is: can we reach our goals faster?

We can -- not just by spending more money but by spending it to greater effect.

That's the lesson of "Narrowing the Gaps to Meet the Goals," the new study UNICEF released last week.

Carefully researched and peer-reviewed, "Narrowing the Gaps" offers not just new analysis but a new approach. For it disputes the common belief that we save more lives in poor countries by focusing on those more reachable; that putting the very poor on the front burner is right in principle, but wrong in practice.

UNICEF's work shows that in this case, principle and practice go hand in hand. An "equity" focus -- approaches aimed at the most deprived -- will save more children per dollar than the one we use now.

Why? Partly because we have learned much about health since 2000 -- for example the way sound nutrition in the first two years of life can avert the stunting that afflicts almost 200 million children in the developing world. Partly because new technology like cell phones allow us to communicate with the most isolated villages on the planet.

The combination means we can now more efficiently deliver low-tech ways to treat the poor. For the hundreds of thousands of women dying during pregnancy and in childbirth each year, often because they give birth without skilled help, we can train non-physicians to perform Caesareans. For the 850,000 children a year dying from malaria we can provide mosquito nets that reduce their deaths by 20 percent.

An equity focus doesn't mean abandoning the worthwhile projects underway, but building on them. And the UNICEF study's modeling does show that if we build by focusing future efforts on the poorest areas we will achieve dramatic results.

By 2015, for example, every $1 million the poorest countries shift to the new approach would save about 60 percent more children each year.

Naturally, one study is not the last word on a complex issue. But the thoroughness of UNICEF's data makes it much more than a first step.

That's particularly true because UNICEF researchers guarded against the impulse to satisfy our own biases by working with distinguished outside consultants. At a recent day-long review of the study, they enthusiastically supported our work.

"Always do right," Mark Twain wrote. "This will gratify some people, and astonish the rest."

At UNICEF we are all a little astonished. Being right in principle turns out to be right in practice. While the developing world desperately needs more money for health care, this approach offers more health care for the money we have. The policy implications that follow from what we found offer sustainable new opportunity to save and help so many more children.

We can't be content only to see that opportunity. We must seize it.

At UNICEF we have already begun to move where the facts lead us. We see results in simple things: the drop of polio vaccine squeezed onto a child's tongue in Tajikistan, where we helped head off an epidemic; a Sudanese mother filling a container with clean water from the newly drilled borehole in her village; a young girl in a classroom in Afghanistan where only 40 percent of girls ever attend elementary schools.

In the final five years of a mission created with such hope, and carried on with such dedication, we urge our partners gathering for the UN summit: help the most children by focusing on those who need help the most.

And we urge readers: imagine the faces and bright futures of our own children -- then support those the world has forgotten. Help dedicated groups and governments care for those children as if they were our own.

As, in a real sense, they are.

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