Chapter 3: Translating the promise into action Bangladesh commits to deepen already strong gains in child survival In July 2013, the Government of Bangladesh announced its commitment to reducing child deaths by an additional 108,000 annually, as it launched a bold initiative under the banner of A Promise Renewed.The goal is to bring down child deaths to 20 per 1,000 live births by 2035, by progressively reducing under-five child mortality, with a particular focus on cutting the neonatal mortality rate. The initiative — Ending Preventable Child Deaths by 2035: Bangladesh Call for Action — was launched by the Ministry of Health and other stakeholders including civil society organizations and professional associations. The initiative’s goal is ambitious, but in 2000 when the MDGs were launched, very few would have guessed that Bangladesh would be able, not only to achieve MDG 4, but also to do so well before the target date. In the past five years, Bangladesh has made strong progress in key maternal, newborn and child survival interventions. The Bangladesh Call for Action identifies a series of measures aimed at expanding the coverage of existing interventions, such as the provision of skilled attendants at birth, and new interventions, including pneumococcal and rotavirus vaccines. Equity lies at the core of the new initiative. Despite Bangladesh’s significant progress in reducing child mortality in all quintiles, the gap in child mortality rates between the richest and poorest has scarcely narrowed. Specific coverage targets have been set for each of the key interventions using a new equity platform developed by UNICEF. Tracer interventions will be monitored to verify that high levels of effective coverage are achieved with equity. There will be a particular focus on urban slums, areas with ethnic minorities such as the Chittagong Hill Tracts, and low-performing districts. The Bangladesh Call for Action also acknowledges that it is imperative to tackle long-standing and emerging threats to young lives. For example, drowning is an increasing concern. The Call for Action seeks to scale up innovative, communitybased approaches to prevent drowning, such as the Anchal and Swim Safe interventions. It also commits the country to expanding nutrition-specific actions, building on the solid progress achieved in raising the national rate of exclusive breastfeeding during the first six months of a child’s life to more than 60%. Planned next steps include revising the operational plans of the Health, Nutrition and Population Sector Development Programme to reflect the Call for Action and expanding the use of communications technology to generate local health reports and maps and support accountability mechanisms. The Call for Action aims to build on Bangladesh’s strong history of grassroots movements to bring about changes in social norms, such as the dramatic reduction of open defecation achieved during the last 20 years. From the grassroots to the executive and legislative levels, everyone will have an important role to play.
government, business, or civil society organization can reduce preventable child deaths independently. Each stakeholder has a role to play. And while governments bear the burden of overall accountability for children’s survival, civil society organizations have an important role in pushing the child survival agenda forward. They can seize the initiative by educating citizens on government commitments and on child mortality in their communities, campaigning for the policies and services needed in the most disadvantaged segments of society, and organizing and supporting community-led efforts in support of child survival.
countability can be strengthened only if citizens know what commitments their governments have made and can see evidence of progress or the lack thereof. Setting, monitoring and publicizing progress against specific national goals for maternal and child survival lets citizens track the gains made locally and nationally and provides a basis for them to support government-led efforts to close the gaps that remain.
The final priority action focuses on monitoring and reporting progress. If the world is to end preventable child deaths within a generation, there must be greater accountability for keeping the promises made to the world’s children. Ac-
Bold targets for maternal, newborn and child survival can be achieved only through the collective and coordinated engagement of all organizations and partners — public and private — that are committed to the well-being of children
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RE-ENERGIZING THE GLOBAL CHILD SURVIVAL MOVEMENT