Challenges

Over the past three decades, the world has seen remarkable progress in child survival, cutting the number of children worldwide who die before their fifth birthday by more than half. But there has been slower progress for newborns. Babies dying in the first month accounted for 47 per cent of all deaths among children under five in 2018, up from 40 per cent in 1990.  In 2018, 2.5 million newborns died in just their first month of life; about a third of them on the first day of life. Among those children, most died from preventable causes such as premature birth, complications during delivery, and infections like sepsis. In addition, more than 2.5 million babies are born dead each year.

Sub-Saharan Africa remains the region with the highest under-five mortality rate in the world. In 2018, the region had an average under-five mortality rate of 78 deaths per 1,000 live births. This translates to 1 in 13 children dying before his or her fifth birthday – 16 times higher than the average ratio of 1 in 199 in high-income countries. Furthermore, despite worldwide declines in child stunting, the progress in Africa has been slow and some regions actually saw increases in the number of children affected between 2000 and 2018: the number of children under 5 with stunting rose by 1.4 million in Eastern and Southern Africa, and by 6.5 million in West and Central Africa.

The large and growing volume of Chinese aid resources earmarked for Africa offers a significant opportunity to improve the health situation of African children. In October 2015, health ministers from China and 50 African countries gathered in Cape Town to discuss their bilateral cooperation in healthand reaffirmed a commitment to make resources and solutions available to address major causes of preventable maternal, newborn and child mortality in Africa. Following this meeting, in December 2015, China’s President announced at the China-Africa Summit in Johannesburg that China would support “special programs focusing on women and children” in its new package of US$60 billion investment in Africa for the next three years (2016-2018).

To seize the momentum, UNICEF provided technical support to China and African countries including information on maternal, newborn and child health needs in selected African countries and recommendations on specific interventions to address these needs.

Specifically, UNICEF supported the Government of China to:

• Ensure that local needs in maternal, newborn and child health were prioritized in support of a long term sustainable development assistance agenda.
• Include a focus on strengthening of primary health care systems for the targeted African countries, in order to make the greatest health gains for children.
• Work with national counterparts in African countries (both ministries of health and government agencies involved in coordinating aid) to prioritize interventions, programmes, and expert exchange to benefit children’s health and well-being as part of China’s aid.
• Strengthen partnerships and build alliances with key stakeholders involved in China-Africa development cooperation, to carry out joint advocacy for children’s rights as a critical part of the agenda.

Toward a Solution

In March 2016, as a follow up to the meeting of Health Ministers and the December 2015 Summit, UNICEF China, with support from UNICEF Headquarters, Regional and Country Offices in the East Asia and the Pacific, Eastern and Southern Africa, Middle East and North Africa, and West and Central Africa Regions, organized a meeting in Beijing to discuss development cooperation between China and Africa on newborn and child health. The meeting brought together senior representatives from the Ministries of Health and Aid Coordination Ministries of both China and eight African countries (Democratic Republic of Congo, Ethiopia, Kenya, Niger, Nigeria, Sierra Leone, Sudan, and Zimbabwe) to further consider commitments to delivering results for children, improving primary health outcomes and strengthening South-South collaboration. The meeting reviewed progress and challenges faced in improving maternal, newborn and child health in the African countries, identified gaps and priorities to support, and explored potential means for cooperation to address the priorities.

As a result of the Beijing meeting, consensus was further built among senior representatives from China and the African countries on how to address maternal, newborn and child health during the next three-year programme cycle. The commitment to invest in human development opened a new field of cooperation between China and Africa, representing a major shift from China’s traditional focus on investing in infrastructure.

In May 2017, a funding agreement was signed between UNICEF and the Government of China, in which China committed to provide USD 8 million to assist 8 African countries in their efforts to address maternal, newborn and child health challenges. With UNICEF’s support from the Country Offices in China and the eight African countries, eight project proposals were developed and shared with the Government of China for review and approval. Following the signing of the implementation agreement for these projects in December 2019, UNICEF and the Government of China are cooperating under the South-South Cooperation Assistance Fund (SSCAF) framework to benefit children in the eight African countries in 2020, marking a concrete step of sharing China’s experiences in this area with other countries. Apart from improving access to health facilities and essential medicines for newborns and pregnant women, the project will also include technical trainings for African delegates in China and field missions of Chinese health experts to these African countries for sharing of technical knowhow and experience.

UNICEF is also working closely with the Government of China under SSCAF to provide much-needed humanitarian assistance to children impacted by Cyclone Idai in Mozambique, Malawi and Zimbabwe.

These are innovative models of South-South cooperation in which UNICEF acts as a broker leveraging China’s aid resources for the benefit of children in Africa.

While specific projects in each of the countries differ and are appropriately adapted to the priority needs of the African countries, there is potential to replicate and scale up this good practice in other African countries and beyond. China’s skills, knowledge, and services related to health could also be critical to the improvement of health conditions in many other Southern countries.

Success factors of the projects included high-level political will and commitment as well as local level support, strong advocacy, provision of technical support, and timely sharing of best practices achieved in the pilot programmes.