New mortality estimates released by Unicef, the World Health Organization (WHO), the United Nations Population Division and the World Bank Group, in South Africa, indicate that the under-five mortality rate declined by 53% over the last seven years - going from 78 deaths per 1000 live births in 2000 to 37 deaths per 1000 live births last year.
South Africa made much faster progress in reducing under-five mortality between 2000 and 2017 than it did in the 1990s. These figures are encouraging as the country is among 84 others that made particularly solid progress since the year 2000.
This achievement will add momentum to the effort to end preventable child deaths and achieve the health-related Sustainable Development Goals (SDG ) particularly Goal 3 which talks of reducing under-five mortality to less than 25 per 1000 live births by 2030.
In addition to the decline over the years, South Africa has already achieved the SDG target of a neonatal mortality rate of 12 deaths or fewer per 1000 live births, and based on current trends, would achieve the SDG target on under-five mortality by 2030.
The trend in South Africa goes hand in hand with the events around the world as fewer children are dying each year. Across the world, the number of children under five who have died from diseases that are deemed to have been preventable has declined dramatically from the 12.6million in 1990 to 5.4 million last year.
Even with these steady achievements we cannot be complacent. There is still much to be done. This is because an estimated 43000 children under five died in this country. Up to 13000 of these children were newborns. The neonatal mortality rate has in particular remained stubbornly stagnant over the last few years.
The vast majority of newborn deaths result from complications due to prematurity, birth complications including lack of oxygen at birth (asphyxia), and neonatal infections - preventable and treatable conditions.
These deaths are inextricably linked to the health and nutrition of the mother and to the care she receives in the antenatal period, in labour and delivery, and immediately after that in the postpartum period.
Achieving the ambitious child survival goals requires an understanding of the levels and trends in child mortality, systematically gathering data and evidence on what works and what doesn’t and making sure that these lessons from experiences can be applied at scale.
Beyond achieving the SDG target, efforts to reduce inequity in mortality within the country should be intensified. To further accelerate progress, we must end all preventable child deaths, we need a new emphasis on districts and communities where child mortality is increasingly concentrated, as well as the multiple deprivations and comorbidities that contribute to preventable child deaths.
South Africa, as a high-HIV prevalence country where hard-won gains in child survival were undermined by the spread of HIV and Aids in the 1990s and early 2000s, needs to be vigilant and continue prevention efforts.
Achieving the ambitious child survival goals also requires ensuring universal health coverage. The most strategic route to achieving universal health coverage is to invest in primary health care as an effective platform for the delivery of integrated services through robust, well-resourced health systems that respond to local contexts and needs and which reach down to the community level. As governments and health ministers from around the world will congregate in Astana, Kazakhstan, on October 25 and 26 to create a renewed commitment to primary health care, universal health coverage and the SDGs targets for health, now is the time to call for progress on ending preventable child deaths.
Ending preventable newborn and child deaths is no fantasy. In fact, it is achievable in our lifetimes. Dramatic progress has been made over the past two decades. But we are failing the youngest citizens on the planet, and with millions of young lives at stake, time is of the essence. We must all commit to giving every child a fair chance at the start of life.
Unicef's Every Child Alive campaign is an urgent appeal to governments, businesses, health-care providers, communities and individuals to fulfil the promise of universal health coverage and keep every child alive.
* Sanjay Wijesekera is the Chief of the Water, Sanitation and Hygiene Division at Unicef's South Africa.