Millennium Development Goals - MDGs in Sri Lanka/Goal 4: Reduce Child Mortality

	MDGs in Sri Lanka
	Goal 1: Eradicate Extreme Poverty and Hunger
	Goal 2: Achieve Universal Primary Education
	Goal 3: Promote Gender Equality and Empower Women
	Goal 4: Reduce Child Mortality
	Goal 5: Improve Maternal Health
	Goal 6: Combat HIV / AIDS, Malaria and Other Diseases
	Goal 7: Ensure Environmental Sustainability
	Goal 8: Develop a Global Partnership for Development

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MDGs in Sri Lanka

Goal 4: Reduce the under-five child mortality rate by two thirds by 2015

“By the same date, to have reduced maternal mortality by three-quarters and under-five child mortality by two-thirds, of their current rates.” Millennium Declaration

“A monthly allowance of Rs200 will be provided to purchase milk for every child from birth up to five years of age.” Mahinda Chintana

Every year, worldwide, almost 11 million children die before their 5th birthday. Most of them live in poverty in developing countries and die from disease or a combination of diseases that can be prevented or treated by inexpensive means.

Sri Lanka has often been cited as a country that has achieved remarkable progress in health and social development. Policies related to childcare, adopted for several decades since independence, have consistently helped reduce the infant and under-five mortality rate.

For Sri Lanka to achieve Goal 4:
•	The under-five mortality rate must be reduced to 12 per 1000 live births
•	The infant mortality rate must be reduced to 12.8 per 1000 live births and
•	99% of infants must be immunized against measles

What are the targets? Goal 4 comprises the following target to be achieved by 2015:

Target 5: Reduce by two-thirds, the Under-five Mortality Rate

Sri Lanka is on track for achieving the target of the under-five child mortality rate of 12 in 1000 live births by 2015. With the lowest rates in the WHO South Asian region, under-five mortality was 19 per 1,000 live births*. The widespread system of Maternal and Child Health (MCH) clinics and their outreach home visits by Public Health Midwives, have contributed to the consistent decline in infant and under-five mortality rates. (* WHO)

How do we measure progress towards Target 1? Through the following indicators:

The Key Indicators are:
13.    Under-five mortality rate per 1000 live births.
14.    Infant mortality rate per 1000 live births.
15.    Proportion of 1-year-old children immunized against measles.

Current status

•	19 out of 1,000 under-five children died in 2002 due to poverty-related causes
•	12 out of 1,000 infants died during the first year of life in 2000

Remarkable progress has been made by Sri Lanka in the social and health sectors since independence, with an extensive network of services. However, since 1990 the country has achieved only a marginal decrease in the overall infant mortality rate. Maternal health and nutrition status during pregnancy and access to quality pre-natal, at delivery and post-natal care are contributing factors. Overall female child mortality rates are lower than that of males, while district-wise, mortality rates for both genders were highest in the North Central and Central Provinces.

Only 42% of mothers in the estate sector are visited by health workers, where infant mortality is 1 in 20 (DHS 2000), while in urban areas 90% of mothers receive home visits.
UNICEF data for 2003 show that 99% of children have been immunized against measles. The highest figures are found in the Central Province, while the lowest in the North and East and estate areas.

Government Strategies and Progress
Diseases, malnutrition and poverty are major causes of child mortality; strategies to eradicate these will help make more children survive. Better quality health care and services for pregnant women and infants will ensure safe delivery and survival.

Apart from the North and East, free public allopathic health care is provided within 4.8km of most homes. Medical officers are available at rural hospitals and specialist pediatricians can be consulted at base hospitals and higher level of hospitals. The long established outreach programme by midwives has been a success. The well-organised and effective system of Health Units has delivered preventive and promotive health services to the population. An efficient measles immunization programme has achieved 99% coverage, with the exception of the North and East and estate areas.

Health infrastructure facilities including district and rural hospitals and ayurvedic dispensaries were improved in 18 districts. A new state-of-the-art children’s hospital was constructed in Peradeniya, Kandy in 2005. (Ministry of Finance and Planning Annual Report 2005 p.73)

Support District budgets linked to MDG targets
NCED Clusters District Map

Challenges
The uneven development of the health service network must be addressed. The poor distribution of services has been caused by health professionals being concentrated in urban areas, due to lack of incentives and facilities in rural and more disadvantaged areas.

Sri Lanka’s greatest challenge to achieve this MDG is to strengthen preventative and curative care, for mothers during pregnancy and infants at birth, in the conflict-affected areas and in the estate sector, through provision of infrastructure, experienced health staff and health education.

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