Get to Zero Projects-web.FINAL

Stop at Nothing
What it will take to end preventable
child deaths

© WorldVision International 2015
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Stop at Nothing: What it will take to end preventable child deaths
i
Foreword
World Vision is no longer talking about reducing child deaths from preventable causes
and hunger but eliminating them completely.
Like the Apollo moon programme of the 1960s, the targeted application of a huge effort
could achieve something the human race has never seen before.
Pie in the sky? I don’t think so. We have plenty of examples of success to spur us on.
In a community on Tanna Island in Vanuatu, local leader Joseph introduced me to Kana,
his four-year-old son and the ‘last child in the village who was malnourished’, thanks to
World Vision’s nutritional training and support. Kana is now thriving and happy.
In Sierra Leone, I visited a community where giving birth had frequently been a
lethal undertaking for a woman. The clever application of mobile phone technology
in an award-winning World Vision project meant no pregnant woman had to face
complications alone any more.
I’m confident that ending hunger, extreme poverty and preventable child deaths is
possible with our collective efforts. We owe it to the human race to aim for the highest
goal possible.
Our generation is uniquely placed to take on this challenge. We have seen
extraordinary progress in the last two decades, including recent gains in maternal and
child health thanks to the Every Woman Every Child movement.
The number of children under five who die each year is half what it was in 1990
– around 17,000 fewer children now die daily. The number of women who die in
childbirth has also been halved.
That should give us courage to face the dismal truth that 6.3 million children still die
each year from preventable causes because they don’t have access to the same health
support as their peers. We can end that.
A problem with the Millennium Development Goals (MDGs) was that they relied
on average targets. A country might appear to be doing well overall yet still retain
considerable pockets of poverty. A zero target makes it impossible to hide misery in the
averages.
If the Post-2015 Sustainable Development Goals (SDGs) are to mean anything, they
must reach the most disadvantaged and vulnerable children in the hardest places to
live. That includes the displaced children of war-affected countries like Syria, unstable
countries like Somalia and poor countries prone to disaster like Haiti.
The proposed SDGs currently include a target to ‘end preventable deaths of newborns
and children under five years of age’. We will stop at nothing to reach this target.
This report is a starting point for a way forward. Rather than focus on global totals
and national averages, we take a deeper look at the issues in 31 nations. The profiles
draw attention to areas where greater action is needed. The countries differ greatly
according to whether they are likely to reach the proposed SDG target by 2030 or not,
based on recent trends.
World Vision is working from grassroots to global levels to end preventable deaths
within a generation. We are proud to be part of the Every Woman Every Child

ii
movement to end preventable deaths. We are partnering with United Nations (UN)
agencies and governments on the SDGs and with the World Bank in its ambitious drive
to eliminate extreme poverty by 2030. We are working in various collaborations with
child-focused agencies and faith-based organisations to ensure civil society has its voice
heard and can play its part.
We are particularly focused on national action and accountability. Our Child Health
Now campaign has been active in 37 countries since 2009. We invested US$2 billion
over five years in audited programmes targeting improved health, nutrition, HIV and
AIDS, and water, sanitation and hygiene.
Crucially, we are working with local communities to give all citizens a chance to have
their voice heard – in particular youth and children, who are most affected, and who
will benefit the most.
This is no time for complacency. The story of Joseph and Kana is sobering because
shortly after my visit tropical cyclone Pam struck Vanuatu and wiped out decades of
development. And in Sierra Leone the Ebola outbreak has exposed the tremendous
weaknesses of a still patchy health care system.
World Vision is present in both places and immediately began helping families and
communities to pick up the pieces. The damage is a reminder of how fragile some of the
gains we make can be in the face of climate change, catastrophes and conflict.
Let’s make the moon shot of our generation.
Join us in our Global Week of Action.
Let’s unite across the world to tackle the worst of extreme poverty.
Kevin J. Jenkins
President and Chief Executive Officer
World Vision International
Mg Myo Thet Khaing (age five) teaches Kevin Jenkins the 8-point technique for
good hand-washing.

1
Contents
Foreword................................................................................................................ i
Overview...............................................................................................................2
Getting to Zero
Afghanistan............................................................................................................4
Bangladesh.............................................................................................................6
Burundi...................................................................................................................8
Cambodia.............................................................................................................10
Chad...................................................................................................................... 12
Democratic Republic of Congo...................................................................... 14
Ethiopia................................................................................................................. 16
Ghana....................................................................................................................18
India .....................................................................................................................20
Indonesia..............................................................................................................22
Kenya....................................................................................................................24
Lesotho................................................................................................................26
Malawi...................................................................................................................28
Mali........................................................................................................................30
Mauritania............................................................................................................32
Nepal....................................................................................................................34
Niger.....................................................................................................................36
Pakistan................................................................................................................38
Papua New Guinea............................................................................................40
Philippines............................................................................................................42
Rwanda.................................................................................................................44
Senegal..................................................................................................................46
Sierra Leone........................................................................................................48
Solomon Islands.................................................................................................50
South Africa........................................................................................................52
Tanzania................................................................................................................54
Timor-Leste........................................................................................................56
Uganda..................................................................................................................58
Vanuatu.................................................................................................................60
Zambia..................................................................................................................62
Zimbabwe............................................................................................................64
Important note on data and projections ....................................................66

2
Overview
World Vision’s Child Health Now campaign launched globally in 2009 with the objective
of making a significant contribution to the achievement of Millennium Development
Goals 4 and 5. Today, Child Health Now is campaigning for change in 37 countries with
high burdens of maternal and child mortality, as well as with donor governments and
multilateral decision-making bodies.
Working with partners, the campaign has provided World Vision with significant
opportunities to influence local, national, regional and global leaders to deliver improved
health outcomes for women and children around the world. Child Health Now has also
played an important role promoting social accountability by empowering communities
to engage in constructive dialogue with decision makers in order to hold government
accountable for improved health services.
As a result, Child Health Now has contributed towards improved health policies for
mothers and children in all regions of the world. For example, we have seen increases
in government health budgets in countries such as India, Bangladesh, Uganda, Kenya and
Bolivia; more local health workers in Lesotho; and the scale up of government nutrition
programmes in Mali and Afghanistan.
From 4 to 11 May 2015, the campaign will once again run a Global Week of Action
aimed at mobilising the public and key stakeholders. In May 2014, World Vision and
partners mobilised 5.9 million people in 71 countries calling on leaders to accelerate
action to finish the job on MDGs 4 and 5, with a particular focus on uncounted and
unreached children. This year the stakes are even higher, and our voices must be louder.
As we count down to the end of the MDGs, we have the chance to build on the
extraordinary progress that has been made in reducing extreme poverty and improving
child well-being, and to set the direction for ensuring a fairer world for all children.
World leaders are negotiating the next set of global development goals, and for the
first time in history, we know that getting to zero on poverty, hunger, violence and
preventable child deaths is possible. However, this will only be achieved with an
ambitious post-2015 framework that reaches the poorest and most vulnerable children
in the hardest places to live.
This report starts us on the next stage of this journey. The gaps in basic opportunities
for child health and survival between different groups of children are holding the world
back from getting to zero. National averages used to mark progress towards the MDGs
have hidden the real picture for many children, particularly the most vulnerable. We
cannot hope to reach zero preventable child and newborn deaths unless we reduce
the child health equity gap and ensure that all children, everywhere, can survive to be
counted, well nourished, healthy and safe. Success in closing the gaps and getting to zero
will govern whether we can truly achieve the next set of development goals for children.
Together, for this Global Week of Action, we will Stop at Nothing to get to zero.

GETTINGTOZEROENDINGPREVENTABLECHILDANDNEWBORNDEATHSBY2030
THIS TARGET, PROPOSED AS PART OF THE SUSTAINABLE DEVELOPMENT GOALS,
SHOULD BE CONSIDERED MET ONLY WHEN MEASURED ACROSS ALL POPULATION GROUPS
START HERE
SINCE 1990,
CHILD DEATHS HAVE BEEN CUT IN HALF.
ISPOSSIBLE
GETTINGTOZERO
6.3 MILLION
UNDER-FIVE CHILD DEATHS:
TAKE PLACE IN THE FIRST MONTH OF LIFE
OCCUR IN FRAGILE & CONFLICT-AFFECTED CONTEXTS
LINKED TO UNDERNUTRITION
53%
45%
44%
HEALTHSERVICESWITHIN REACH OF ALL CHILDREN
PREVENTION OF
MALARIA, FULL
IMMUNISATION,
WATER, SANITATION
& HYGIENE
ALL BIRTHS
REGISTERED
WITH ENOUGH
TRAINED
HEALTH
WORKERS
PROVIDING
QUALITY
CARE AROUND
BIRTH
SUPPORTING
BREASTFEEDING
AND GOOD
NUTRITION
THE POWER OF
PEOPLE –
CHILDREN, YOUTH
AND ADULTS
HOLDING LEADERS
ACCOUNTABLE
START HERESTART HERE
ALL CHILDREN
SHOULD BE COUNTED,
HEALTHY, NOURISHED
AND SAFE
FOCUS ON MOST
DISADVANTAGED AND
VULNERABLE CHILDREN IN THE
HARDEST PLACES TO LIVE
A CHILD’S CHANCES OF SURVIVAL DEPENDS ON
FACTORS INCLUDING FAMILY INCOME,
PLACE OF BIRTH AND MATERNAL EDUCATION.

4
56%
43%
mothers with
secondary
education
or higher
mothers
with no
education
Getting to Zero in Afghanistan
Ending preventable child and newborn deaths
Based on current trends Afghanistan will get to zero preventable under-five deaths in
2038 and zero preventable newborn deaths in 2053.This is too late for hundreds of
thousands of children.We can accelerate progress and get to zero faster.
National averages hide the real picture for many children, particularly the most vulnerable
BIRTH REGISTRATION
SKILLED BIRTH ATTENDANCE
Data source: UN Inter-agency Group for Child Mortality Estimation, Demographic and Health Surveys and Multiple Indicator Cluster Surveys.
http://www.childmortality.org | http://dhsprogram.com | http://mics.unicef.org/surveys
poorest women
richest women
16%
76%
LEGEND
Reduction in mortality
rate (up to 2014)
Projected reduction
(based on recent trends)
Target for zero
preventable deaths
Target year to reach zero
preventable deaths
33% rural children
60% urban children
Under 5 Mortality
Target for Afghanistan will be achieved in 2038 at current rates
YEAR
DEATHSPER1000LIVEBIRTHS
1960 1980 2000 2020 2040
0100200300
1960 1980 2000 2020 2040
0100200300
Under-five Mortality Newborn Mortality
Newborn Mortality
YEAR
1990 2000 2010 2020 2030 2040 2050
01020304050
1990 2000 2010 2020 2030 2040 2050
01020304050
YEAR YEAR
CHILDHOOD STUNTING

5
The Government of Afghanistan must publicly commit and take action to end preventable
maternal, newborn and child deaths as a priority, including through:
• Identifying the most vulnerable children and better targeting resources towards them.
• Increasing investment in quality, accessible health services with sufficiently trained staff.
• Expanding coverage of essential maternal, newborn, child health and nutrition activities, especially lifesaving
interventions in the most rural communities (e.g. Family Health Houses, Home-based
Life-saving Skills).
• Scaling up efforts to ensure improved nutrition, including community-based programmes.
• Strengthening accountability systems that include citizen participation in monitoring and review.
Uncounted and unreached:
Afghanistan’s most vulnerable children
Projections on when Afghanistan could end preventable
child and newborn deaths are based on national averages
and hide the real picture for many children. Averages
conceal gaps between population groups, including rich
and poor, urban and rural, those with access to education
and those without. For many of the most vulnerable
children, data is inaccurate, inconsistent or unavailable,
leaving them at risk of falling through the gaps. In the next
15 years measurement must be different and success must
be redefined; in the post-2015 development framework
no target can be considered met by Afghanistan unless it
is measured and met by all population groups. Getting to
zero preventable child and newborn deaths in Afghanistan
requires renewed commitment, additional financing and
more detailed roadmaps with greater attention to targeting
the most vulnerable. Strong accountability mechanisms
are critical, with progress measured against outcomes
for the most vulnerable. Skilled birth attendance, birth
registration and nutrition show particular disparities for the
most vulnerable children. For Afghanistan to get to zero
preventable child and newborn deaths all children must be
counted, heard and reached.
Skilled birth attendance to ensure mothers
and newborns survive and thrive
One-third of all child deaths in Afghanistan occur during
the first 28 days in life.1 Access to quality, skilled care
around the time of birth could save the lives of many of
the 37,000 Afghan children who die in their first month.2
On average only 36% of deliveries are assisted by a skilled
birth attendant, but this is skewed by huge inequalities.
Wealthy mothers are nearly five times more likely than
poor mothers to have a skilled attendant at birth, and
educated mothers are 2.4 times more likely to have a
skilled attendant at birth than those with no education.3
Skilled birth attendance is crucial to closing the equity gaps
in Afghanistan and accelerating progress towards ending
preventable maternal and newborn deaths.
Birth registration to provide an identity,
access to services and protection
Only one in three Afghan children under five has his or her
birth registered and certified.4 Birth registration provides
legal identity, serves as a gateway to access services such
as health care and education, and provides legal protection
from violence, abuse, exploitation and neglect.5 However,
3 million unregistered Afghan children are not afforded
these rights or protections.6 Children from urban areas
are twice as likely to be registered than children from rural
areas, and the wealthiest children are also two times more
likely to be registered than their poor counterparts.
Nutrition for survival, health, development
and well-being
In Afghanistan 41% of children under five are stunted,
a form of chronic malnutrition the effects of which are
largely irreversible.7 Children living in rural areas and
children in the poorest households are more likely to be
stunted, and Afghan children whose mothers have no
education are 1.3 times more likely to be stunted than
children whose mothers have secondary education or
higher.8 Good nutrition, especially during the critical 1,000
days between pregnancy and age two, is foundational
to the physical and cognitive development of infants and
young children. Urgently addressing malnutrition will not
only save lives but also reduce inequalities and build strong,
resilient children, families, communities and populations.
© World Vision Afghanistan 2015 | www.childhealthnow.org
1 UNICEF and WHO (2014). Countdown to 2015: Fulfilling the Health Agenda for
Women and Children: The 2014 Report. Afghanistan Profile.
2 UNICEF (2014). Committing to Child Survival: A Promise Renewed: Progress
Report 2014.
3 Central Statistics Organisation Afghanistan and UNICEF (2012). Afghanistan
Multiple Indicator Cluster Survey 2010–11.
4 UNICEF (2013). Every Child’s Birth Right: Inequities and Trends in Birth
Registration.
5 World Vision International (2014). Registering Births to Count Every Newborn,
Every Child.
6 UNICEF (2013).
7 Ministry of Public Health Afghanistan and UNICEF (2014). National Nutrition
Survey Afghanistan 2013.
8 Central Statistics Organisation Afghanistan and UNICEF (2012).

6
Getting to Zero in Bangladesh
Based on current trends Bangaldesh will get to zero preventable under-five deaths
in 2018 and zero preventable newborn deaths in 2023. Hundreds of thousands of
children’s lives are at stake.We can accelerate progress and get to zero faster.
CHILDHOOD STUNTING BIRTH REGISTRATION
51%
23%
poorest women
richest women
12%
64%mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
29% rural children
35% urban children
Under 5 Mortality
Target for Bangladesh will be achieved in 2018 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250300350
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250300350
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
YEAR YEAR

7
World Vision recommends that the Government of Bangladesh take action to end preventable
Bangladesh’s most vulnerable children
Projections on when Bangladesh could end preventable
no target can be considered met by Bangladesh unless it
is measured and met by all population groups. Getting to
zero preventable child and newborn deaths in Bangladesh
most vulnerable children. For Bangladesh to get to zero
An alarming 60% of all child deaths in Bangladesh occur
during the first 28 days in life.1 Access to quality, skilled
care around the time of birth could save the lives of many
of the 77,000 Bangladeshi children who die in their first
month.2 On average only 32% of deliveries are assisted
by a skilled birth attendant, but this is skewed by huge
inequalities. Wealthy mothers are more than five times
more likely than poor mothers to have a skilled attendant
at birth; likewise, educated mothers are nearly 5.5 times
more likely to have a skilled attendant at birth than those
with no education.3 Skilled birth attendance is crucial to
closing the equity gaps in Bangladesh and accelerating
progress towards ending preventable maternal and
newborn deaths.
Only 31% of Bangladeshi children under five have their
birth registered.4 Birth registration provides legal identity,
serves as a gateway to access services such as health
care and education, and provides legal protection from
violence, abuse, exploitation and neglect.5 However, 10
million unregistered Bangladeshi children are not afforded
these rights or protections, making Bangladesh home to
the fifth highest number of unregistered children globally.
Children from urban areas are nearly 20% more likely
to be registered than children from rural areas, and the
wealthiest children are twice as likely to be registered as
the poorest.6
and well-being
In Bangladesh 41% of children under five are stunted,
largely irreversible.7 Childhood wasting stands at 16% and
underweight at 37%. Therefore these three global nutrition
targets are off track. Good nutrition, especially during
the critical 1,000 days between pregnancy and age two,
is foundational to the physical and cognitive development
of infants and young children. Bangladeshi children of
uneducated mothers are more than twice as likely to be
chronically malnourished than children of mothers with
secondary education. Urgently addressing malnutrition
will not only save lives but also reduce inequalities and
build strong, resilient children, families, communities and
populations.
© World Vision Bangladesh 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Bangladesh Profile.
Report 2014.
3 National Institute of Population Research and Training, Mitra and Associates,
and ICF International (2013). Bangladesh Demographic and Health Survey 2011.
Registration.
Every Child.
6 UNICEF (2013).
7 IFPRI (2014). Global Nutrition Report 2014: Actions and Accountability to
Accelerate the World’s Progress on Nutrition.

8
Getting to Zero in Burundi
Based on current trends Burundi will get to zero preventable under-five deaths in 2025,
but will not get to zero preventable newborn deaths until 2032.Tens of thousands of
61%
31%
poorest women
richest women
51%
81%mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
74% rural children
87% urban children
Under 5 Mortality
Target for Burundi will be achieved in 2025 at current rates
YEAR
1960 1980 2000 2020
050100150200250
1960 1980 2000 2020
050100150200250
Newborn Mortality
YEAR
1990 2000 2010 2020 2030
010203040
1990 2000 2010 2020 2030
010203040
YEAR YEAR

9
The Government of Burundi must publicly commit and take action end preventable maternal,
newborn and child deaths as a priority, including through:
Burundi’s most vulnerable children
Projections on when Burundi could end preventable child
and newborn deaths are based on national averages and
hide the real picture for many children. Averages conceal
gaps between population groups, including rich and poor,
urban and rural, those with access to education and those
without. For many of the most vulnerable children, data
is inaccurate, inconsistent or unavailable, leaving them
at risk of falling through the gaps. In the next 15 years
our measurement must be different and success must
no target can be considered met by Burundi unless it is
measured and met by all population groups. Getting to
zero preventable child and newborn deaths in Burundi
most vulnerable children. For Burundi to get to zero on
More than one-third of all under five children deaths in
Burundi occur during the first 28 days in life.1 Access to
quality, skilled care around the time of birth could save the
lives of many of the 12,950 Burundi children who die in the
first month.2 On average 72.9% of deliveries are assisted
inequalities.3 Wealthy mothers are 1.5 times more likely
than poor mothers to have a skilled attendant at birth,
and educated mothers are 1.7 times more likely to have a
skilled attendant at birth than those with no education.4
Skilled birth attendance is crucial to closing the equity
gaps in Burundi and accelerating progress towards ending
On average 75% of Burundian children under five have
their birth registered.5 Birth registration provides legal
identity, serves as a gateway to access services such as
health care and education, and provides legal protection
nearly half a million unregistered Burundi children are not
afforded these rights or protections.7 Moreover, there is
an important gap between the rates of birth registration
based on sociodemographic factors: 87% of children
from urban areas are registered compared to 74% of
children from rural areas; 87% of the wealthiest children
are registered compared to only 64% of their poor
counterparts.8
and well-being
In Burundi 49% of children under five are stunted, a
form of chronic malnutrition the effects of which are
largely irreversible.9 Good nutrition, especially during the
critical 1,000 days between pregnancy and age two, is
foundational to the physical and cognitive development of
infants and young children. Children in Cankuzo province
are twice as likely to be stunted as children in Bujumbura.
Except for Bujumbura, Mairie, and Mwaro all the other
15 provinces are above the critical stunting threshold of
40% set by WHO. Mothers with no education are two
times more likely to have stunted children than mothers
with secondary education or higher.10 Urgently addressing
malnutrition will not only save lives but also reduce
inequalities and build strong, resilient children, families,
communities and populations.
© World Vision Burundi 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Burundi Profile.
Report 2014.
3 Ministere de la Sante Publique et de la Lutte contre le Sida (2013). Programme
National de Sante de la Reporduction, Rapport Annuel 2013.
4 Institut de Statistiques et d’Études Économique, Ministère de la Santé
Publique et de la Lutte contre le Sida and ICF International (2012). Enquête
Démographique et de Santé Burundi 2010.
Registration.
Every Child.
7 UNICEF (2013). Burundi Institute of Statistics and Economic Research
(2008). IFPRI (2014). Global Nutrition Report 2014: Actions and Accountability to
8 Institut de Statistiques et d’Études Économiques du Burundi, Ministère de la
Santé Publique et de la Lutte contre le Sida Burundi, and ICF International
(2012).
9 WFP Burundi (2014). Analyse Globale de la Securite Alimentaire, de la Nutrition
et de la Vulnerabilite au Burundi.
10 Institut de Statistiques et d’Études Économiques du Burundi, Ministère de la
Santé Publique et de la Lutte contre le Sida Burundi, and ICF International
(2012).

10
Getting to Zero in Cambodia
Based on current trends Cambodia will get to zero preventable under-five deaths in
2016 and zero preventable newborn deaths in 2017.Tens of thousands of children’s
lives are at stake.We can accelerate progress and get to zero faster.
48%
31%
poorest women
richest women
49%
97%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
60% rural children
74% urban children
Under 5 Mortality
Target for Cambodia will be achieved in 2016 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010
050100150200250300
1950 1960 1970 1980 1990 2000 2010
050100150200250300
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015
010203040
1990 1995 2000 2005 2010 2015
010203040
YEAR YEAR

11
To end preventable maternal, newborn and child deaths, the Royal Government of Cambodia
(RGC) should further prioritise:
• Implementing of the multi-sector National Strategy for Food Security and Nutrition (2014–2018).
• Fortifying food and diversifying dietary programmes to improve the nutritional status of children.
• Protecting the first 1,000 days by enforcing legislation on breast-milk substitute retail and marketing.
Cambodia’s most vulnerable children
Projections on when Cambodia could end preventable
child and newborn deaths is dependent on how vulnerable
population groups, including the poor, remote communities
and those with poor access to services, are reached.
The post-2015 development framework presents a new
opportunity to ensure national measurements accurately
reflect the challenges facing these groups – progress in
urban and wealthier provinces must not overshadow
the urgent need for nationwide progress. Renewed
commitment to vulnerable groups is required, along with
additional financing and detailed roadmaps that ensure key
interventions, like skilled birth attendants, birth registration
and growth monitoring. The most vulnerable Cambodian
children must be counted, heard and reached.
National progress in reducing children under-five mortality
rates decreased from 83 to 54 deaths per 1,000 live births
between 2005 and 2010 respectively.1 However, more
focused government programmes will be required to end
the 7,000 annual child deaths.2 Up to 40% of Cambodian
children are stunted, including 14% severely stunted.
Mothers with no education are more than 50% more
likely to have stunted children compared to mothers with
secondary education.3 The rate of reduction is far too slow,
and malnutrition interventions must be urgently prioritised.
Strengthening a multi-sector approach to
improving child and newborn nutrition
World Vision research in 2014 found that only 53% of
Cambodians could identify diverse causes of malnutrition.4
To address fully the causes and effects of malnutrition,
effort is required across a range of sectors, including
agriculture, education, water sanitation, and health.
Multi-sector approaches require strong coordination and
accountability across responsible government ministries
to lead to improved outcomes.5 The RGC must urgently
prioritise the implementation of the National Strategy for
Food Security and Nutrition (NSFSN 2014–2018), including
adequate budget allocation and accountability mechanisms
for each contributing ministry. The government must
also build upon its recent commitment to the Scaling Up
Nutrition (SUN) movement by strengthening proven
nutrition interventions and increasing cross-sector
coordination for nutrition.
Dietary diversification, food fortification and
complementary feeding practices
Increasing intake of micronutrients by encouraging the
consumption of foods with high nutritional value and
adding micronutrients to staple foods during manufacturing
should be a central component of Cambodia’s nutrition
and child health programme. Increasing consumption of
highly nutritious and fortified food significantly contributes
to getting to zero preventable child and newborn deaths.
In particular, food fortification has proven to be a rapid and
cost-effective method to enhance nutrition without drastic
changes in diet (as seen in the success of mandatory salt
iodisation). World Vision research shows that only 34% of
Cambodians have taken action to improve nutrition in the
last two years.6 While fortification programmes can help
to improve nutritional status, further cultural shifts are
necessary.
New policies on food composition standards and a sub-
decree for mandatory iron fortification of fish and soya
sauce should be immediate priorities of the government.
Protecting the first 1,000 days by enforcing
legislation on breast-milk substitutes
A World Vision perception study showed that only 28%
of people think that breast milk is better than breast-milk
substitutes, like baby formula.7 This low rate is made worse
by misleading marketing, promotion and labelling of baby
formula.8 Cambodia’s existing legislation, Sub-decree 133,
Marketing of Products for Infant and Young Child Feeding, is
not effectively enforced, and many companies violate the
legislation freely.
Breast-milk substitutes are targeted mainly at children
0–24 months, which is a critical period for a child’s physical
and cognitive development. Getting to zero preventable
child and newborn deaths will require a functional
monitoring authority for the advertising, retailing and
promotion of breast-milk substitutes.
© World Vision Cambodia 2015 | www.childhealthnow.org
1 National Institute of Statistics, Directorate General for Health, and ICF
Macro (2011). Cambodia Demographic and Health Survey 2010.
Report 2014.
3 National Institute of Statistics, Directorate General for Health, and ICF
Macro (2011).
4. World Vision Cambodia and GNIM Chandara (2014). Nutrition Public
Perception Survey: Baseline Report.
5 World Bank (2013). Improving Nutrition Through Multi-sectoral Approaches.
6 World Vision Cambodia and GNIM Chandara (2014).
7 Ibid.
8 World Vision Cambodia (2014). Improving Child Nutrition by Enforcing Sub-
Decree 133 on Market of Product for Infant and Young Child Feeding.

12
Getting to Zero in Chad
Based on current trends Chad will get to zero preventable under-five deaths in 2050
and zero preventable newborn deaths in 2076.This is too late for tens of thousands
of children.We can accelerate progress and get to zero faster.
42%
24%
poorest women
richest women
8%
61%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
9% rural children
42% urban children
Under 5 Mortality
Target for Chad will be achieved in 2050 at current rates
YEAR
1960 1980 2000 2020 2040
050100150200250
1960 1980 2000 2020 2040
050100150200250
Newborn Mortality
YEAR
2000 2020 2040 2060 2080
01020304050
2000 2020 2040 2060 2080
01020304050
YEAR YEAR

13
The Government of Chad must improve public commitment to and take more action to end
preventable maternal, newborn and child deaths as a priority, including through:
Chad’s most vulnerable children
Projections on when Chad could end preventable child
without. Of children age zero to four years, 1.6% are
handicapped, as are 3% of children age five to fourteen
years. The only available information does not include
anything on the needs of disabled children or respect for
their rights.1 For many of the most vulnerable children,
data is inaccurate, inconsistent or unavailable, leaving them
at risk of falling through the gaps.
Success must be redefined; in the post-2015 development
framework no target can be considered met by Chad
unless it is measured and met by all population groups.
Skilled birth attendance, birth registration and nutrition
show particular disparities for the most vulnerable children.
Strong accountability mechanisms are critical, with progress
measured for outcomes of the most vulnerable. Getting
to zero preventable child and newborn deaths in Chad
detailed roadmaps targeting the most vulnerable; all
Skilled birth attendance and reproductive
health to ensure mothers and newborns
survive and thrive
Nearly one-third of all child deaths in Chad occur during
around the time of birth could save the lives of many of the
23,000 Chadian children that die in the first month.3 On
average only 35% of deliveries at home and 26% in health
facilities are assisted by a skilled birth attendant, but this is
skewed by huge inequalities.4 Wealthy mothers are nearly
eight times more likely than poor mothers to have a skilled
attendant at birth; likewise educated mothers are nearly
eight times more likely than those with no education to
have a skilled attendant at birth.5 Reproductive health is
also an issue in rural areas, where the rate of contraception
use is 3% and 1.6% for modern methods; only 15% of
family planning demand is met.6 Skilled birth attendance
and reproductive health are crucial to closing the equity
gaps in Chad and accelerating progress towards ending
Only 16% of Chadian children under five have their birth
registered and certified; this is the fifth lowest rate in the
world.7 Birth registration provides legal identity, serves
as a gateway to access services such as health care and
education, and provides legal protection from violence,
abuse, exploitation and neglect.8 However, thousands of
unregistered Chadian children are not afforded these rights
or protections. Children from urban areas are nearly five
times more likely to be registered than children from rural
areas (42% and 9%), and the wealthiest children are nine
times more likely to be registered than the poorest (42%
and 5%); children who have a mother with secondary
education or higher are four times more likely to be
registered than those with mothers with no education.9
and well-being
In Chad 39% of children under five are stunted, a form
of chronic malnutrition the effects of which are largely
irreversible.10 Childhood wasting stands at 16% and
underweight at 30%. All three of these global nutrition
targets are off track. Good nutrition, especially during the
infants and young children. Chadian children of uneducated
mothers are nearly two times as likely to be chronically
malnourished than children of mothers with secondary
education. Urgently addressing malnutrition will not only
save lives but also reduce inequalities and build strong,
© World Vision Chad 2015 | www.childhealthnow.org
1 IBCR (International Bureau for Children’s Rights) (2014). Cartographie et
Évaluation du Système de Protection de l’Enfant et de la Formation des Forces de
Sécurité sur les Droits de l’Enfant au Tchad.
Women and Children: The 2014 Report. Chad Profile.
3 UNICEF (2014). Committing to Child Survival: A Promise Renewed: Progress Report
2014.
4 Republique du Tchad (2013). Annuaire des Statistiques Sanitaires du Tchad 2013.
5 UNICEF Chad and Ministry of Planning, Economy and International
Cooperation (2011). Multiple Indicator Cluster Survey 2010.
6 UNICEF and WHO (2014).
7 UNICEF (2013). Every Child’s Birth Right: Inequities and Trends in Birth Registration.
Every Child.
9 UNICEF Chad and Ministry of Planning, Economy and International
Cooperation (2011).
10 IFPRI (2014). Global Nutrition Report 2014: Actions and Accountability to Accelerate
the World’s Progress on Nutrition.

14
Getting to Zero in
Democratic Republic of Congo
Based on current trends Democratic Republic of Congo will get to zero preventable
under-five deaths in 2035 and zero preventable newborn deaths in 2050.This is too late
for hundreds of thousands of children.We can accelerate progress and get to zero faster.
51%
13%
poorest women
richest women
66%
98%mothers with
superior
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
22% rural children
30% urban children
Under 5 Mortality
Target for Congo DR will be achieved in 2035 at current rates
YEAR
1960 1980 2000 2020
050100150200250
1960 1980 2000 2020
050100150200250
Newborn Mortality
Target for Congo DR will be achieved in 2050 at current rates
YEAR
1990 2000 2010 2020 2030 2040 2050
010203040
1990 2000 2010 2020 2030 2040 2050
010203040
Target for DRC will be achieved in 2035 at current rates
YEAR YEAR
Target for DRC will be achieved in 2050 at current rates

15
The Government of the Democratic Republic of Congo must officially commit and take action
to end preventable maternal, newborn and child deaths as a priority, including through:
• Increasing allocation of resources to the health sector to 15% of the total national budget and ensuring
accountability and transparency of resource use.
• Prioritising children’s health and development in the post-2015 development framework, including
through goals and targets to end preventable maternal, newborn and child deaths, to eliminate childhood
malnutrition, and to end all forms of violence against girls and boys.
• Focusing on the most vulnerable and hardest-to-reach children, particularly those affected by fragility
and conflict.
• Building accountability systems that include citizen participation in monitoring and evaluation.
DRC’s most vulnerable children
Projections on when the Democratic Republic of Congo
(DRC) could end preventable child and newborn deaths
are based on national averages and hide the real picture for
many children. Averages conceal gaps between population
groups, including rich and poor, urban and rural, those with
access to education and those without. For many of the
most vulnerable children, data is inaccurate, inconsistent
or unavailable, leaving them at risk of falling through the
gaps. In the next 15 years our measurement must be
different and success must be redefined; in the post-2015
development framework no target can be considered met
by DRC unless it is measured and met by all Congolese.
Getting to zero preventable child and newborn deaths in
DRC requires renewed commitment, additional financing
and more detailed roadmaps with greater attention
to targeting the most vulnerable. Strong accountability
mechanisms are critical, with progress measured against
outcomes for the most vulnerable. Skilled birth attendance
and nutrition show particular disparities for the most
vulnerable children. For DRC to get to zero preventable
child and newborn deaths all children must be counted,
heard and reached.
One-third of all child deaths in the DRC occur during the
first 28 days of life.1 Access to quality, skilled care around
the time of birth could save the lives of women who die
during childbirth or shortly after and of many Congolese
children who die in the first month of life. On average,
80% of deliveries are assisted by a skilled birth attendant,2
but wealthy mothers are 1.5 times more likely than poor
mothers to have a skilled attendant at birth.3 Skilled birth
attendance is crucial to closing the equity gaps in DRC and
accelerating progress towards ending preventable maternal
and newborn deaths.
In the DRC, only one in four children under age five has
his or her birth registered and certified.4 Almost 30% of
children in urban areas are registered, compared to 22%
of children in rural areas.5 Birth registration provides legal
from violence, abuse, exploitation and neglect. However,
8 million Congolese children whose births have not been
registered do not receive these rights and protection.6
and well-being
In the DRC 43% of children under five are stunted, a form
irreversible.7 Good nutrition, especially during the first
1,000 days between pregnancy and age two, is critical
to the physical and cognitive development of children.
Congolese children of uneducated mothers are nearly
four times more likely to be chronically malnourished than
those whose mothers have superior education.8
Worldwide, children in the poorest households are two
to three times more likely to die or to be malnourished
than those living in the wealthiest. In the DRC one in
eight children under five living in rural areas are likely to
die versus one in ten children under five in urban areas.9
Urgently addressing malnutrition will not only save lives but
also reduce inequalities and build strong, resilient children,
families, communities and populations.
© World Vision DRC 2015 | www.childhealthnow.org
1 UNICEF (2015). State of the World’s Children 2015.
2 République Démocratique du Congo (2014). EDS-RDC II (Democratic Republic
of Congo Demographic and Health Survey 2013–2014).
3 Ibid.
4 Ibid.
5 UNICEF (2015).
7 République Démocratique du Congo (2014).
8 Ibid.
9 Ibid.

16
Getting to Zero in Ethiopia
Based on current trends Ethiopia will get to zero preventable under-five deaths
43%
8%
poorest women
richest women
2%
46%mothers with
more than
secondary
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
5% rural children
29% urban children
Under 5 Mortality
Target for Ethiopia will be achieved in 2020 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
YEAR YEAR

17
The Government of Ethiopia and development partners should commit to and take action to
end preventable maternal, newborn and child deaths as a priority, including through:
• Scaling up efforts to address the bottlenecks of low skilled birth attendance by working with faith-based
and community-based organisations.
Ethiopia’s progress to date on national and
international commitments
Ethiopia has made significant progress improving maternal
and child health through co-sponsoring the ‘A Promise
Renewed’ initiative, which contributed to achieving
Millennium Development Goal 4 ahead of the deadline.1
Yet, despite encouraging trends, national average
projections on when Ethiopia could end preventable
child and newborn deaths hide the real picture. Averages
conceal gaps between population groups, including rich and
poor, urban and rural, those with access to education and
those without. For many of the most vulnerable children,
data is inaccurate, inconsistent or unavailable, leaving
them at risk of falling through the gaps. Success must
no target can be considered met by Ethiopia unless it
is measured and met by all population groups. Strong
accountability mechanisms are critical, with progress
measured against outcomes for the most vulnerable. Skilled
birth attendance, birth registration and nutrition show
particular disparities for the most vulnerable children.
Getting to zero preventable child and newborn deaths
in Ethiopia requires renewed commitment, additional
financing and more detailed roadmaps with greater
attention to targeting the most vulnerable; all children must
be counted, heard and reached.
and newborn survive and thrive
Four of every ten child deaths in Ethiopia occur during
the first 28 days in life.2 Currently, only 15% of births
are attended by a skilled professional.3 The number of
midwives has increased nearly fourfold since 2008; this
needs to double again to reach the 2015 target.4 The
wealthiest mothers are nearly 27 times more likely to
receive skilled attendance during birth compared to their
poor counterparts; likewise mothers with secondary
education or higher are 16 times more likely to receive care
than mothers with no education.5 Skilled birth attendance
is crucial to closing the equity gaps in Ethiopia and
and newborn deaths.
The most recent statistics on birth registration, a decade
old, report that only 5% of children under five are
registered at birth; this is the third lowest in the world.6
More than 80% of registered children do not have a birth
certificate.7 Birth registration provides legal identity, serves
abuse, exploitation and neglect.8 A shocking 13 million
Ethiopian children are not afforded these rights or
protections. Urban children are nearly six times more likely
to be registered than children in rural areas; the wealthiest
children are seven times more likely to be registered
than the poorest. Registering every newborn and child in
Ethiopia will provide an identity, access to social services
and protection.
and well-being
In Ethiopia 40% of children under five are stunted, a form
irreversible.9 Good nutrition, especially during the critical
1,000 days between pregnancy and age two, is foundational
to the physical and cognitive development of infants. While
Ethiopia reduces stunting at an average rate of 2.3% a
year, there are still over 6 million chronically malnourished
Ethiopian children.10 The poorest children in Ethiopia are
nearly two times more likely to be chronically malnourished
than their wealthy counterparts; likewise, children living in
Affar region are two times more likely to be stunted than
children living in Addis Ababa. Ethiopia is currently off track
to reach the Global Nutrition Target on stunting, wasting
and anemia.11 Urgently addressing malnutrition will not
© World Vision Ethiopia 2015 | www.childhealthnow.org
1 UNICEF (2012). Committing to Child Survival: A Promise Renewed: Progress Report
2014.
Women and Children: The 2014 Report. Ethiopia Profile.
3 Central Statistical Agency Ethiopia (2014). Ethiopia Mini Demographic and Health
Survey 2014.
4 UNFPA (United Nations Population Fund) (2012). The State of the World’s
Midwifery. Ethiopia Profile.
5 Central Statistical Agency Ethiopia and ICF International (2012). Ethiopia
Demographic and Health Survey 2011.
6 Central Statistical Agency Ethiopia and ORC Macro (2006). Ethiopia
Every Child.
9 Central Statistical Agency Ethiopia (2014).
10 Scaling Up Nutrition (2014). Annual Progress Report. Ethiopia Profile.
11 IFPRI (2014). Global Nutrition Report 2014: Actions and Accountability to Accelerate
the World’s Progress on Nutrition.

18
Getting to Zero in Ghana
Based on current trends Ghana will get to zero preventable under-five deaths in 2044
and zero preventable newborn deaths in 2058.This is too late for tens of thousands
of children.We can accelerate progress and get to zero faster.
29%
13%
poorest women
richest women
39%
98%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
55% rural children
72% urban children
Under 5 Mortality
Target for Ghana will be achieved in 2044 at current rates
YEAR
1960 1980 2000 2020 2040
050100150200250
1960 1980 2000 2020 2040
050100150200250
Newborn Mortality
YEAR
1990 2000 2010 2020 2030 2040 2050 2060
010203040
1990 2000 2010 2020 2030 2040 2050 2060
010203040
YEAR YEAR

19
We encourage the Government of Ghana to publicly commit and take action to end
preventable maternal, newborn and child deaths, including through:
• Accelerating progress towards attaining the Millennium Development Goals while continuing to improve
maternal, newborn and child health under the post-2015 framework.
• Improving equitable access to health care by increasing the national health budget as per the Abuja
Declaration (2001) and prioritising posting of skilled and motivated health professionals, particularly skilled
birth attendants, to rural communities.
• Identifying the most vulnerable children in Ghana, who are often uncounted, unseen and unreached, and
ensuring they have access to quality and appropriate health care.
• Scaling up efforts to ensure improved nutrition, particularly in remote and hard-to-reach areas.
Ghana’s most vulnerable children
Projections on when Ghana could end preventable child
hide the reality for many children. Averages conceal gaps
between population groups, including rich and poor,
without. For many of the most vulnerable children, data is
inaccurate, inconsistent or unavailable, leaving them at risk
of falling through the gaps. In the post-2015 development
framework measurement must be different and success
must be redefined; no target should be considered met
by Ghana unless it is measured and met by all population
groups. Getting to zero preventable child and newborn
deaths in Ghana requires renewed commitment, additional
targeting of the most vulnerable. Strong accountability
outcomes for the most vulnerable. Skilled birth attendants,
birth registration and nutrition show particular disparities
for the most vulnerable children. For Ghana to get to zero
Skilled birth attendants to ensure mothers
In every 100,000 live births in Ghana each year 329
mothers are likely to die.1 Close to half of all child deaths in
Ghana occur during the first 28 days of a child’s life. Access
to quality, skilled care around the time of birth could save
the lives of thousands of Ghanaian children and mothers
each year. Wealthy mothers are 2.5 times more likely than
poor mothers to have a skilled attendant at birth, and
educated mothers are four times more likely to give birth
with a skilled attendant than those with no education.2
Essential health care has huge disparities between urban
and rural areas.3 Skilled birth attendants are crucial to
closing the equity gaps in Ghana and accelerating progress
towards ending preventable maternal and newborn deaths.
Only 63% of children under five have their birth registered
and certified, leaving 38% of children under five without
any legal document to support their identity. Most of these
children are found in rural and hard-to-reach areas.4 Birth
registration provides legal identity, serves as a gateway
to access services such as health care and education, and
provides legal protection from violence, abuse, exploitation
and neglect.5 In Ghana 1.3 million children’s births are not
registered. There are large geographical disparities with
regards to birth registration. The Ashanti region has the
highest number of unregistered children (16%) followed
by Western (13%), Northern (13%), Eastern (12%), Brong
Ahafo (12%) and Volta region (11%). Urban dwellers are
30% more likely to obtain birth registration certificates
than their rural counterparts.6
and well-being
Malnutrition is the underlying cause of nearly half of all
child deaths worldwide.7 In Ghana 23% of children under
five are stunted, a form of chronic malnutrition the effects
of which are largely irreversible, with large disparities
along socioeconomic and geographical lines.8 A recent
study suggests that the high prevalence of undernutrition
and inadequate nutrition practices for mothers and young
children might be reasons for the stagnated reduction of
child mortality in Ghana.9 Good nutrition, especially during
of infants and young children. Urgently addressing
inequalities and build strong, resilient children, families and
communities.
© World Vision Ghana 2015 | www.childhealthnow.org
1 UN Estimation Group (2014). Levels and Trends in Maternal Mortality 2014.
2 Ghana Statistical Service. (2011). Ghana Multiple Indicator Cluster Survey with
an Enhanced Malaria Module and Biomarker, 2011, Final Report.
3 Ibid.
4 Ibid.
Every Child.
6 Ghana Statistical Service (2011).
8 Ghana Statistical Service (2011).
9 Badasu (2013). Child Health Now Assessment on Health Policies Implementation
in Ghana.

20
Getting to Zero in India
Based on current trends India will get to zero preventable under-five deaths in 2023,
but will not get to zero preventable newborn deaths until 2031. Millions of children’s
57%
22%
poorest women
richest women
24%
85%mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
35% rural children
59% urban children
Under 5 Mortality
Target for India will be achieved in 2023 at current rates
YEAR
1960 1980 2000 2020
050100150200250
1960 1980 2000 2020
050100150200250
Newborn Mortality
YEAR
1990 2000 2010 2020 2030
01020304050
1990 2000 2010 2020 2030
01020304050
YEAR YEAR

21
The Government of India must commit and take action to end preventable maternal, newborn
and child deaths as a priority, including through:
• Identifying the most vulnerable children, with a specific focus on Scheduled Castes and Scheduled Tribes
and other marginalised communities, providing access to free, quality health services.
• Increasing investment in free, quality, accessible health services with sufficient trained staff.
• Strengthening accountability systems that include citizen participation in monitoring and review, especially
engaging the most marginalised communities.
India’s most vulnerable children
Projections on when India could end preventable child
and newborn deaths are based on national averages,
which hide the real picture for many children. Averages
or those without, those belonging to the Scheduled
Castes and Tribes (SC ST) or minorities. For many of the
most vulnerable children, data is inaccurate, inconsistent
or unavailable, leaving them at risk of falling through the
gaps. In the next 15 years our measurement must be
different and success must be redefined; in the post-2015
development framework no target can be considered met
by India unless it is measured and its impact seen by all
population groups. Getting to zero preventable child and
newborn deaths in India requires renewed commitment,
additional financing and more detailed roadmaps with
greater attention to targeting the most vulnerable and
addressing the social determinants that perpetuate this
cycle. Strong accountability mechanisms are critical,
with progress measured against outcomes for the most
vulnerable. Skilled birth attendance, birth registration and
nutrition status show particular disparities for the most
vulnerable children. For India to get to zero preventable
heard and reached.
More than half of all child deaths in India occur during the
first 28 days in life.1 Access to quality, skilled care around
the time of birth could save the lives of many of the
748,000 Indian children who die in the first month.2 On
average 52% of deliveries are assisted by a skilled birth
attendant, but this is skewed by huge inequalities.3 Wealthy
mothers are 3.5 times more likely than poor mothers to
have a skilled attendant at birth. Skilled birth attendance is
crucial to closing the equity gaps in India and accelerating
progress towards ending preventable maternal and
newborn deaths.
Nearly one in three unregistered children of the globe live
in India.4 Birth registration provides legal identity, serves
abuse, exploitation and neglect.5 However, 71 million
unregistered Indian children are not afforded these rights
or protections.6 Children from urban areas are 1.7 times
more likely to be registered than children from rural areas,
and the wealthiest children are three times more likely
to be registered than their poor counterparts. Similarly,
children of SC ST are twice as likely to be unregistered at
birth as children of other castes.
and well-being
In India 48% of children under five are stunted, a form
irreversible.7 Good nutrition, especially during the
foundational to the physical and cognitive development
of infants and young children. The poorest children in
India are nearly three times more likely to be chronically
malnourished than their wealthy counterparts; likewise,
children of uneducated mothers are 2.6 times more
likely to be chronically malnourished; those who dwell
in rural areas are also at higher risk. Urgently addressing
© World Vision India 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. India Profile.
Report 2014.
3 UNICEF (2015). The State of the World’s Children 2015: Reimagine the Future:
Innovation for Every Child.
Registration.
Every Child.
6 International Institute for Population Sciences (IIPS) and Macro International
(2007). National Family Health Survey (NFHS-3), 2005–06: India.

22
Getting to Zero in Indonesia
Based on current trends Indonesia will get to zero preventable under-five deaths
BIRTH REGISTRATION
poorest women
richest women
58%
97%
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
58% rural children
76% urban children
Under 5 Mortality
Target for Indonesia will be achieved in 2016 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010
050100150200250300
1950 1960 1970 1980 1990 2000 2010
050100150200250300
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015
051015202530
1990 1995 2000 2005 2010 2015
051015202530
YEAR YEAR
CHILDHOOD STUNTING
40%
25%
Mothers with
secondary
education
or higher
Mothers
with no
education
DATA
N
O
T
AVAILABLE

23
The Government of Indonesia must publically commit and take action to end preventable
• Identifying the most vulnerable children and prioritising resources towards them.
• Increasing investment in ensuring availability of sufficiently trained staff at accessible quality health facilities
in the most deprived provinces and districts.
• Fully adopting the International Code of Marketing of Breastmilk Substitutes.
• Improving maternity protection by ensuring that public facilities and workplaces support breastfeeding
women.
• Strengthening public accountability systems, including citizen participation in monitoring and review.
Indonesia’s most vulnerable children
Projections on when Indonesia could end preventable
no target can be considered met by Indonesia unless it is
zero preventable child and newborn deaths in Indonesia
registration and nutrition show particular disparities for
the most vulnerable children. For Indonesia to get to zero
Half of all child deaths in Indonesia occur during the first
28 days in life.1 Access to quality, skilled care around the
time of birth could save the lives of many of the 66,000
Indonesian children who die in their first month.2 On
average 83% of deliveries are assisted by a skilled birth
attendant, but this is skewed by huge inequalities. Wealthy
mothers are 1.6 times more likely than poor mothers to
have a skilled attendant at birth, and educated mothers are
three times more likely to have a skilled attendant at birth
than those with no education.3 Skilled birth attendance
is crucial to closing the equity gaps in Indonesia and
and newborn deaths.
Only two in three Indonesia children under five have their
8 million unregistered Indonesian children are not afforded
these rights or protections.6 Children from urban areas are
1.3 times more likely to be registered than children from
rural areas, and the wealthiest children are 2.2 times more
likely to be registered than their poor counterparts.
and well-being
In Indonesia 37% of children under five are stunted, a
Indonesia are nearly twice as likely to be chronically
malnourished as their wealthy counterparts; children
of uneducated household heads are more likely to be
chronically malnourished. Those who dwell in rural areas
are also at higher risk.8 Urgently addressing malnutrition
will not only save lives but reduce inequalities and build
strong, resilient children, families, communities and
populations.
© World Vision Indonesia 2015 | www.childhealthnow.org
1 Statistics Indonesia, National Population and Family Planning Board,
Kementerian Kesehatan, and ICF International (2013). Indonesia Demographic
and Health Survey 2012.
Report 2014.
Kementerian Kesehatan, and ICF International (2013).
Registration.
Every Child.
6 UNICEF (2013).
Kementerian Kesehatan, and ICF International (2013).
8 Ibid.

24
Getting to Zero in Kenya
Based on current trends Kenya will get to zero preventable under-five deaths in 2028
but will not get to zero preventable newborn deaths until 2043.Hundreds of thousands
of children’s lives are at stake.We can accelerate progress and get to zero faster.
31%
17% poorest women
richest women
31%
93%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
57% rural children
76% urban children
Under 5 Mortality
Target for Kenya will be achieved in 2028 at current rates
YEAR
1960 1980 2000 2020
050100150200250300
1960 1980 2000 2020
050100150200250300
Newborn Mortality
YEAR
1990 2000 2010 2020 2030 2040
051015202530
1990 2000 2010 2020 2030 2040
051015202530
YEAR YEAR

25
The County Governments in Kenya should take action to end preventable maternal,
newborn and child deaths by:
• Increasing investment in quality and accessible health services with sufficiently trained staff.
• Strengthening accountability systems; including reporting on performance, fostering transparency and public
participation in decision-making on health-related matters.
Kenya’s most vulnerable children
Projections on when Kenya could end preventable child
urban and rural, those with access to education and
them at risk of falling through the gaps. In the next 15
years measurement must be different and success must
no target can be considered met by Kenya unless it is
zero preventable child and newborn deaths in Kenya
the most vulnerable. In Kenya, County Governments
have a particular responsibility for health care service
delivery and, as such, have a vital role to play in ensuring
access to quality services for women and children. Strong
measured against outcomes for the most vulnerable.
For Kenya to get to zero preventable child and newborn
deaths all children must be counted, heard and reached.
Of all child deaths in Kenya 42% occur during the first 28
days of life.1 Access to quality, skilled care around the time
of birth could save the lives of many of the 189,000 Kenyan
children who die in their first month.2 On average 62%
of deliveries are assisted by a skilled birth attendant, but
this is skewed by huge inequalities. Wealthy mothers are
three times more likely than poor mothers to have a skilled
attendant at birth, and educated mothers are three times
more likely to have a skilled attendant at birth than those
closing the equity gaps in Kenya and accelerating progress
At the beginning of 2014 Kenya had achieved 50.1% birth
registration coverage.4 Birth registration provides legal
from violence, abuse, exploitation and neglect. Even
though the Government of Kenya has a civil registration
strategic plan for 2013–17 in place, more financial
and human resources are required to reach the most
vulnerable children living in the hard-to-reach parts of the
country and to ensure they are registered and issued birth
certificates.
and well-being
In Kenya, one in every four children under five is stunted,
irreversible. Stunting increases with increase in child age.5
Ten per cent of children under six months are stunted,
while 36% of children aged 18–23 months are stunted.
Good nutrition, especially during the critical 1,000 days
between pregnancy and age two, is foundational to
the physical and cognitive development of infants and
young children. Mothers with no education are more
than two times more likely to have stunted children,
compared to mothers with secondary education or higher.
Urgently addressing malnutrition by scaling up nutrition
interventions will enable Kenya to attain Vision 2030 and
improve the quality of life of children. Adequate resources
should be allocated to support nutrition interventions
including linkages to agriculture, water, sanitation and
hygiene, and education.
© World Vision Kenya 2015 | www.childhealthnow.org
1 Kenya National Bureau of Statistics, Ministry of Health and ICF International
(2015). Kenya Demographic and Health Survey 2014 Key Indicators.
2 Ibid. Ministry of Health (2013). World Health Statistics: A National Framework
and Plan of Action for the Implementation of Integrated Case Management (ICCM)
in Kenya, 2012–2017.
(2015).
4 Republic of Kenya, Civil Registration Department, Strategic Plan (2013–2017).
(2015).

26
Getting to Zero in Lesotho
Based on current trends Lesotho will get to zero preventable under-five deaths in
2071 and zero preventable newborn deaths in 2097.This is too late for thousands of
children.We can accelerate progress and get to zero faster.
41%
31%
poorest women
richest women
35%
90%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
46% rural children
43% urban children
Under 5 Mortality
Target for Lesotho will be achieved in 2071 at current rates
YEAR
1960 1980 2000 2020 2040 2060
050100150200250
1960 1980 2000 2020 2040 2060
050100150200250
Newborn Mortality
YEAR
2000 2020 2040 2060 2080 2100
010203040
2000 2020 2040 2060 2080 2100
010203040
YEAR YEAR

27
The Government of Lesotho must publicly commit and take action to end preventable
• Taking steps to ensure that birth registration is effectively implemented and enforced.
• Commiting financial resources and technical capacity to equip the National Identity and Civil Registry
Department to promote the effectiveness of birth registration systems and processes.
Lesotho’s most vulnerable children
Projections on when Lesotho could end preventable child
no target can be considered met by Lesotho unless it
is measured and met by all Basotho. Getting to zero
preventable child and newborn deaths in Lesotho requires
renewed commitment, additional financing and more
detailed roadmaps with greater attention to targeting the
most vulnerable. Strong accountability mechanisms are
critical, with progress measured against outcomes for the
most vulnerable. Skilled birth attendance, birth registration
vulnerable children. For Lesotho to get to zero preventable
heard and reached.
In Lesotho 46% of all child deaths occur during the first
Basotho children who die in their first month each year.2
On average 61.5% of deliveries are assisted by a skilled
birth attendant, but the wealthiest are 2.5 times more
likely to receive skilled birth attendance than their poor
counterpart.3 Skilled birth attendance is crucial to closing
the equity gaps in Lesotho and accelerating progress
Nearly half of all Basotho children under five have their
birth registered, but 60% of registered children do not
have a birth certificate.4 Birth registration provides legal
from violence, abuse, exploitation and neglect.5 Despite
the establishment of the National Identity and Civil
Registration Department in 2012, challenges regarding
birth registration remain. These include lack of knowledge
on the documents required for registration, and, in
cases where guardians of orphaned children are seeking
to register them, they often do not have the particular
information required regarding the orphan’s birth.
and well-being
In Lesotho 39% of children under five are stunted, a form
irreversible.6 Childhood wasting in Lesotho stands at 4%
and overweight at 7%. Childhood anaemia is also high.
Lesotho is off track on all four global nutrition targets
currently measured. Good nutrition, especially during the
of infants and young children. Children of mothers with
no education are 30% more likely to be chronically
malnourished compared to children of their educated
counterparts. Similarly, the poorest children are 60% more
likely to be chronically malnourished than the wealthiest
Basotho children. Urgently addressing malnutrition will not
© World Vision Lesotho 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Lesotho Profile.
Report 2014.
3 Ministry of Health and Social Welfare (MOHSW) Lesotho and ICF Macro
(2010). Lesotho Demographic and Health Survey 2009.
Registration.
Every Child.

28
Getting to Zero in Malawi
Based on current trends Malawi will get to zero preventable under-five deaths in
CHILDHOOD STUNTING
53%
39%
poorest women
richest women
63%
89%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
Under 5 Mortality
Target for Malawi will be achieved in 2019 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
0100200300
1950 1960 1970 1980 1990 2000 2010 2020
0100200300
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020
01020304050
1990 1995 2000 2005 2010 2015 2020
01020304050
BIRTH REGISTRATION
23% rural children
59% urban children
DATA NOT AVAILABLE
YEAR YEAR

29
The Government of Malawi must publicly commit and take action to end preventable maternal,
• Identifying the most vulnerable children and better targeting of resources towards them.
• Ensuring implementation of birth registration across Malawi within three years.
• Accelerating implementation of existing instruments to end child marriages.
Malawi’s most vulnerable children
Projections on when Malawi could end preventable child
is inaccurate, inconsistent or unavailable, leaving them at
risk of falling through the gaps. Success must be redefined;
in the post-2015 development framework no target can
be considered met by Malawi unless it is measured and
met by all population groups. Getting to zero preventable
child and newborn deaths in Malawi requires renewed
commitment, additional financing and more detailed
roadmaps with greater attention to targeting the most
vulnerable. Skilled birth attendance, birth registration, child
protection and nutrition show particular disparities for
the most vulnerable children. For Malawi to get to zero
One-third of all child deaths in Malawi occur during the
first 28 days of life.1 Access to quality, skilled care around
the time of birth could save the lives of many of the 14,000
Malawian children who die in their first month.2 On
average 87% of mothers delivered with a skilled attendant.3
Nearly 90% of mothers in the wealthiest quintile of the
population received skilled birth attendance compared
to only 63% of mothers in the poorest quintile, despite
the Government’s commitment to ensure full coverage
of skilled birth attendance.4 Addressing this is crucial to
closing the equity gaps in Malawi and accelerating progress
Every child should be registered at birth. Birth registration
provides legal identity, serves as a gateway to access
services such as health care and education, and provides
legal protection from violence, abuse, exploitation and
neglect.5 The Malawi Constitution – Section 23(2) –
provides that all children shall have the right to a name and
nationality. Even though the National Registration Bill
No. 15 assented into law on 8 January 2010 as the National
Registration Act No. 13 of 2010, less than 20% of all births
are registered.6
Eliminating early marriages to protect children
Malawi has instilled policy to protect children from early
marriage, including the Child Care, Protection and Justice
Act (2010), Malawi Gender Equality Act (2013) and the
new Marriage Divorce and Family Relations Act (2015).
Malawi continues to register unprecedented levels of early
marriage, with 49.6% of girls married before age 18.7 The
basic human rights of these girls are violated, subjecting
them to a vicious cycle of exploitation.
and well-being
In Malawi 42.4% of children under five are stunted, a form
irreversible.8 More than half (53%) of children born to
mothers with no education are stunted, compared to 39%
of children whose mothers have secondary education or
higher.9 Good nutrition, especially during the critical 1,000
days between pregnancy and age two, is foundational
young children. Urgently addressing malnutrition will
save lives and reduce inequalities to build strong, resilient
children, families, communities and populations.
© World Vision Malawi 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Malawi Profile.
Report 2014.
3 National Statistical Office Malawi (2014). Malawi MDG Endline Survey 2014,
Key Findings.
4 National Statistical Office Malawi and ICF Macro (2011). Malawi Demographic
Every Child.
6 UNICEF (2015). Fast facts on Children: Birth Registration.
7 Government of Malawi (2014). Violence against Children and Young Women in
Malawi: Findings from a National Survey: Report 2013.
9 National Statistical Office and ICF Macro (2011).

30
Getting to Zero in Mali
Based on current trends Mali will get to zero preventable under-five deaths in 2027,
40%
24%
poorest women
richest women
35%
94%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
82% rural children
95% urban children
Under 5 Mortality
Target for Mali will be achieved in 2027 at current rates
YEAR
1960 1980 2000 2020
0100200300400500
1960 1980 2000 2020
0100200300400500
Newborn Mortality
YEAR
1990 2000 2010 2020 2030 2040
0102030405060
1990 2000 2010 2020 2030 2040
0102030405060
YEAR YEAR

31
The Government of Mali must publicly commit and take action to end preventable maternal,
• Continuing to extend health services towards universal coverage of quality health care, fully addressing gaps
in essential interventions, especially emergency obstetric and newborn care, malnutrition management and
Integrated Management of Childhood Illnesses.
• Working progressively to reach the most vulnerable children through the expansion of universal health
insurance coverage, training and retaining midwives and community health agents, and improving
inter-ministerial dialogue, coordination and sectoral budget prioritisation.
• Implementing a national strategic plan to improve the reproductive health of adolescents, including clear
measures to address early marriage, early pregnancies and female genital mutilation.
Mali’s most vulnerable children
Projections on when Mali could end preventable child
of falling through the gaps. Success must be redefined; in
the post-2015 development framework no target can be
considered met by Mali unless it is measured and met by all
population groups. Getting to zero preventable child and
newborn deaths in Mali requires renewed commitment,
greater attention to targeting the most vulnerable. Strong
For Mali to get to zero preventable child and newborn
deaths all children must be counted, heard and reached,
including through universal coverage of essential health
services and access to health insurance to reduce financial
barriers for the poor.
More than one-third of all child deaths in Mali occur
of the 28,000 children who die in their first month.2 On
average, 59% of deliveries are assisted by a skilled birth
attendant, but this average is skewed by huge inequalities.
The wealthiest women are 2.7 times more likely to have
a skilled attendant at birth compared to the poorest
women; similarly, educated mothers are 1.7 times more
likely to have a skilled attendant at birth than those with no
education. Neonatal mortality is 40% higher for mothers
under 20 compared to women aged 20-29; the risk of
dying before reaching one year of age is 19% higher for
children of mothers aged 15-19 compared with children
born to mothers aged 20 years or older.3 Equal access to
skilled birth attendance and addressing the adolescent
reproductive health needs, including early marriage and
early pregnancies, are crucial to accelerate progress
towards ending preventable maternal and newborn deaths
in Mali.
Three in four children under the age of five in Mali have
their birth registered and certified.4 Birth registration
neglect.5 However, thousands of unregistered Malian
children are not afforded these rights or protections.
The birth registration rate for children from urban areas
is 13% higher than for children from rural areas, and the
wealthiest children are 50% more likely to be registered
than their poor counterparts.6
and well-being
In Mali 38% of children under five are stunted, a form
irreversible. Good nutrition, especially during the
infants. The poorest children in Mali are nearly two times
more likely to be stunted than their wealthy counterparts.
Likewise, children of uneducated mothers are 60%
more likely to be stunted than children of mothers with
secondary education or higher.7 Urgently addressing
malnutrition will save lives, reduce inequalities and build
strong, resilient children, families and communities.
© World Vision Mali 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Mali Profile.
Report 2014.
3 Institut National de la Statistique, INFO-STAT and ICF International (2014).
Enquête Démographique et de Santé au Mali 2012–2013.
4 Ibid.
Every Child.
6 Institut National de la Statistique, INFO-STAT and ICF International (2014).

32
Getting to Zero in Mauritania
Based on current trends Mauritania will get to zero preventable under-five deaths
in 2050 and zero preventable newborn deaths in 2071.This is too late for tens of
33%
21%
poorest women
richest women
27%
96%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
49% rural children
75% urban children
Under 5 Mortality
Target for Mauritania will be achieved in 2050 at current rates
YEAR
1960 1980 2000 2020 2040
050100150200250300
1960 1980 2000 2020 2040
050100150200250300
Newborn Mortality
YEAR
2000 2020 2040 2060
010203040
2000 2020 2040 2060
010203040
YEAR YEAR
preventable deaths

33
The Government of Mauritania must publicly commit to and take action to end preventable
• Ensuring an effective implementation of the national health development plan to accelerate progress
towards reducing maternal, newborn and child deaths.
• Improving coverage of essential health care and ensuring equitable access by addressing socioeconomic
barriers by effectively implementing subsidies for maternal care.
• Intensifying and diversifying activities to prevent chronic malnutrition and scale up treatment of acute
malnutrition, particularly in rural areas and urban slums.
Mauritania’s most vulnerable children
Although Mauritania has made some progress towards
reducing child mortality, much more must be done in
order to reach zero preventable child and newborn deaths.
Projections on when Mauritania could end preventable
children, data is inaccurate or unavailable, leaving them
our measurement must be different; in the post-2015
development framework no target can be considered
met by Mauritania unless it is measured and met by all
population groups. Getting to zero preventable child
deaths in Mauritania requires renewed commitment,
measured against outcomes for the most vulnerable. For
Mauritania to get to zero preventable child and newborn
deaths all children must be counted, heard and reached.
More than 40% of all child deaths in Mauritania occur
of these 4,000 children.2 On average 61% of deliveries are
assisted by a skilled birth attendant, but this is skewed by
huge inequalities. The probability of educated women and
women living in urban areas accessing skilled care is almost
two times higher than women with no education and from
rural areas. Poverty is a huge barrier to accessing care. The
richest are almost four times as likely to receive skilled care
at birth compared with the poorest women.3 Skilled birth
attendance is crucial to accelerate progress towards ending
Only 59% of children under five in Mauritania (75%
urban and 49% rural) have their birth registered and
certified.4 Birth registration provides legal identity, serves
abuse, exploitation and neglect.5 The proportion of
registered children is around 50% higher amongst
children with educated mothers and those in urban areas,
compared with those whose mothers have no education
and those in rural areas. Children from the richest families
are twice as likely to be registered as children from the
poorest, showing that poverty is a key barrier to birth
registration.6
and well-being
In Mauritania 30% of children under five are stunted,
a form of chronic malnutrition the effects of which
are largely irreversible. Malnutrition is the underlying
cause of more than 50% of child deaths in Mauritania.7
between pregnancy and age two, is foundational to the
physical and cognitive development of infants and young
children. Children of mothers without education are
60% more likely to be stunted than children of mothers
with secondary education or higher; likewise, children
living in rural areas are 30% more likely to be chronically
malnourished. Stunting rates are twice as high amongst the
poorest families compared with their richest counterparts.8
© World Vision Mauritania 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Mauritania Profile.
Report 2014.
3 Office National de la Statistique, UNICEF (2014). L’enquête par grappes à
indicateurs multiples de la Mauritanie (MICS) 2011.
4 Ibid.
Every Child.
6 Office National de la Statistique, UNICEF (2014).
7 Ibid.
8 Ibid.

34
Getting to Zero in Nepal
Based on current trends Nepal will get to zero preventable under-five deaths in 2018
and zero preventable newborn deaths in 2023.Tens of thousands of children’s lives
are at stake.We can accelerate progress and get to zero faster.
48%
26%
poorest women
richest women
11%
82%
mothers
with school
leaving
certificate
and above
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
42% rural children
44% urban children
Under 5 Mortality
Target for Nepal will be achieved in 2018 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250300350
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250300350
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
YEAR YEAR

35
The Government of Nepal must publicly commit and take action to end preventable maternal,
• Increasing financial and human resources to reach the unreached population of Nepal, especially the most
vulnerable mothers and children.
• Ensuring proper implementation of National Health Policy 2014 to enhance equity and ensure universal
access to quality health-care services, particularly in poor and marginalised communities.
• Emphasising child and maternal nutrition in national development and taking concrete action to reduce
undernutrition.
• Increasing accountability of the Government for the health sector through improved monitoring and data.
Nepal’s most vulnerable children
Nepal has made significant progress in achieving the
Millennium Development Goals related to child and
maternal health and has received international praise
for doing so. Considering the difficult context these
achievements should be considered remarkable.1
Projections on when Nepal could end preventable child
and newborn deaths are also promising; however, the
projections are based on national averages and hide the
real picture for many children. Averages conceal gaps
between population groups, including rich and poor,
no target can be considered met by Nepal unless it is
zero preventable child and newborn deaths in Nepal
requires renewed commitment, additional financing
and more detailed roadmaps with greater attention to
targeting the most vulnerable. Progress must be measured
against outcomes for the most vulnerable. Skilled birth
attendance and nutrition show particular disparities for
the most vulnerable children. For Nepal to get to zero
Despite tremendous progress, mothers and children are
still dying from preventable causes. The main causes of
child mortality include neonatal problems, pneumonia
and diarrhoea. A large percentage of births in Nepal still
take place at home with no skilled birth attendant. This
is particularly true for the poorest women. The health
and nutrition of a mother has a great effect on her child’s
health, particularly during its first months of life.2
The 2011 Nepal Demographic and Health Survey provides
information on the differences in health outcomes across
population groups. It includes the intersection between
caste/ethnicity and region and provides a useful framework
for identifying subcategories of groups and their relative
disadvantaged status. The maternal mortality ratio in
Nepal varies considerably by age and social group. It is
lowest amongst women 20–34 years old and highest
amongst those over 35 and under 20 years of age.
Infant and under-five mortality rates are highest in the
mountains (at 73 and 87 per 1,000 live births respectively)
and lowest in the hills (50 and 58 respectively). The
corresponding rates in the Terai population group are
53 and 62.3
Expanded and improved information on the disparities
of health access and outcomes across population groups
must be used to better target resources to reach the most
vulnerable as well as featuring prominently in improved
monitoring and accountability.
Addressing nutrition and the social
determinants of health
Social determinants are an important factor in the
health of women and newborns. Poverty, inequality and
societal unrest undermine maternal and newborn care
in numerous ways, such as poor nutritional status of girls
and women (including during pregnancy) and inadequate
housing and sanitation. Urgently addressing malnutrition
will not only save lives but also reduce inequalities and
build strong, resilient children, families, communities and
populations.
© World Vision International Nepal 2015 | www.childhealthnow.org
1 UNDP (2014). Nepal Millennium Development Goals Progress Report 2013.
2 Ibid.
3 Ibid.

36
Getting to Zero in Niger
Based on current trends Niger will get to zero preventable under-five deaths in 2022
and zero preventable newborn deaths in 2027.Tens of thousands of children’s lives
are at stake.We can accelerate progress and get to zero faster.
45%
23%
poorest women
richest women
12%
71%
mothers with
secondary
education or
higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
60% rural children
92% urban children
Under 5 Mortality
Target for Niger will be achieved in 2022 at current rates
YEAR
1960 1980 2000 2020
050100150200250300
1960 1980 2000 2020
050100150200250300
Newborn Mortality
YEAR
1990 2000 2010 2020
01020304050
1990 2000 2010 2020
01020304050
YEAR YEAR

37
The Government of Niger must increase its commitment and take action to end preventable
• Increasing access to essential health services by effective implementation of the free health-care initiative
and the roll out of the Integrated Management of Childhood Illness.
• Intensifying and diversifying activities to prevent chronic malnutrition, including education and behaviour
change, and scale up treatment of acute malnutrition, particularly in rural areas.
Niger’s most vulnerable children
Niger has made remarkable progress in reducing
child mortality and is on track to achieve Millennium
Development Goal 4; however, more must be done to
reach zero preventable deaths. Projections on when
Niger could end preventable child deaths are based on
national averages and hide the real picture for many
children. Averages conceal gaps between population
groups, including rich and poor, urban and rural, those with
access to education or those without. For many of the
most vulnerable children, data is inaccurate or unavailable,
leaving them at risk of falling through the gaps. In the
next 15 years our measurement must be different and
success must be redefined; in the post-2015 development
framework no target can be considered met by Niger
Getting to zero preventable child and newborn deaths in
Niger requires renewed commitment, additional financing
outcomes for the most vulnerable. Skilled birth attendance,
for the most vulnerable children. For Niger to get to zero
preventable child and newborn deaths, all children must be
Twenty-six per cent of all child deaths in Niger occur
of the 24,000 children that die in the first month.2 On
average, 30% of deliveries are assisted by a skilled birth
attendant, but this is skewed by huge inequalities. The
probability of educated women giving birth assisted by
a skilled birth attendant is three times higher than for
women with no education, and the likelihood is four times
higher for women living in urban areas compared with
women in rural areas. Moreover, the richest mothers are
six times more likely than the poorest to access skilled care
at birth, showing that poverty is a particularly large access
barrier.3 Skilled birth attendance is crucial to closing the
equity gaps in Niger and accelerating progress towards
ending preventable maternal and newborn deaths.
Between 2006 and 2012, Niger increased the number of
children who had their birth registered and certified from
32% to 64%, but more progress must be made.4 Birth
and neglect.5 The percentage of children registered at birth
is higher in urban areas compared with rural areas and
is amongst two times higher amongst the richest families
compared with the poorest families.6
and well-being
In Niger, 44% of children under five are stunted, a form
of chronic malnutrition, the effects of which are largely
irreversible.7 Good nutrition, especially during the
infants and young children. Children of mothers without
education and those living in rural areas are two times
more likely to suffer from chronic malnutrition compared
with those with mothers with secondary education or
higher and those living in urban areas. But the difference in
stunting rates between rich and poor households is small.8
Urgently addressing malnutrition will save lives, reduce
inequalities and build strong, resilient children, families and
communities.
© World Vision Niger 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Niger Profile.
Report 2014.
3 Institut National de la Statistique and ICF International (2013). Enquête
Démographique et de Santé et à Indicateurs Multiples du Niger 2012.
4 Ibid.
Every Child.
6 Institut National de la Statistique and ICF International (2013).
7 UNICEF, WFP and Institut National de la Statistique (2014). Rapport
d’Enquête Nationale Nutrition Niger: June/July 2014.
8 Institut National de la Statistique and ICF International (2013).

38
Under 5 Mortality
Target for Pakistan will be achieved in 2043 at current rates
YEAR
1960 1980 2000 2020 2040
0100200300400
1960 1980 2000 2020 2040
0100200300400
Getting to Zero in Pakistan
Based on current trends Pakistan will get to zero preventable under-five deaths in
2043 and zero preventable newborn deaths in 2063.This is too late for hundreds of
55%
21%
poorest women
richest women
30%
85%mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
23% rural children
59% urban children
Newborn Mortality
YEAR
2000 2020 2040 2060
01020304050
2000 2020 2040 2060
01020304050
YEAR YEAR

39
The Government of Pakistan must publicly commit and take action to end preventable
Pakistan’s most vulnerable children
Projections on when Pakistan could end preventable child
no target can be considered met by Pakistan unless it is
zero preventable child and newborn deaths in Pakistan
the most vulnerable. Strong accountability mechanisms are
vulnerable children. For Pakistan to get to zero preventable
heard and reached.
Half of all child deaths in Pakistan occur during the first
Pakistani children who die in their first month.2 On average
52% of deliveries are assisted by a skilled birth attendant,
but this is skewed by huge inequalities. Wealthy mothers
are 2.8 times more likely than poor mothers to have a
skilled attendant at birth, and educated mothers are
2.6 times more likely to have a skilled attendant at birth
than those with no education. Skilled birth attendance
is crucial to closing the equity gaps in Pakistan and
and newborn deaths.
Only one in three Pakistani children under five has his
or her birth registered and certified.3 Birth registration
neglect.4 However, 16 million unregistered Pakistani
children are not afforded these rights or protections.5
Children from urban areas are 2.5 times more likely
to be registered than children from rural areas, and
the wealthiest children are 14 times more likely to be
registered than their poor counterparts.
and well-being
In Pakistan 45% of children under five are stunted, a
Pakistan are nearly four times more likely to be chronically
malnourished than their wealthy counterparts. Children
of uneducated mothers are 2.7 times more likely to be
chronically malnourished; and those who dwell in rural
areas are also at higher risk.7 There is nearly a fourfold
difference in district stunting prevalence, showing vast
geographic disparities in stunting across Pakistan.8 Urgently
addressing malnutrition will not only save lives but also
reduce inequalities and build strong, resilient children,
© World Vision Pakistan 2015 | www.childhealthnow.org
1 National Institute of Population Studies and ICF International (2013). Pakistan
Demographic and Health Survey 2012–13.
Report 2014.
3 National Institute of Population Studies and ICF International (2013).
Every Child.
Registration.
7 National Institute of Population Studies and ICF International (2013).
8 M. Di Cesare et al. (2015). ‘Geographical and Socioeconomic Inequalities in
Women and Children’s Nutritional Status in Pakistan in 2011: An Analysis of
Data from a Nationally Representative Survey.’ The Lancet Global Health 3/4:
e229–e239.

40
Getting to Zero in
Papua New Guinea
Based on current trends Papua New Guinea will get to zero preventable under-five
deaths in 2041 and zero preventable newborn deaths in 2051.This is too late for tens
of thousands of children.We can accelerate progress and get to zero faster.
CHILDHOOD STUNTING
40%
27%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
Under 5 Mortality
Target for Papua New Guinea will be achieved in 2041 at current rates
YEAR
1960 1980 2000 2020 2040
050100150200
1960 1980 2000 2020 2040
050100150200
Newborn Mortality
YEAR
1990 2000 2010 2020 2030 2040 2050
051015202530
1990 2000 2010 2020 2030 2040 2050
051015202530
BIRTH REGISTRATION
poorest women
richest women
30%
85%
23% rural children
59% urban children
YEAR YEAR
DATA
N
O
T
AVAILABLE DATA
N
O
T
AVAILABLE
DATA
N
O
T
AVAILABLE

41
World Vision recommends that the Government of Papua New Guinea (PNG) take action to
end preventable maternal, newborn and child deaths as a priority, including through:
• Increasing investment in quality, accessible health services through a well-resourced Village Health
Volunteer (VHV) programme.
• Ensuring every child is registered at birth.
PNG’s most vulnerable children
Projections on when PNG could end preventable child and
newborn deaths are based on national averages because
regional data is not available for many indicators in PNG.
The available data therefore conceals gaps between
population groups, including rich and poor, urban and rural,
those with access to education and those without, and
hides the real picture for many children. In the next 15
years measurement must be different. PNG needs to begin
gathering the data required to enable targeting of services
to the most vulnerable. Getting to zero preventable
child and newborn deaths in PNG requires renewed
commitment to better data collection, additional financing
outcomes for the most vulnerable. Nutrition, skilled
birth attendance and birth registration show particular
disparities for the most vulnerable children. For PNG
to get to zero preventable child and newborn deaths all
and well-being
In PNG over 48% of children under five are stunted, a
form of chronic malnutrition, the effects of which are
of infants and young children.2 Although data is severely
limited, children from rural areas and the highlands
are more likely to be stunted than their counterparts,
suggesting that significant disparities in stunting rates
exist amongst communities in PNG. Urgently addressing
communities and populations. While the Government is
currently developing a national nutrition policy, it is vital
that this policy be targeted to vulnerable groups most
at risk of stunting and that it be adequately resourced to
achieve results rapidly.
The status of maternal and newborn health in PNG is
dire: 5,000 babies die in PNG in their first month of life
annually,3 on average only 40% of deliveries are assisted
by a skilled birth attendant4 and the PNG National
Department of Health estimates that five women die in
childbirth each day. These death rate are unacceptable,
especially when research shows that almost 30% of these
maternal deaths and up to 70% of newborn deaths could
be prevented with full coverage of family and community
care delivered through a comprehensive VHV programme
and improved resourcing of aid posts to ensure every
woman delivers with the assistance of a skilled birth
attendant and in an appropriate health facility.5
While there are no official records of birth registration
rates in PNG, it is estimated that on average only
1–10% of PNG children have their birth registered and
certified. Birth registration provides legal identity, serves
abuse, exploitation and neglect.6 However, the vast
majority of PNG children are not afforded these rights
or protections. While work continues on developing
a national identification system, it is vital that the
Government of PNG give birth registration a high priority
in this new system.
© World Vision PNG 2015 | www.childhealthnow.org
1 National Statistical Office (2009/2010). Papua New Guinea Household Income
and Expenditure Survey.
Report 2014. Burnett Institute and IMPACT (2014).
4 Pacific Islands Forum Secretariat (2014). Pacific Regional MDGs Tracking Report
2014.
5 Burnett Institute and World Vision (2011). Family and Community Health Care
in PNG.
Every Child.

42
Getting to Zero in the Philippines
Based on current trends the Philippines will get to zero preventable under-five deaths
in 2020 and zero preventable newborn deaths in 2020.Tens of thousands of children’s
CHILDHOOD STUNTING
51%
33%
poorest women
richest women
42%
96%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
Under 5 Mortality
Target for Philippines will be achieved in 2020 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150
1950 1960 1970 1980 1990 2000 2010 2020
050100150
Newborn Mortality
Target for Philippines will be achieved in 2020 at current rates
YEAR
1990 1995 2000 2005 2010 2015 2020
05101520
1990 1995 2000 2005 2010 2015 2020
05101520
BIRTH REGISTRATION
23% rural children
59% urban children
DATA NOT AVAILABLE
Target for the Philippines will be achieved in 2020 at current rates
YEAR YEAR
Target for the Philippines will be achieved in 2020 at current rates

43
The Government of the Philippines must publicly commit and take action to end preventable
• Passing national bills and local ordinances to improve nutrition and civil registration.
Philippines’s most vulnerable children
Projections on when the Philippines could end preventable
data is inaccurate, inconsistent or unavailable, leaving them
at risk of falling through the gaps.
In the next 15 years measurement must be different and
framework no target can be considered met by the
Philippines unless it is measured and met by all population
groups. Getting to zero preventable child and newborn
deaths in the Philippines requires renewed commitment,
For the Philippines to get to zero preventable child and
newborn deaths all children must be counted, heard and
reached.
In 2013 the Philippines had the following reproductive
and maternal health statistics: 84% of pregnant women
had at least four antenatal check-ups, 73% had a skilled
attendant at birth and 61% had institutional deliveries.1
The presence of skilled birth attendants during delivery
is vital, as they are able to recognize complications and
refer cases for more specialised emergency care.2 Wealthy
mothers are more than twice as likely as poor mothers
to have a skilled attendant at birth, and college educated
mothers are more than five times more likely to have a
skilled attendant at birth than those with no education.
in the Philippines and accelerating progress towards ending
Birth registration to provide an identity, access
to services and protection
In the Philippines nine out of ten children are registered
at birth.3 But in 500 communities this rate is as low
as two out of every ten children.4 The Autonomous
Region in Muslim Mindanao has the highest rate of
unregistered individuals at 62%, or roughly 970,000 people.
Approximately 1 million Filipino children have not been
registered at birth and are therefore stripped of civil and
democratic rights, such as secondary education and the
right to vote.5 The office of Civil Registration and Vital
Statistics provides a legal identity and the recognition as a
citizen by the State. Without a reliable birth-registration
system, unregistered children will continue to be invisible in
the eyes of the Government.
and well-being
In the Philippines 71,000 children die every year before
they reach their fifth birthday; of these 46%, or 33,000
lives, are lost during the first month.6 Malnutrition
contributes to about half of these under-five deaths.7
between pregnancy and age two, is foundational to the
physical and cognitive development of infants and young
children. Little has changed in the nutritional status of
Filipino children in the past five years. Since 2011 childhood
stunting has decreased slightly to 30%, underweight
remains at 20% and wasting has increased to 8%.8 Urgently
© World Vision Philippines 2015 | www.childhealthnow.org
1 Philippine Statistics Authority and ICF International (2014). Philippines
National Demographic and Health Survey 2013.
2 UNICEF Policy Brief No. 1 (2010). The Filipino Child Global Study on Child
Poverty and Disparities: Philippines.
Registration.
4 The Philippine Star (2013). ‘7.5M Pinoys Have No Birth Certificate’.
5 UNICEF (2014). The State of the World’s Children 2015: Reimagine the Future:
Innovation for Every Child.
Report 2014.
7 R. E. Black et al. (2013). ‘Maternal and Child Undernutrition and Overweight
in Low-Income and Middle-Income Countries.’ The Lancet 282 (9890):
427–51.
8 Food and Nutrition Research Institute and Department of Science and
Technology (2014). Eighth National Nutrition Survey.

44
Getting to Zero in Rwanda
Based on current trends Rwanda will get to zero preventable under-five deaths in
52%
23%
poorest women
richest women
61%
86%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
64% rural children
60% urban children
Under 5 Mortality
Target for Rwanda will be achieved in 2016 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010
050100150200250
1950 1960 1970 1980 1990 2000 2010
050100150200250
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020
010203040
1990 1995 2000 2005 2010 2015 2020
010203040
YEAR YEAR

45
The Government of Rwanda and its partners must publicly commit and take action to end
• Ensuring sufficiently trained health workers are recruited and improving the quality of community health
worker service delivery.
• Continued prioritising of prenatal care, newborn heath and nutrition within the continuum of care.
• Reinforcing domestic financing mechanisms and expanding institutional inter-sectoral collaboration.
Rwanda’s most vulnerable
Rwanda has made tremendous progress in improving
the health status of its women and children through
development, adoption and implementation of a range of
health policies, particularly those related to community
health workers and health insurance. However, progress
to date and projections on when Rwanda is likely to end
preventable child and newborn deaths are based on
national averages, which conceal gaps between population
groups, including rich and poor, urban and rural, those
with access to education and those without. Skilled birth
attendance, infant mortality and birth registration show
particular disparities for the most vulnerable children. For
many of the most vulnerable children, data is inaccurate,
inconsistent or unavailable, leaving them at risk of falling
through the gaps. Success must be redefined; in the post-
2015 development framework no target can be considered
met unless it is measured and met by all population groups.
in Rwanda requires renewed commitment, additional
attention to targeting the most vulnerable. All children in
Rwanda must be counted, heard and reached.
Skilled birth attendants (SBA) for every
mother and baby
Antenatal care and the presence of a SBA at birth could
drastically reduce maternal and newborn deaths. Maternal
deaths in Rwanda are most often caused by haemorrhage
(34%) and hypertension (19%), both of which could be
adequately managed by a SBA’s presence at delivery;
unfortunately, only 69% of births are attended by a skilled
provider.1 Expectant mothers in rural regions, with primary
education or less, and belonging to the lowest wealth
quintile are less likely to have a SBA present at birth; 88%
of pregnant women with secondary education or higher
are attended by an SBA, compared to only 57% of those
with no education.2 To attain 95% skilled birth attendance
by 2015, an estimated 586 health professionals need to be
trained.3
In order for a comprehensive package of services to be
available to all mothers and their children it is important
to ensure that community health workers receive quality
training and supervision.
Improving nutrition for development
and growth
In Rwanda undernutrition continues to be a serious source
of childhood morbidity and mortality, with 44% of children
under five stunted, 11% underweight and 3% wasted.
This level of stunting is the ninth highest globally, and
undernutrition in Rwanda has devastating consequences
to short-term child survival and long-term cognitive and
social development.4 Stunting needs to be reduced another
18.5% by 2015 to meet Rwanda’s Every Woman Every
Child commitment.5 Currently all of the global nutrition
targets are off track in Rwanda.6 There are also serious
economic costs to consider, with a 2013 study estimating
that Rwanda loses up to 11.5% of gross domestic product
(GDP) as a result of undernutrition.7
Increased domestic financing to end
preventable deaths
In 2001, Rwanda adopted the Abuja Declaration and
committed to increase its national health sector budget to
15% of total government expenditure by 2015.8 Rwanda
is one of only nine countries in the region that has met its
Abuja commitments.9 It reached and surpassed the 15%
budget target in 2007, and this figure has continued to rise
since. Even though health expenditure is increasing as both
a percentage of public expenditure and actual per capita
spending, 38% of these resources are externally financed.
If Rwanda is going to galvanise the health sector in a
sustainable manner, domestic funding mechanisms need to
be reinforced.
© World Vision Rwanda 2015 | www.childhealthnow.org
1 National Institute of Statistics of Rwanda, Ministry of Health Rwanda, and
ICF International (2012). Rwanda Demographic and Health Survey 2010.
2 Ibid.
3 UNFPA (United Nations Population Fund) (2011). State of the World’s
Midwifery 2011 Report. Rwanda Profile.
4 UNICEF (2013). Improving Child Nutrition: The Achievable Imperative for Global
Progress.
5 UNFPA (2015). Every Woman Every Child Commitment. Rwanda Profile.
7 African Union Commission and World Food Programme (2013). The Cost of
Hunger in Rwanda.
8 WHO (2001). The Abuja Declaration.
9 WHO (2014). Global Health Expenditure Database: Health System Financing.
Rwanda Profile.

46
Getting to Zero in Senegal
Based on current trends Senegal will get to zero preventable under-five deaths in
21%
10%
poorest women
richest women
29%
85%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
50% rural children
80% urban children
Under 5 Mortality
Target for Senegal will be achieved in 2018 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250300350
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250300350
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020
010203040
1990 1995 2000 2005 2010 2015 2020
010203040
YEAR YEAR

47
The Government of Senegal must publicly commit to and take action to end preventable
• Increasing investment in quality, accessible health services with sufficiently trained staff, including an
increase in the health budget to ensure efficient implementation.
Senegal’s most vulnerable children
Projections on when Senegal could end preventable child
is inaccurate, inconsistent or unavailable, leaving them
our measurement must be different and success must
no target can be considered met by Senegal unless it is
measured and met by all population groups. Although
there are already several initiatives in place in Senegal
targeting the most vulnerable children with free health
and nutrition services, including interventions such as
vaccinations, treatment for tuberculosis, therapeutic feeding
and micronutrient supplementation, more must be done
to ensure all children are reached.1 Skilled birth attendance,
for the most vulnerable children. Strong accountability
outcomes for the most vulnerable. Getting to zero
preventable child and newborn deaths in Senegal requires
renewed commitment, additional financing and more
detailed roadmaps with greater attention to targeting the
most vulnerable; all children must be counted, heard
and reached.
While under-five mortality remains high in Senegal, with
one child in 19 dying before age five, 42% of all child deaths
occur during the first 28 days in life.2 Access to quality,
skilled care around the time of birth could save the lives
of many of the tens of thousands of Senegalese children
who die in the first month. On average 59% of deliveries
are assisted by a skilled birth attendant, but this is skewed
by huge inequalities. Wealthy mothers are three times
more likely than poor mothers to have a skilled attendant
at birth, and educated mothers are 1.6 times more likely
to have a skilled attendant at birth than those with no
education.3 Skilled birth attendance is crucial to closing the
equity gaps in Senegal and accelerating progress towards
ending preventable maternal and newborn deaths.
Only 73% of Senegalese children under age five have their
from violence, abuse, exploitation and neglect.5 Children
from urban areas are 1.6 times more likely to be registered
than children from rural areas, and the wealthiest children
are 2.5 times more likely to be registered than their poor
counterparts.6
and well-being
In Senegal, 18.7% of children under five are stunted, a form
irreversible.7 Good nutrition, especially during the critical
1,000 days between pregnancy and age two, is foundational
young children. The poorest children in Senegal are nearly
three times more likely to be chronically malnourished than
their wealthy counterparts; likewise, children of uneducated
mothers and those who dwell in rural areas are also at
higher risk.8 Urgently addressing malnutrition will not only
save lives but also reduce inequalities and build strong,
© World Vision Senegal 2015 | www.childhealthnow.org
1 Ministère de la Sante et de L’action Sociale (2013). Plan Stratégique de
Développement de la Couverture Maladie Universelle au Sénégal 2013–2017.
2 UNICEF and WHO (2014). Countdown to 2015: Fulfilling the Health Agenda
for Women and Children: The 2014 Report. Senegal Profile. Agence Nationale
de la Statistique et de la Démographie and ICF International (2015). Sénégal:
Enquête Démographique et de Santé Continue.
3 Ibid.
4 Ibid.
Every Child.
6 Agence Nationale de la Statistique et de la Démographie and ICF
International (2015).
7 Ibid.
8 Ibid.

48
Getting to Zero in Sierra Leone
Based on trends prior to the Ebola outbreak, Sierra Leone will get to zero preventable
under-five deaths in 2038 and zero preventable newborn deaths in 2059.This is too late
for tens of thousands of children.We can accelerate progress and get to zero faster.
39%
33%
poorest women
richest women
51%
83%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
76% rural children
80% urban children
Under 5 Mortality
Target for Sierra Leone will be achieved in 2038 at current rates
YEAR
1960 1980 2000 2020 2040
0100200300400
1960 1980 2000 2020 2040
0100200300400
Newborn Mortality
Target for Sierra Leone will be achieved in 2059 at current rates
YEAR
1990 2000 2010 2020 2030 2040 2050 2060
01020304050
1990 2000 2010 2020 2030 2040 2050 2060
01020304050
Target for Serra Leone will be achieved in 2038 at current rates
YEAR YEAR
Target for Serra Leone will be achieved in 2059 at current rates

49
The Government of Sierra Leone and partners should prioritise maternal and child health
during Ebola recovery to get back on track towards achieving the Agenda for Prosperity and
towards ending preventable child deaths by 2030, including through:
• Increased and sustained funding to build a resilient health system capable of providing quality essential care
to mothers and children and handling future emergency outbreaks like Ebola.
• Prioritising efforts to target the most vulnerable children, improving access to skilled birth attendance and
increasing health-seeking behaviour through social mobilisation.
• Prioritising food assistance for pregnant women and young children and ensuring they are reached by
essential nutrition interventions such as maternal micronutrients and Vitamin A for children under two.
Moving towards zero preventable deaths
Before the Ebola outbreak, Sierra Leone was making
progress in improving maternal and child health; however,
it still had child and maternal mortality rates amongst
the highest in the world.1 Ebola has taken a huge toll on
children’s health and nutrition, and it is estimated that
the country’s development has been set back a decade.
The outbreak has crippled the ability of Sierra Leone’s
health system to provide essential care to children and
pregnant women.2 Due to lack of data we do not know
the actual number of mothers and children who have died
due to being unable to access care, but UNICEF warns
that maternal and child deaths have and will increase
significantly due to Ebola.3 As Sierra Leone transitions
to recovery, it is paramount to invest in building a strong
health system that will provide quality essential care and
respond better to future outbreaks. Current projections
on when Sierra Leone could end preventable child deaths
are based on pre-Ebola data and are national averages that
poor, urban and rural. For many vulnerable children data
is inaccurate or unavailable, leaving them at risk of falling
through the gaps. In the next 15 years, as Sierra Leone
recovers from Ebola and progressively implements the
Agenda for Prosperity and the Sustainable Development
Goals, no target can be considered met impact is seen
amongst all population groups. Getting to zero preventable
child deaths in Sierra Leone will require renewed
commitment, additional financing and greater attention to
targeting the most vulnerable, including through ensuring
children are registered at birth. Strong accountability
outcomes for the most vulnerable.
Investing in rebuilding the health system
Rebuilding the health system – stronger and more
resilient – must be a key priority during Ebola recovery.
Government, donors and aid agencies resources must be
increased, and distributed where the needs are greatest.
Sierra Leone’s annual budget allocation to the health
sector has been too low to provide enough skilled health
workers, drugs and equipment to meet national plans; this
made implementing the Free Health Care Initiative difficult
and left the health system unable to cope adequately
with Ebola.4 The health budget trend has fluctuated over
time, but Sierra Leone has never met the Abuja target
of 15% of the total budget.5 Adequate predictable funds
for the Ministry of Health must be prioritised to build a
health system that provides for women and children and is
resilient to crisis.
Prioritising care at the time of birth
Access to quality, skilled care around the time of birth can
prevent most maternal and newborn deaths. Before Ebola,
54% of deliveries were assisted by a skilled birth attendant
(SBA) with large differences between socioeconomic
groups.6 According to UNICEF, access to SBAs has
dropped by 30% since the outbreak started, likely leading
to higher maternal and newborn mortality. Pregnant
women have abandoned use of health facilities because
of fear of contracting Ebola and many health workers left
their duty stations due to fear of being infected.7 Ensuring
access to SBAs must be prioritised, including through social
mobilisation to rebuild confidence in the health system.
Nutrition for survival and development
Before the outbreak 38% of children under five in Sierra
Leone were stunted, with poor children, those with
uneducated mothers and those living in rural areas being
particularly disadvantaged.8 The increased scarcity of
food due to Ebola puts pregnant women and young
children at higher risk of malnutrition.9 Children who
are malnourished from pregnancy to age two may never
catch up with their peers, even with proper nutrition later.
Addressing malnutrition will improve child health, nutrition
and development and help build a stronger Sierra Leone.
© World Vision Sierra Leone 2015 | www.childhealthnow.org
1 UN (2014). UN Millennium Development Goals Report 2014.
2 UNDP (2014). Road to Recovery; World Bank, Ebola in Sub-Saharan Africa:
Update Estimates for 2015.
3 IRIN (8 October 2014). ‘Ebola Effect Reverses Gains in Maternal, Child
Mortality.’
4 UNDP (2014). Road to Recovery.
5 Ministry of Finance and Economic Development. Sierra Leone Annual Budget
Speeches 2009–2015.
6 Statistics Sierra Leone and ICF International (2014). Sierra Leone Demographic
7 IRIN (8 October 2014). UNDP (2014).
8 Sierra Leone Demographic and Health Survey 2013.
9 WFP (November 2014). ‘How Can We Estimate the Impact of Ebola on Food
Security in Guinea, Liberia and Sierra Leone?’; UNDP (2014).

50
59% urban children
Getting to Zero in
Solomon Islands
Based on current trends Solomon Islands will get to zero preventable under-five
deaths in 2029 and zero preventable newborn deaths in 2024.Thousands of children’s
CHILDHOOD STUNTING
38%
30%
poorest women
richest women
74%
95%
mothers with
more than
secondary
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
Under 5 Mortality
Target for Solomon Islands will be achieved in 2029 at current rates
YEAR
1960 1980 2000 2020
050100150200
1960 1980 2000 2020
050100150200
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
051015
1990 1995 2000 2005 2010 2015 2020 2025
051015
YEAR YEAR
BIRTH REGISTRATION
23% rural children
DATA NOT AVAILABLE
preventable deaths

51
The Government of the Solomon Islands must publicly commit and take action to end
• Ensuring basic health services for all mothers and children through establishing and funding a Village Health
Volunteer (VHV) programme.
• Improving resourcing of aid posts to ensure availability of all essential medicines at all times.
• Increasing the proportion of the health budget allocated to maternal, newborn and child health.
Solomon Islands’ most vulnerable children
Projections on when the Solomon Islands could end
preventable child and newborn deaths are based on
national averages, which conceal gaps between population
groups, including rich and poor, urban and rural, those
with access to education and those without. Skilled birth
attendance, infant mortality and birth registration show
particular disparities for the most vulnerable children. For
many of the most vulnerable children, data is inaccurate,
inconsistent or unavailable, leaving them at risk of falling
through the gaps. Success must be redefined; in the post-
2015 development framework no target can be considered
met unless it is measured and met by all population groups.
in the Solomon Islands requires renewed commitment,
greater attention to targeting the most vulnerable. All
children in the Solomon Islands must be counted, heard
and reached.
VHVs to ensure mothers and newborns
survive and thrive
There are large disparities in neonatal mortality across
regions in the Solomon Islands; children in Honiara are
twice as likely to survive the first month of life as children
in rural regions.1 Access to quality, skilled care around the
time of birth could save the lives of many babies born in
remote, regional communities. VHV programmes, which
train local community members to provide essential basic
health care to the hardest to reach, improve access to
essential care.
It has been stated that up to one-third of maternal deaths,
over two-thirds of newborn deaths and half of child deaths
could be prevented through national scale up of the VHV
programme in Papua New Guinea, a similar context.2
A similar programme in the Solomon Islands could end
needless preventable deaths.
Well-resourced aid posts to provide essential
equipment and medicines
A World Vision Solomon Islands’ assessment of resourcing
levels at aid posts in its programme areas revealed
numerous gaps. Most aid posts lacked basic neonatal and
antenatal equipment, such as resuscitating kits, weighing
scales, measuring tapes and stethoscopes, and had either
no or inadequate birthing kits, thus exposing women to
unsterile or minimal sterile birthing. Many aid posts did not
have vaccines due to not being integrated into the ‘cold
chain’ system that is necessary for consistent stocking. No
inventory has been undertaken by the Ministry of Health,
which could identify commodity gaps and provide access to
lifesaving equipment and medicines.
Increased allocation of health budget to
maternal, newborn and child health
Twenty-seven per cent of the health budget was allocated
to primary health care in 2010, a decrease from 29% in
2008.3 In a tightening primary health budget it is vital that
funds be prioritised for a VHV system and for improving
stocking levels of aid posts as efficient and effective ways to
ensure that vulnerable mothers and children are reached.
While existing legislation requires birth registration access,
less than 25% of all births are registered; levels are even
lower in the more remote islands.4 Birth registration
neglect.5
© World Vision Solomon Islands 2015 | www.childhealthnow.org
1 UNICEF (2012). Children in Solomon Islands: Atlas of Social Indicators.
2 Burnett Institute and World Vision (2011). Improving Maternal, Newborn and
Child Health in Papua New Guinea through Family and Community Health Care.
3 Ministry of Health of Solomon Islands (2013). Solomon Islands Core Indicators
Report.
4 Secretariat of the Pacific Community (2014). Improving Legal Frameworks to
Support Birth and Death Registration. Solomon Islands Profile.
Registration.

52
Getting to Zero in South Africa
Based on current trends South Africa will get to zero preventable under-five deaths
in 2022 and zero preventable newborn deaths in 2024.Tens of thousands of children’s
CHILDHOOD STUNTING
38%
13%
mothers with
more than
secondary
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
poorest women
richest women
91%
98%
Under 5 Mortality
Target for South Africa will be achieved in 2022 at current rates
YEAR
1960 1980 2000 2020
020406080100120
1960 1980 2000 2020
020406080100120
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
05101520
1990 1995 2000 2005 2010 2015 2020 2025
05101520
BIRTH REGISTRATION
23% rural children
59% urban children
DATA NOT AVAILABLE
YEAR YEAR

53
The Government of South Africa must publicly commit and take action to end preventable
• Promoting the prevention and termination of all forms of violence against children through a strong policy
framework and a targeted multi-dimensional approach.
South Africa’s most vulnerable children
Projections on when South Africa could end preventable
them at risk of falling through the gaps. Success must be
redefined; in the post-2015 development framework no
target can be considered met by South Africa unless it is
zero preventable child and newborn deaths in South Africa
most vulnerable children. For South Africa to get to zero
Around 40% of all child deaths in South Africa occur
of the 16,000 South African children who die in their first
month.2 On average 91% of deliveries are assisted by a
skilled birth attendant, and wealthy mothers are 10% more
likely than poor mothers to have a skilled attendant at
birth; educated mothers are 30% more likely than those
with no education to have a skilled attendant at birth.3
in South Africa and accelerating progress towards ending
All but 5% of South African children under five have their
birth registered;4 however, progress has been uneven and
rural areas lag behind.5 Birth registration provides legal
in the poorest and most disadvantaged communities high
birth registration fees remain a barrier.7 These barriers are
especially challenging after the 30-day deadline, at which
point registration is deemed ‘late’ and additional conditions
must be met to register a birth.8
and well-being
In South Africa 24% of children under five are stunted,
of infants and young children. Children of uneducated
mothers are three times as likely to be chronically
malnourished compared to the children of educated
mothers. During the period 2013–14 the mortality rate
attributed to malnutrition was above 11%, and highest in
Eastern Cape, North West, Free State and Mpumalanga.
Urgently addressing malnutrition will not only save lives
but reduce inequalities and build strong, resilient children,
© World Vision South Africa 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. South Africa Profile.
Report 2014.
3 Department of Health, Medical Research Council, ORC Macro (2007). South
Africa Demographic and Health Survey 2003.
Registration.
5 The Presidency of South Africa: Office of the Rights of the Child (2009).
Situation Analysis of Children in South Africa.
Every Child.
7 UNICEF (2013).
8 Statistics South Africa (2013). Recorded Live Births 2012: Statistical Release
P0305.

54
Getting to Zero inTanzania
Based on current trends Tanzania will get to zero preventable under-five deaths in
45%
22%
poorest women
richest women
33%
90%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
10% rural children
44% urban children
Under 5 Mortality
Target for Tanzania will be achieved in 2018 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020
010203040
1990 1995 2000 2005 2010 2015 2020
010203040
YEAR YEAR

55
The Government of Tanzania must publicly commit and take action to end preventable
• Strengthening Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services.
• Increasing investment in quality, accessible maternal, newborn and child health services with sufficiently
trained staff.
Saving women’s and newborns’ lives by
strengthening Comprehensive Emergency
Obstetric and Newborn Care
Tanzania has shown considerable success reducing child
mortality, including achieving Millennium Development
Goal 4 before 2015; despite this, maternal and neonatal
mortality have shown slow progress. Neonatal deaths now
account for 41% of all under-five deaths; this, up from 26%
two decades ago, results in 39,000 annual deaths.1 Likewise,
Tanzanian women have a 1 in 44 lifetime risk of maternal
death, which results in 7,900 annual deaths.2 While the
vast majority of these lives could be saved with proven and
cost-effective interventions, the availability of CEmONC
services, chronic shortage of skilled health providers and
a weak referral system still plague the health system. The
government should honour its commitment to establishing
life-saving services at health centres across Tanzania to
provide CEmONC services closer to the people.3
Skilled assistance at delivery to ensure
mothers and newborns survive and thrive
Only half of all births in Tanzania are attended by a skilled
health worker, with a major gap in access between urban
and rural areas. Rural women, who make up nearly
80% of all deliveries, are nearly three times less likely
to receive skilled birth attendance than urban women.4
Health facilities, where only 50% of women deliver, are
generally unable to provide basic emergency obstetrics
care. Only a quarter of facilities that offer normal delivery
services have all infection-control items at the service
site.5 The Government and other stakeholders should
improve systems and resources for recruitment, career
development and retention of health professionals,
with equitable rural and urban distribution. Skilled birth
attendance is crucial to closing the equity gaps in Tanzania
and accelerating progress towards ending preventable
maternal and newborn deaths.
In Tanzania only 16% of children under five have been
registered; of these, only 8% have a birth certificate.6 This
rate has not improved in a decade and is the fifth lowest in
the world. Birth registration provides legal identity, serves
abuse, exploitation and neglect.7 However, 7 million
unregistered Tanzanian children are not afforded these
rights or protections.8 Urban children are more than four
times more likely to have their births registered and six
times more likely to have a birth certificate than their
rural counterparts.9 The Government has made birth
registration mandatory by law, but the heavily centralised
process, low awareness and related costs prevent many
parents or caregivers from providing their children with an
identity and protection.
Multi-sectoral response to stunting for
nutrition, development and well-being
In Tanzania 35% of children under five are stunted or
too short for their age. This results from poor maternal
nutrition before and during pregnancy; a child’s subsequent
inadequate intake of nutritious food, including breast milk;
and frequent or severe infections or illness.10 In addition,
of children under five 7% are wasted, 6% are overweight
and anaemia is a significant issue. Thus all four global
nutrition targets are currently off track. Good nutrition,
especially during the critical 1,000 days between pregnancy
and age two, is foundational to the physical and cognitive
development of infants and young children. The poorest
children in Tanzania are nearly two times more likely to be
chronically malnourished than their wealthy counterparts;
likewise, children of uneducated mothers are two times
more likely to be chronically malnourished, and those
who dwell in rural areas are also at higher risk.11 Urgently
families, communities and populations.12
© World Vision Tanzania 2015 | www.childhealthnow.org
Report 2014.
Women and Children: The 2014 Report. Tanzania Profile.
3 Ministry of Health and Social Welfare. The National Road Map Strategic Plan
to Accelerate Reduction of Maternal Newborn and Child Deaths in Tanzania
2008–2015.
4 National Bureau of Statistics and ICF Macro (2011). Tanzania Demographic and
Health Survey 2010.
5 White Ribbon Alliance Tanzania. Be Accountable So that Mothers and Newborns
Can Survive Childbirth.
6 National Bureau of Statistics and ICF Macro (2011).
Every Child.
Registration.
12 The United Republic of Tanzania (2014). Towards Eliminating Malnutrition in
Tanzania: Nutrition Vision 2025.

56
Getting to Zero inTimor-Leste
Based on current trendsTimor-Leste will get to zero preventable under-five deaths in
2021 and zero preventable newborn deaths in 2025.Thousands of children’s lives are
at stake.We can accelerate progress and get to zero faster.
63%
42%
poorest women
richest women
11%
69%mothers with
more than
secondary
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
57% rural children
50% urban children
Under 5 Mortality
Target for Timor Leste will be achieved in 2021 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200
1950 1960 1970 1980 1990 2000 2010 2020
050100150200
Newborn Mortality
Target for Timor−Leste will be achieved in 2025 at current rates
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
1990 1995 2000 2005 2010 2015 2020 2025
01020304050
Target for Timor-Leste will be achieved in 2021 at current rates
YEAR YEAR
Target for Timor-Leste will be achieved in 2025 at current rates

57
The Government of Timor-Leste must commit and take action to end preventable maternal,
• Scaling up efforts to ensure improved nutrition, including signing up to Scaling Up Nutrition (SUN).
• Increasing investment in quality, accessible health services with sufficiently resourced clinics and adequately
remunerated staff.
• Increasing the national health budget from current inadequate levels of just 4–5% of the national budget.
Timor-Leste’s most vulnerable children
Projections on when Timor-Leste could end preventable
child and newborn deaths are based on national averages,
which conceal gaps between population groups, including
rich and poor, urban and rural, those with access to
education and those without. Skilled birth attendance,
infant mortality and birth registration show particular
disparities for the most vulnerable children. For many
of these children, data is inaccurate, inconsistent or
unavailable, leaving them at risk of falling through the gaps.
Success must be redefined; in the post-2015 development
framework no target can be considered met unless it is
zero preventable child and newborn deaths in Timor-
Leste requires renewed commitment, additional financing
and more detailed roadmaps with greater attention to
targeting the most vulnerable. All children in Timor-Leste
must be counted, heard and reached.
Scaling up nutrition for survival, health,
development and well-being
In Timor-Leste 50.2% of children under five are stunted,
Timor-Leste are more likely to be chronically malnourished
than their wealthy counterparts with almost 63% stunting
rates amongst the poorest children and 47% stunting rate
amongst those from wealthy families.2 Likewise, children
of uneducated mothers are 1.5 times more likely to be
stunted than those with educated mothers.3 Urgently
addressing malnutrition will not only save lives but reduce
communities and populations. As well as increasing funding
levels to nutrition programming, we recommend that the
Government of Timor-Leste join the SUN movement that
strengthens nutrition policy and programming.4
Quality basic health care for all
We applaud the government’s commitment to improving
community access to primary health-care services by
ensuring all villages with a population between 1,500 and
2,000 in very remote areas have a health post to provide
a comprehensive package of services by 2015.5 However,
while the target of placing health posts in each village
has been mostly achieved, the under-resourcing of some
health posts is preventing delivery of quality care to these
communities. Further, while the government also conducts
monthly integrated community-based health services
known as SISCa with the assistance of health volunteers
(PSFs), this is done only once in the centre of villages,
with those living far from the village centre remaining
unreached.
Investment must be increased in health posts to ensure
they have the capacity and resources to fulfil their role as
the community’s entry point to health services and as a key
player in ending preventable maternal and child deaths.
Health budget boost needed to ensure
mothers and newborns survive and thrive
The Government of Timor-Leste has currently allocated
just 4–5% of the national budget to health. This is
significantly smaller than regional peers such as PNG
and the Solomon Islands, which both allocate 13% of
government spending to health.6 This small allocation
is insufficient to fund the health investment required to
establish a comprehensive health system that reaches
the most vulnerable mothers and children. Progressively
increasing the national health budget to at least 10% of
government spending by 2025 is urgently needed in order
to improve quality basic health care and nutrition.
© World Vision Timor-Leste 2015 | www.childhealthnow.org
2 National Statistics Directorate, Ministry of Finance, and ICF Macro (2010).
Timor-Leste Demographic and Health Survey 2009–10.
3 Ibid.
4 Scaling Up Nutrition (2012). Movement Strategy 2012–2015.
5 Ministry of Health (2011). National Health Sector Strategic Plan 2011–2030.
6 WHO (2014). Global Health Expenditure Database.

58
Getting to Zero in Uganda
Based on current trends Uganda will get to zero preventable under-five deaths in 2020
and zero preventable newborn deaths in 2023. Hundreds of thousands of children’s
42%
25%
poorest women
richest women
44%
88%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
29% rural children
38% urban children
Under 5 Mortality
Target for Uganda will be achieved in 2020 at current rates
YEAR
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250
1950 1960 1970 1980 1990 2000 2010 2020
050100150200250
Newborn Mortality
YEAR
1990 1995 2000 2005 2010 2015 2020 2025
010203040
1990 1995 2000 2005 2010 2015 2020 2025
010203040
YEAR YEAR

59
The Government of Uganda must publicly commit and take action to end preventable
Uganda’s most vulnerable children
Projections on when Uganda could end preventable child
of falling through the gaps. In the next 15 years
measurement must be different and success must be
redefined; in the post-2015 development framework
no target can be considered met by Uganda unless it is
zero preventable child and newborn deaths in Uganda
the most vulnerable. Strong accountability mechanisms are
vulnerable children. For Uganda to get to zero preventable
heard and reached.
More than one-third of all child deaths in Uganda occur
of the 35,000 Ugandan children who die in their first
month annually.2 On average 58% of deliveries are assisted
inequalities. Wealthy mothers are two times more likely
than poor mothers to have a skilled attendant at birth.3
Skilled birth attendance is crucial to closing the equity
gaps in Uganda and accelerating progress towards ending
Only three in ten children in Uganda have their birth
registered and certified.4 Birth registration provides legal
5 million unregistered Ugandan children under five are not
afforded these rights or protections.6 Similarly, children
in urban areas are 30% more likely to be registered than
children in rural areas.7
and well-being
In Uganda, about one-third of children under five are
stunted, a form of chronic malnutrition the effects of which
are largely irreversible.8 The global nutrition target for
stunting is currently off track. Good nutrition, especially
during the critical 1,000 days between pregnancy and
age two, is foundational to the physical and cognitive
development of infants and young children. Children of
uneducated mothers are nearly two times more likely to
be chronically malnourished than children of educated
mothers. Regional disparities are also huge, with children in
Karamoja more than three times more likely to be stunted
than children in Kampala. Children who dwell in other
rural areas are also at higher risk.9 Urgently addressing
© World Vision Uganda 2015 | www.childhealthnow.org
1 Government of Uganda (2013). Reproductive Maternal, Newborn and Child
Health Sharpened Plan for Uganda. UNICEF and WHO (2014). Countdown to
2015: Fulfilling the Health Agenda for Women and Children: The 2014 Report.
Uganda Profile.
Report 2014.
3 Uganda Bureau of Statistics and ICF International (2012). Uganda
4 Ibid.
Every Child.
Registration.
7 Uganda Bureau of Statistics and ICF International (2012).
9 Uganda Bureau of Statistics and ICF International (2012).

60
Getting to Zero in Vanuatu
Vanuatu reached the target set for ending preventable under-five deaths in 1998 and newborn
deaths in 1997, but hundreds of children’s lives are still at stake. Further progress is needed to
ensure that all children, particularly the most vulnerable, are counted, heard and reached.
43%
7%
poorest women
richest women
77%
95%
mothers with
secondary
education
or higher
mothers
with no
education
LEGEND
rate (up to 2014)
Target for zero
preventable deaths
75% rural children
76% urban children
Under 5 Mortality
Target for Vanuatu was achieved by 1998
YEAR
1950 1960 1970 1980 1990 2000 2010
050100150
Newborn Mortality
Target for Vanuatu was achieved by 1997
YEAR
1990 1995 2000 2005 2010
051015
Target for Vanuatu was reached in 1998
YEAR YEAR
Target for Vanuatu was reached in 1997

61
The Government of Vanuatu must publicly commit and take action to end preventable
• Fully implementing its nutrition policy, focusing particularly on preventative approaches and malnutrition.
• Ensuring lifesaving vaccines are available to all children regardless of location.
• Strengthening the civil registration and vital statistics system to ensure critical data is captured on cause of
death to ensure prioritisation of appropriate health interventions.
Vanuatu’s most vulnerable children
Following the devastation wrought by Cyclone Pam, it
is essential that ending preventable child and newborn
deaths remain at the centre of recovery efforts. Even
before the cyclone hit, World Vision baseline studies
revealed that children living in the more remote island
communities in Vanuatu were more vulnerable to infection
and malnutrition.1 In the context of post-recovery, now
more than ever, it is vital that greater attention be given
to targeting the most vulnerable mothers and children.
Nutrition and immunisation levels show particular
disparities for those living in remote island communities,
and important cause-of-death information that could
improve targeting of health interventions is lacking. For all
of Vanuatu’s children to be able to survive and thrive, each
and every one, regardless of where the child lives, must be
Nutrition policy to prioritise prevention
and malnutrition
A baseline study from World Vision’s health project on
the island of Tanna found almost 50% of children under
five were stunted,2 a form of chronic malnutrition the
effects of which are largely irreversible.3 Good nutrition,
especially during the critical 1,000 days between pregnancy
and age two, is foundational to the physical and cognitive
development of infants and young children. Vanuatu
suffers a double burden of under and over-nutrition, and
the national stunting average of 26% masks the reality
that in some remote areas, like Tanna, malnutrition is at
crisis levels. A more comprehensive nutrition policy that
addresses malnutrition and also puts greater focus on
preventative approaches, both for the avoidance of
undernutrition and over-nutrition, is urgently needed.
Universal access to life-saving vaccines
The urban-rural divide is also clearly apparent in
immunisation levels. While the national average for
measles immunisation is 80%,4 World Vision’s experience
in Tanna revealed that less than 40% of children had fully
completed immunisation schedules.5 Low immunisation
levels in remote areas are most often due to technical
challenges with transporting vaccines that require cold
chain infrastructure. Given the demonstrated lifesaving
benefits of immunisation, we call upon the Government of
Vanuatu to invest in the technology, training, systems and
structures necessary to ensure that vaccines are available
to all children, regardless of location.
Improving treatment by capturing critical
cause-of-death information
While the Government of Vanuatu, in collaboration with
UNICEF, has been making great progress in improving
birth-registration levels, very limited work has been done
on registering deaths and cause-of-death information. This
data is instrumental to avoiding preventable deaths by
enabling prioritisation of appropriate health interventions
and, in particular, targeting them towards the most
vulnerable. World Vision, therefore, highly recommends
to the Government that cause-of-death information be
prioritised in its broader civil registration and vital statistics
policies and systems. World Vision understands the many
cultural sensitivities that can prevent communities from
sharing cause-of-death information and would welcome
the opportunity to assist the Government in working
with communities to ensure this information, so crucial to
preventing future deaths, is captured.
© World Vision Vanuatu 2015 | www.childhealthnow.org
1 World Vision Vanuatu (2014). Tanna Healti Kommuniti: End of Project
Evaluation.
2 Ibid.
4 Pacific Islands Forum Secretariat (July 2014). Pacific Regional MDGs Tracking
Report 2014.
5 World Vision Vanuatu (2014).

62
Getting to Zero in Zambia
Based on current trends Zambia will get to zero preventable under-five deaths in 2023,
45%
18% poorest women
richest women
45%
94%
mothers with
more than
secondary
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
7% rural children
20% urban children
Under 5 Mortality
Target for Zambia will be achieved in 2023 at current rates
YEAR
1960 1980 2000 2020
050100150200
1960 1980 2000 2020
050100150200
Newborn Mortality
YEAR
1990 2000 2010 2020 2030
010203040
1990 2000 2010 2020 2030
010203040
YEAR YEAR

63
The Government of Zambia should publicly commit and take action to end preventable
• Ensuring national implementation of the Every Newborn Action Plan.
• Increasing investment in quality, accessible health services with sufficient trained staff.
Zambia’s most vulnerable children
Projections on when Zambia could end preventable child
of falling through the gaps. In the next 15 years
measurement must be different and success must be
redefined; in the post-2015 development framework
no target can be considered met by Zambia unless it is
zero preventable child and newborn deaths in Zambia
more detailed roadmaps with more focus on the most
vulnerable. Strong accountability mechanisms are critical,
with progress measured against outcomes for the most
vulnerable. Skilled birth attendance, birth registration and
nutrition status show particular disparities for the most
vulnerable children. For Zambia to get to zero preventable
heard and reached.
In Zambia over 30% of all child deaths occur in the first
28 days of life.1 Access to quality, skilled care around the
Zambian children who die in the first month.2 On average
64% of deliveries are assisted by a skilled birth attendant,
but this is skewed by inequalities.3 The wealthiest mothers
are twice as likely to have a skilled attendant at birth as
their poor counterparts, whilst educated mothers are also
twice as likely to receive skilled birth attendance than those
closing the equity gaps in Zambia and accelerating progress
In Zambia only 11% of children under five have their births
registered; this is the fourth lowest rate in the world.5 Birth
and neglect.6 However, 89% of all children in Zambia
are not registered and thus not afforded these rights or
protections. Children from urban areas are registered
at three times the rate of children living in rural areas.
Moreover, the wealthiest children are six times more
likely to have their births registered than their poor
counterparts.7
and well-being
In Zambia 40% of children under five are stunted, a
infants and young children. The poorest children in Zambia
are 1.5 times more likely to be chronically malnourished
than their wealthy counterparts; likewise, children of
uneducated mothers are 2.5 times more likely to be
chronically malnourished than those of educated mothers.
Children who dwell in rural areas are also at higher risk.9
© World Vision Zambia 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Zambia Profile.
Report 2014.
3 Central Statistical Office Zambia, Ministry of Health Zambia and ICF
International. (2014). Zambia Demographic and Health Survey 2013–14.
4 Ibid.
Registration.
Every Child.

64
Getting to Zero in Zimbabwe
Based on current trends Zimbabwe will get to zero preventable under-five deaths in
31%
14%
poorest women
richest women
70%
96%mothers with
more than
secondary
education
mothers
with no
education
LEGEND
rate (up to 2014)
Projected reduction
Target for zero
preventable deaths
preventable deaths
23% rural children
57% urban children
Under 5 Mortality
Target for Zimbabwe will be achieved in 2072 at current rates
YEAR
1960 1980 2000 2020 2040 2060
050100150
1960 1980 2000 2020 2040 2060
050100150
Newborn Mortality
Target for Zimbabwe will be not be achieved by 2100 at current rates
YEAR
2000 2020 2040 2060 2080 2100
010203040
2000 2020 2040 2060 2080 2100
010203040
YEAR YEAR

65
The Government of Zimbabwe must publicly renew its commitment and take action to end
• Ensuring implementation and increased investment in community-based health planning, service delivery
and referral systems particularly focused on poor and rural communities.
• Identifying the most vulnerable women and children and better targeting resources towards them.
• Increasing investment in quality, accessible maternal and newborn health services with sufficiently trained
staff.
• Scaling up efforts to ensure improved nutritional status through community-based programmes.
• Strengthening accountability systems, including citizen participation in monitoring and review of health
services.
Zimbabwe’s most vulnerable children
Projections on when Zimbabwe could end preventable
and do not clearly articulate the plight of many children.
Averages conceal gaps between population groups,
including rich and poor, urban and rural, those with access
to education and those without. For many of the most
vulnerable children, data is inaccurate, inconsistent or
unavailable, leaving them at risk of falling through the gaps.
In the next 15 years measurement must be different and
framework no target can be considered met by Zimbabwe
in Zimbabwe requires renewed commitment, additional
attention to targeting the most vulnerable. Strong
For Zimbabwe to get to zero preventable child and
newborn deaths all children must be counted, heard and
reached.
Nearly half of all child deaths in Zimbabwe occur during
around the time of birth could save the lives of many of the
17,000 Zimbabwean children who die in their first month.2
On average 80% of deliveries are assisted by a skilled
birth attendant, but this is skewed by huge inequalities.
Wealthy mothers are nearly 40% more likely than poor
mothers to have a skilled attendant at birth; likewise, urban
mothers are nearly 25% more likely than rural mothers to
have a skilled attendant at birth.3 Access to skilled birth
attendants is crucial in closing the equity gaps in Zimbabwe
and accelerating progress towards ending preventable
maternal and newborn deaths.
Only 32% of Zimbabwean children under five have their
birth registered, and only 19% were able to present the
certificate.4 Birth registration provides legal identity, serves
abuse, exploitation and neglect.5 However, thousands of
unregistered Zimbabwean children are not afforded these
rights or protections. Children from urban areas are nearly
2.5 times as likely to be registered as children from rural
areas, and the wealthiest children are four times more
likely to be registered than the poorest.6
and well-being
In Zimbabwe 27.6% of children under five are stunted,
largely irreversible. The global nutrition target for stunting
is off track. Childhood wasting stands at 3.3%, and
underweight at 11.2%.7 Good nutrition, especially during
of infants and young children. Zimbabwean children of
uneducated mothers are more than twice as likely to
be chronically malnourished as children of mothers with
more than secondary education.8 Urgently addressing
© World Vision Zimbabwe 2015 | www.childhealthnow.org
Women and Children: The 2014 Report. Zimbabwe Profile.
Report 2014.
3 Zimbabwe National Statistics Agency (2015). Zimbabwe Multiple Indicator
Cluster Survey 2014, Final Report.
4 Ibid.
Every Child.
6 Zimbabwe National Statistics Agency (2015).
8 Zimbabwe National Statistics Agency (2015).

66
Important note on data and
projections
There are a number of ‘zero’ goals proposed for the post-2015 development framework,
including ending hunger, ending preventable deaths and ensuring that no child should be
subjected to violence or abuse. However, it is not possible to reach a 100% reduction in
child deaths or get to ‘zero’ in literal terms. Heartbreakingly for some families, even with
the best health care and best available technologies, some children will die in their first day,
month or five years of life in all countries. This is why World Vision supports the inclusion
of a target in the proposed Sustainable Development Goals to end the preventable deaths of
newborns and children by 2030 – those deaths that are needless if only women and children
have access to a minimum set of universal quality health-care interventions.
A ‘zero’ target for under-five mortality means reaching a rate of no more than 25
child deaths per 1,000 children born alive. This is the target being included as part of the
proposed Sustainable Development Goals.
A ‘zero’ target for newborn mortality means reaching a rate of no more than 12
newborn deaths per 1,000 babies born alive. This figure is half of the under-five mortality
target based on the proportion of under-five deaths that are neonatal. Newborn deaths are
those that occur within the first 28 days of life.
Projections of when countries will ‘get to zero’ are calculated based on each country’s
average rate of reduction of mortality between 2000 and 2013. For some countries whose
annual rates of reduction changed dramatically in that period, the most recent five years of
data have been used to avoid giving a misleading picture of recent progress. These forecasts
are simple, linear projections.
The estimates of when countries will get to zero are based entirely on the trends in the
data and do not account for recent initiatives in child health (since 2013), plans for future
initiatives, recent conflicts or political instability, crises such as the Ebola crisis, droughts and
food crises, or natural disasters such as cyclone Pam, which may affect the trends or rates
of progress in either direction.
Estimates for under-five mortality and neonatal mortality have been provided by the UN
Inter-agency Group for Child Mortality Estimation (http://www.childmortality.org). Since
data for most developing countries is incomplete, time series data has been estimated from
available sources using a statistical model that yields lower, median and upper estimates
for each year. These three estimates give a sense of the central estimate (median) and a
confidence interval for this estimate (the lower to upper zones). We have used the median
estimates as a basis for forecasts beyond 2013 when the data series end. These forecasts
are simple extrapolations based on the average rates of change in mortality over previous
years. In almost all cases the average rates of change since 2000 were used. In a handful
of cases in which increases in mortality in the early 2000s would have given a misleading
picture of recent progress, only the most recent five years of data were used to estimate
the average change.
Given the large uncertainties in the statistical estimation of the data, as well as the wide
confidence intervals given, the estimates we have given for when countries will reach the
Sustainable Development Goal targets should be understood as indicative estimates based
on assuming the continuity of the trends since the Millennium Development Goals were
developed, rather than precise predictions.
Data for the equity graphics is sourced from UNICEF, demographic and health surveys
(DHS) and multiple indicator cluster surveys (MICS), which draw on data collected by a
country’s government (national government estimates and other surveys). There is often a
time lag between international and national data collection and publishing. For these reasons
the country profile data may vary slightly from that which governments use themselves.

World Vision is a Christian relief, development and
advocacy organisation dedicated to working with
children, families and communities worldwide to
reach their full potential by tackling the causes of
poverty and injustice. World Vision is dedicated to
working with the world’s most vulnerable people.
World Vision serves all people regardless of religion,
race, ethnicity or gender.
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