Eritrea is one of the very few countries in sub-Saharan Africa on track to achieving Millennium Development Goal (MDG) Four of reducing child mortality. According to the 2002 Eritrea Demographic and Health Survey (EDHS) under-five mortality rate (U5MR) has declined steadily from 136 per 1,000 live births in 1995 to 93 in 2002, and was estimated at 74 in 2006. This and other factors have been attributed to this achievement, providing some valuable lessons to be learned.

Lesson learned

The emphasis on Expanded Programme on Immunization (EPI), malaria control, the expansion of access to health care services, the adoption of the Integrated Management of Childhood Illness (IMCI) approach including community based IMCI, vitamin A supplementation twice a year for 6-59 month children and implementation of therapeutic and supplementary feeding programmes for malnourished children are seen as major contributory factors to the reduction in child mortality in Eritrea.

Expanded Programme on Immunization and vitamin A supplementation 

This includes immunization and Vitamin A supplementation. High immunization coverage has led to a decrease in vaccine-preventable diseases. Eritrea is polio-free bringing it a step closer to certification of polio-free status. There have been no measles deaths in the past two years and no maternal and neonatal tetanus. Twice a year, the Ministry of Health, UNICEF and other partners conduct routine immunization and Vitamin A supplementation for all children aged 6 – 59 months. The vaccination and Vitamin A supplementation campaigns have reached coverage of 95 per cent in 2007. To buttress the campaign, in 2006, the Vitamin A campaign was complemented with a measles vaccination and a hand-washing campaign in elementary schools. In 2007, the campaign included routine child immunization, coverage of two doses of tetanus toxoid among pregnant women.

Integrated Management of Childhood Illnesses

Eritrea was one of the first countries in Sub-Saharan Africa that decided to introduce IMCI as early as 1996. The strategy is designed to provide health workers with guidelines to treat the principal causes of morbidity and mortality in Eritrean children. IMCI is a more integrated approach to address the overall health and well-being of a child rather than a single health problem by considering clinical guidelines which are adapted to the local situation. The guidelines include protocols for detecting the most severely ill children and referring them to higher level facilities.

Moving further, Ministry of Health and its partners adopted the third component i.e. household/community-based Integrated Management of Illness (HH/c-IMCI)) in 2003 to address child deaths that were taking place at home. Supported by UNICEF, in 2007 alone, HH/c-IMCI services were scaled up to six sub-regions in Debub, and introduced to six sub-zobas in Anseba and Northern Red Sea regions.

Supported by UNICEF and WHO, in 2007 MoH incorporated newborn care into the existing IMCI guidelines. IMCI is now called IMNCI where “N” stands for neonatal. Moreover Eritrea has developed a national child survival strategy, and this strategy has included key, successful, feasible, low-cost interventions that address the maternal, neonatal and child survival problems. The IMNCI programme has been coordinating its activities across programmes that are relevant to newborn and child health.

Therapeutic and supplementary feeding

The implementation of a supplementary feeding programme at national level targeting moderately malnourished children and introduction of facility-based and community-based therapeutic feeding programmes to manage malnutrition among children has proven to contribute to a reduction of child mortality.

Future priorities

The Government of the State of Eritrea has officially adopted the strategy of primary health care and the MDGs. The adopted strategy is a three tires one. It contributes to the realization of the vision of providing access to all Eritrean children – new born, infants, under five children and school children with good quality, preventive, curative and rehabilitative health care at all levels of health system. This will contribute to their healthy growth and development and good quality of life.

Although scaling up of availability and use of impregnated bed nets and other child survival interventions (immunization, Vitamin A distribution, etc) has resulted in a reduction of mortality by more than 70 per cent over the last 10 years, infant mortality and under five mortality are still considered high since the country has to reach the target of 49 per 1000 live births by 2015 (MDG 4).

Newborn and peri-natal problems are ongoing problems. Neonatal deaths are high and increasing in proportionate terms. Neonatal mortality represents 50 per cent of infant deaths and 27 per cent of the U5 mortality. Levels of malnutrition of children in Eritrea are also one of the highest levels worldwide. Diarrhoea and pneumonia still account for many deaths and morbidities in Eritrea. In addition to the high levels of malnutrition and morbidity and mortality of children, the socio demographic indicators of Eritrea still show that Eritrea has a lot of room for improvement.  HIV and AIDS are an emerging potential problem.

A child survival strategy is a core component of the national health policy towards achieving the national vision in Eritrea. The following are the adopted programme strategies:

• Support health systems development by providing a strategic interventions framework to analyze and address bottlenecks for scaling up key interventions to reduce maternal and child mortality.
• Integrated approach to specific interventions.
• Accelerate delivery of interventions by enhanced outreach using mobile health service delivery strategies, maternal and child health days , high risk district approach and reaching every district approach (RED) supported by effective  programme communication strategies.
• Intensify social change communication for community capacity development in promoting newborn and child care practices; immunization, IMCI, malaria and HIV/AIDS, capitalizing on all available and emerging effective technologies to complement current behaviour change communication efforts.
• Support a continuum of care from the household to the health facility, including care for women before and in pregnancy, delivery and essential newborn care at home and health facilities. Community-based interventions will be highly supported.
• In order to scale up the coverage of interventions, health systems will be strengthened especially delivery systems and the required human resources to deliver services. Household and community level (micro-level), health systems and other sector level (meso-level) and at policy level (macro level) will be strengthened.
• High level advocacy will be undertaken to ensure adequate health financing (government and partners).
• Improve inter-ministerial and intra-ministerial coordination.
• Resource mobilization and ensure best utilization of available resources.

MoH has adopted the following low cost, high impact package of services which are to be scaled up towards achieving health related MDGs:

• Breastfeeding protection and promotion
• Complementary foods and feeding
• Micronutrient supplements to combat vitamin A and iodine deficiencies
• Supplementary and therapeutic feeding
• Immunization including Hib vaccine
• Insecticide treated bed nets
• Prompt treatment for malaria
• Oral re-hydration therapy for diarrhoea treatment
• Preventive and care of pediatric HIV/AIDS
• Antibiotic treatment for pneumonia, sepsis and dysentery
• Antenatal care and tetanus toxoid vaccination in pregnancy
• Safe delivery and emergency obstetric care
• Essential newborn care

The selection criteria of priority interventions in Eritrea based on evidence include their sustainability and feasibility to be scaled up and to achieve a high and equitable coverage. The Ministry of Health, with key national partners and international stakeholders will build on the child survival and development achievements so far as well as existing opportunities to overcome the challenges towards achieving the health related MDGs.

About UNICEF Eritrea

The United Nations Children’s Fund (UNICEF) has operated in Eritrea since 1992 through a Basic Cooperation Agreement with the Government of the State of Eritrea (GSE). The Agreement is the basis for UNICEF’s programmes of cooperation, which means that all programmes, projects and activities undertaken by the Country Office have been jointly agreed by the Government and UNICEF for the benefit of Eritrea’s children and women. To date, the GSE and UNICEF are implementing the 2007 – 2011 Country Programme of Cooperation and the priorities are:

• Young Child Survival and Development
• Basic Education and Gender Equality
• Water, Sanitation and Hygiene
• Child Protection
• Advocacy and Partnerships for Children
  

All these interventions are complementary and work in convergence to leverage resources and results for the most vulnerable children and women with the objective of creating an enabling environment for the realization of children’s rights.