UNICEF: `revolution' in child survival. Agency views broadening regional cooperation as a key to success

On its 40th anniversary, UNICEF - the United Nations Children's Fund - has a challenge for the world: Every week 280,000 children under the age of five die from malnutrition and disease. Do something about it.

Already over the past five years more than 4 million children have been saved through cheap, readily available means. What UNICEF calls a ``revolution'' in child survival is picking up speed. But so many more children could be saved - almost 7 million a year within the next decade, says UNICEF director James Grant.

This year there is a new and encouraging development in the global effort to save children's lives: regional collaboration. The nations of both Central America and South Asia have signed unprecedented accords pledging to work together to protect the development and survival of children.

At the core of these agreements is the belief that the well-being of children transcends politics - and that perhaps promotion of this well-being can foster some understanding in a hostile setting. Both this year and last, El Salvador has shown that this can work. One day each month for three consecutive months, guerrillas and government soldiers laid down their arms so that children could be immunized.

On the regional level, the new agreements provide for the sharing of experience and supplies. In Central America, there have already been many cases of cross-border cooperation, as detailed in UNICEF's annual report released yesterday, ``The State of the World's Children 1987'': In April, Nicaragua rushed 100,000 doses of vaccine to Honduras when it realized its neighbor did not have enough for its child survival campaign. Honduras has provided Guatemala and El Salvador with oral rehydration salts (a cheap method of fighting dehydration, from which millions of children suffer). Technical teams from Guatemala have helped with immunization in El Salvador and Nicaragua.

Last month, the seven nations of South Asia followed in Central America's footsteps, signing a ``covenant of mutual child assistance.'' The nations have resolved to work toward universal child immunization by 1990. If the covenant is enacted, it can save 2 million out of the 6 million children that die every year in that part of the world, UNICEF officers say. And there could be political benefits.

``A lot of synergism can come from getting Pakistanis and Indians and Bangladeshis, who have been separated for all this time, together on this kind of theme,'' Mr. Grant said in an interview.

This year has seen other expansion in regional activism. Last month, the Conference of Latin American Bishops agreed to a program for child survival, in which it will help UNICEF and other agencies in their efforts. Since late last year, media associations committed to disseminating messages that promote these agency efforts have sprung up in West and East Africa and Latin America.

One of the biggest challenges to progress in child survival is the third world's continuing economic recession. As nations reform their policies to adjust for declining trade and commodity prices, programs for women and children tend to be the first that are cut. In a study to be released early next year, UNICEF officers conclude that health and education services are declining in many nations, leading to a rise in malnutrition.

UNICEF officials argue for ``adjustment with a human face'' and warns that policies that hurt children only mortgage a nation's future. The international financial institutions, at least, have begun to show an increasing awareness of this problem, UNICEF officers say.

Despite the continuing recession, Grant remains bullish about the child survival revolution. ``At times of economic adversity, when governments are having to retrench on so many sides, the opportunity to do something for a large part of the population at a low cost becomes politically relevant,'' he says.

For example, the Pakistani government deferred the building of a big new hospital in favor of launching a national immunization/oral rehydration effort and retaining 20,000 to 30,000 traditional birth attendants. Indonesia has had to cut back on most expenses, but at the same time has increased expenditures on immunization and on village health posts for children.

Looking ahead over the rest of this decade, Grant sees Africa as the toughest part of UNICEF's goal of universal child immunization. Currently, the focus is on Senegal, which is working toward total child immunization by next April 7, designated as World Health Day.

As one of Africa's more developed nations, Senegal has had trouble getting the child survival message down to the lowest strata of society. But it hopes to achieve its goal through a method that has worked in many other countries, ``social mobilization'' - where religious leaders, schools, politicians, journalists, women's groups, and other organizations all work together.

In 1980, 14,000 children died each day worldwide from lack of immunization. Now that figure is 10,000. UNICEF's goal is for it to be under 1,000 by decade's end.

The agency, considered one of the UN's most successful entities, may also have to do some polishing of its image at home. Tuesday, an internal UN auditor criticized UNICEF for being too involved with ``show-business fund raising'' to concentrate on pursuing its programs. The UN auditor says recent fund-raising events have been unsuccessful and have diverted the attention of field workers from their principle duties.

UNICEF's response to these criticisms is that these fund-raising events have raised millions of dollars for the agency. They spend only 10 percent of what they make on their administrative costs and this is considered a completely acceptable figure.

Momentarily pondering the past and the future, UNICEF's director says, ``We've had our Normandy landing. We're well established on the beachhead. The question is, can we really take advantage and break out to win. The progress is very real to date.''

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