Feature Health in developing countries

Who cares for baby?

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39365.579016.94 (Published 18 October 2007) Cite this as: BMJ 2007;335:798
  1. Hannah Brown, freelance journalist
  1. Cambridge
  1. Hannah{at}two-cultures.com

    Divisions between maternal and child health services in the developing world, first reported 20 years ago, left services for newborns overlooked. Today, neonatal mortality is still unacceptably high. Hannah Brown reports on initiatives trying to bridge the gap

    There are few better examples of the wasteful and damaging results of uncoordinated health efforts than in Cambodia. Hundreds of well meaning non-governmental organisations have taken up residence in various parts of the country's 20 provinces since the brutal civil war of the 1970s and 1980s gave way to peace. But although this massive influx of resources is welcome, the confusing array of organisations, programmes, and priorities has proved unable to meet Cambodia's needs—particularly when it comes to improving maternal and child health.

    Many actors mean many approaches. This has created an incomprehensible patchwork of programmes that have a bewildering range of effects on the population's health. Unequipped for such a complex managerial challenge, the resource poor government has little capacity to get the non-governmental organisations to coordinate or put in place national programmes that can capitalise on the influx of resources. Instead, disparate independent aid offerings are often the only services many of the country's 14 million citizens see. So coverage is low for even essential interventions and services are heterogeneous and patchy.

    Nutrition is one example. Good nutrition is an essential component of programmes to improve both child and maternal health. But a 2002 nutrition sector review in Cambodia done by Helen Keller International—with the cooperation of 58 United Nations agencies and non-governmental organisations working in the country—revealed a jumbled mess of programmes, approaches, interventions, and coverage rates.1 Some areas received vitamin A supplements and others iron tablets. Where breastfeeding information was available, it did not necessarily conform to international guidelines and was independent of complementary feeding advice. Some …

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