REVOLT OF THE TRANZIS

UNICEF leadership 2005-2015
(Richard Horton, The Lancet, December, 3rd, 2004)

The selection of UNICEF's next executive director lies in the gift of Kofi Annan, the UN's secretary-general. This mysterious procedure leaves open the possibility of crude political deal-making in identifying an acceptable candidate --acceptable, many observers suspect, to the UN's largest funder, the US government. Those close to the secretary-general concede that the next executive director of UNICEF is likely to be an American, irrespective of the person's skills or experience. And here is the intractable difficulty for Kofi Annan--there are no agreed criteria by which the global political or health community can judge a candidate to lead UNICEF. This discredited process threatens to damage the integrity of the UN system and, more importantly, it may well prove disastrous for the future of child health.

It is widely, if regrettably, accepted that UNICEF has lost its way during Carol Bellamy's long term of office. A corporate lawyer and financier for many years, Bellamy went on to become a New York politician who was thrust into a position that demanded deep experience of children's issues--and child health especially--worldwide. It was a role that she was ill-equipped for, despite her evident enthusiasm for UNICEF's ideals. While Bellamy has focused on girl's education, early childhood development, immunisation, HIV/AIDS, and protecting children from violence, abuse, exploitation, and discrimination, she has failed to address the essential health needs of children. It was left to independent child health researchers and advocates, driven by intense frustration at Bellamy's unwillingness to engage with child survival, to draw attention to UNICEF's pervasive neglect of its central mission.

The call for a reorientation of UNICEF's work came with a simple question: "Where and why are 10 million children dying every year?".2 Based on new data from the Child Health Epidemiology Reference Group, Robert Black and colleagues reported that half the world's deaths among children under 5 years of age occurred in just six countries-- India (2·4 million deaths); Nigeria (834 000); China (784 000); Pakistan (565 000); Democratic Republic of Congo (484 000); and Ethiopia (472 000). Although the highest absolute number of deaths occurred in south Asia, the highest rates were found in sub-Saharan Africa, where mortality in many countries is actually increasing.

These figures were shocking to those who believed that UNICEF had been making steady progress in improving child survival. Worse still, over 60% of these deaths were and remain preventable. Undernutrition contributes to the deaths of over half of all children. Cost-effective interventions are available for all major causes of child mortality. But coverage levels for these interventions are appallingly low in the 42 countries that account for 90% of child deaths. 80% of children do not receive oral rehydration therapy when they need it. 61% of children under 6 months of age are not exclusively breastfed. 60% do not receive treatment for acute respiratory infections. 45% do not receive vitamin A supplements. A quarter of children do not receive the diphtheria-pertussis-tetanus vaccine. And the gap in survival between the richest and poorest children is increasing. In sum, for almost a decade, child survival has failed to get the attention it deserves. Child health needs better leadership, improved coordination of services, and increased funding. [...]

Given this escalating evidence base for child health, but all on a paradoxical background of failure to meet the MDG on child survival, UNICEF clearly has a pivotal role to lead the world's efforts to make children a global priority. Under Bellamy's leadership, UNICEF is presently in a poor position to do so. Her distinctive focus has been to advocate for the rights of children. This rights-based approach to the future of children fits well with the zeitgeist of international development policy. But a preoccupation with rights ignores the fact that children will have no opportunity for development at all unless they survive. The language of rights means little to a child stillborn, an infant dying in pain from pneumonia, or a child desiccated by famine. The most fundamental right of all is the right to survive. Child survival must sit at the core of UNICEF's advocacy and country work. Currently, and shamefully, it does not.

This critique from within the progressive, internationalist circle is a little turgid, but comes with a bite nonetheless. Essentially Dr. Horton is accusing Ms Bellamy of letting children die while she pursues her political agenda. Ms. Bellamy appears to fit well in the community of well-heeled professional boomers who earn gold and glory pushing abstract drivel while those they are charged with protecting suffer.