40 million children have no access to basic healthcare

While child survival has tremendously improved in the past decades — the  global under-five mortality rate has fallen by 32% between 1990 and 2009 — many children still live without the most basic healthcare services.  Some 40 million children in 25 developing countries with high levels of child mortality are living in healthcare deserts.

Our latest report Healthcare Deserts: Severe healthcare deprivation among children in developing countries shows that one in seven children living in these countries can’t access any basic healthcare services, meaning  the child has not received any of the routine vaccinations or, when the child had a recent illness, like diarrhoea, it didn’t receive any treatment.

Living in a healthcare desert refers to a situation of severe healthcare deprivation. Healthcare deserts, in some cases, describe a geographical context where basic services are absent or too far away to be reached.  However in many cases, healthcare deserts refer to the situation where services are unaffordable, or of such poor quality that people don’t bother trying to access them or they are sought out, but are unavailable.

Living in healthcare deserts

Our study, which updates a Bristol-LSE paper released in 2005, uses data from the Demographic and Health Surveys to estimate the number of severely healthcare deprived children. Of the 40 million children in our sample who had not received any of the routine immunisations or treatment for bouts of diarrhoea, India accounts for 13 million followed by Nigeria and Ethiopia, with 7.8 million and 4.7 million people, respectively.  These three countries are part of the ten countries which had the most deaths of children aged below  five years in 2009.  Children from the poorest households are, on average, three times more likely to  experience severe healthcare deprivation than those born in the richest households.

Severe healthcare deprivation and child survival

While we did not test in our paper if  living in healthcare deserts directly causes child mortality, it’s worth noting that children born in the bottom wealth quintile are  more likely to both experience severe healthcare deprivation and die before their fifth birthday than those from the top wealth quintile.

Gains in child survival have been in favour of children from  better-off households in many developing countries as shown in independent research by Save the Children and UNICEF.  This suggests that improving the access to healthservices of the poorest households might help towards a more equitable reduction of under-five deaths.

The experience of Bangladesh shows us that it possible to roll out effective healthcare interventions widely.  For example, measles coverage for the bottom fifth of households went up from 62% in 1996 to 80% in 2007, bringing it almost at a par with the national average (national measles vaccination rates increased from 70% to 83% during the same period).  I have argued in a recent study that this strategy has made Bangladesh — one of the few low income countries on-track to meet Millennium Development Goal 4 — relatively more successful in spreading the gains of child survival across its population than neigbouring India.

In order to take children out of healthcare deserts,  we have to ensure that  quality healthcare services are available to the poorest and most vulnerable children, and that their families actually seek out and use them.

Unless basic healthcare services reach these 40 million children, it is unlikely that Millennium Development Goal 4 will be met in the poorest countries with very high under-five mortality burdens.