Strengthening Primary Healthcare Systems to Prevent Childhood Mortality

A Rwandan mother carrying her baby on her back

Rosa, a Rwandan mother from Gakenke District, carries her one-year old daughter Mukeshimana on her back. She has wrapped her baby’s body in a colorful kitenge cloth, tightly tied around her. Rosa cannot see that the tiny angel she carries is sweating, but she knows that her baby has had a fever and a cough for almost a week.

Worried, Rosa is taking Mukeshimana to Kinihira Hospital. The mother ignores the discomfort of her feet in a pair of green bodaboda shoes as she wonders how the doctor will diagnose her daughter. She hopes for the best but is worried about what will happen next, worried about the unknown. Her left hand is carrying the secondhand bag she purchased from the market, while her right hand holds up a colorful umbrella to protect Mukeshimana from the aggressive sun rays in the afternoon sky.

Rosa can’t believe it was raining all morning and now the sun is burning like the fire in her kitchen. This rainy season has flooded her mind with anxiety. While the heavy rains are a blessing to her crops, mosquitos invade her community as if they are awakening from the cursed ground. The risk of malaria is high. Rosa imagines how the hospitals will be overwhelmed with patients in the coming weeks, and her worry grows.

When a functional primary healthcare system is in place, the prevention and control of local endemic diseases is possible, as is the quality treatment of those do become ill.

What happens during rainy season when the risk of malaria is heightened should be a given, but quite often it is not. Rosa’s family is not using mosquito nets, as the ones they had had big holes that even birds could pass through. Some of their neighbors don’t have nets, and others don’t even understand why they should use them. There is no protocol in place to refer children or other sick people to specialists when their conditions worsen. In other words, the primary healthcare system is not operating as it should be. When a functional primary healthcare system is in place, the prevention and control of local endemic diseases is possible, as is the quality treatment of those do become ill.

Two of the most inspirational but least understood terms in global health are “universal health coverage for all “and “primary healthcare”. These themes became core policy issues for the World Health Organization first with the explicit commitment to expanding primary healthcare for all in Alma-Ata Declaration in 1970 and later with the 2000 Abuja Declaration of “Health for All”. Some developing countries are already taking a lead on developing integrated, comprehensive community health programs. For instance, Rwanda has a well-defined model of management of malaria and pneumonia. This signals that progress is possible, but there is immense unmet need.

I am privileged to be a part of this global human family, but it pains me that so many people are dying from preventable or treatable conditions. So many people are suffering because of our society’s lack of interest, compassion, and concern. The mortality rate of children in developing countries is a particularly saddening metric. In other countries, the deaths of the children that these statistics represent would have been avoided in most circumstances. With 24-hour access to hospitals and doctors in developed countries, children have the opportunity to have their illnesses treated in a timely manner, or even prevent them before they begin.

Unfortunately, in developing countries, many children die because there is simply no integrated curative and preventive interventions to address the immediate and underlying determinants of their health. No child is born to die! As a global health activist, I believe that we should reject the status quo and drive a change. I recognize that serious change in global health will only be achieved with the skills, time and passion of a diverse community of leaders committed to building equitable health systems.

Rosa’s child might not have died of malaria if there was a functional system in place to prevent and control local endemic diseases. Who knows? If there was an integrated referral pathway, Rosa’s child’s imminent death could have been prevented. Perhaps she would have lived to grow into a beautiful woman. Rosa’s daughter is just one example of millions of children who are dying of preventable diseases.

The end of this story — and the lives of the Rosa’s and the Mukeshimana’s of the world — will depend on the choices that we make as policymakers, as leaders and as members of the global human family.

Here are some interventions that could help to reduce rates of child mortality in the developing world: 
· educating parents and health workers about hand-washing to prevent diarrhea and gastro-enteritis.
· ensuring health facilities are equipped with water, soap, and hygienic disposal methods.
· distributing mosquito nets and educating parents on the best use of them to reduce childhood malaria.
· supporting mothers to breastfeed their children to avoid exposure to pathogens that cause dangerous illnesses.
· ensuring medicines and supplies for treating major childhood illnesses are available.

It’s our responsibility to step up to the plate to establish functional primary healthcare systems with no disparities or inequalities. Doing this work is not just for health practitioners or Ministers of Health. It’s for anyone who cares about the wellbeing of our global human family and wants to make universal primary healthcare a reality.

As Margaret Mead said, “Never believe that a few caring people can’t change the world. For indeed, that’s all who ever have.” The end of this story — and the lives of the Rosa’s and the Mukeshimana’s of the world — will depend on the choices that we make as policymakers, as leaders, and as members of the global human family.


Sandra Isano is a 2016–2017 Global Health Corps fellow working with the Rwanda Zambia HIV Research Group as a Program Officer in Kigali, Rwanda. Sandra is the founder of the E-CARE Initiative, a digital platform for HIV patient follow-up. Sandra has a degree in pharmacy from the University of Kigali, and is committed to using her expertise to ensure health equity.