Awa Marie Coll Seck

Awa Marie Coll Seck

Senegal's Health Minister

According to The Economist, child mortality in Senegal has dropped 40 percent in just five years from 2005-2010, one of fastest reductions the world has ever witnessed. The country had falls of more than eight percent a year since 2005, almost double of the percentage necessary to reach the Millennium Development Goal 4. At Falling Walls, Senegal's health minister Coll Seck will explain how the immunisation and malaria control are the main reasons for these achievements. Professor Awa Marie Coll-Seck has an unparalleled experience as a specialist in infectious diseases in leading hospitals in Dakar, Senegal and Lyon, France, and as a health policy maker with leading roles at the UNAIDS, the Roll Back Malaria (RBM) Partnership, and recognitions like the title of Chevalier de l’Ordre du Mérite de la République Francaise. As Minister of Health, she reformed the health sector in Senegal activating partnerships involving government, civil society and private sector to implement and expand the public health programmes. In her 15 minutes lecture, her unique vision and experience on how financing for malaria and other major diseases, can help save lives in every endemic country and community.

Breaking the Wall of Child Mortality. How Immunisation and Malaria Control are Saving Senegal's New Generations


Ladies and gentlemen, it is a great pleasure for me to be here, and I would like to add another word to this: I really realised that it is a victory of freedom, but also a victory for Germany, a victory for the world. I was saying to my students at this time: you need to be proud, because you are part of this world, but you also need to learn from that. Today I would like to speak with you about another wall, which is the one of child mortality. What we have seen for a long time is that we have a real wall between the children from the North and those from the South. Those from the South are dying everyday because of preventable diseases. But let us first go to what we mean by child mortality. We need to all agree on the fact that child mortality is all the people dying in an age under-five, and this is really per thousand live births per year. But I will also use other terms like ‘infant mortality’, and this is just for those between 0 to 1 year, and also ‘neonatal mortality’, because it is also those between 0 to 28 days. All these are important, because we will see that we often need other types of strategy in function of the different groups. Reducing child mortality is also one of the Millennium Development Goals. It is the fourth Millennium Development Goal, along with maternal mortality, but also a lot of infectious diseases, like HIV/Aids, malaria, tuberculosis, and other infectious diseases. What is the aim of this reduction of child mortality? It is to reduce by two thirds the under-five mortality rates from 1990 to 2015. I would like to stop here on two issues. The first one is that when we are at looking child mortality, we need to correlate it with state failure. All the countries, where you have difficulties in stability or a lot of corruption, a lot of problems, you have also a very high rate of child mortality. But also, when we look at the physical quality of life index, this is also one of the indicators, but we have also life expectancy and we have also the level of literacy in a country.

Just to show that child mortality is really something very important when we look at health and development: when we look at this map, we will see very clearly that all the the countries, which are green (low level of child mortality), are countries from the U.S. or North America, Latin America, and Russia, China etc. But all the others are from Africa, and a little bit Southeast Asia. It is where you have the high level of child mortality. But we can say that overall we have a progress towards this MDG-4, and the number of under-five deaths worldwide has declined—from 12 million in 1990 to 6.9 million in 2011. This is a big progress, but it still applies that we have 19,000 children under- five dying everyday. This is a lot. It is too much. We can also say that when we look at the annual rate of reduction of children under- five deaths, we will see that it is accelerated everywhere but insufficiently when you look at Sub-Saharan Africa. 98% of the deaths of children under-five are occurring across 42 countries, and all of them are in the developing world, mainly in Africa and in Southeast Asia. When you look at Africa, it is mainly West Africa, Central Africa, and Somalia, where you have the highest rates. But, the highest rates of child mortality are still in Sub-Saharan Africa. When you are looking at Sub-Saharan Africa, you will see that you have one child in nine dying before the age of five. This is 16 times more than what you are seeing in the developed world. Three countries in Africa have seen a real decrease of their child mortality: Senegal, Rwanda, Kenya, but these countries have seen falls of more than 8%, and what we would like to see every year is 4% to reach the Millennium Development Goals. It is just to say that they are doing well, and I would like to go into more detail to explain what happened. But let me also tell you that, in fact, in all these countries in Africa, what we are seeing, is that the children are dying of treatable and preventable diseases: mainly acute respiratory diseases, diarrhoea, and complication during childbirth—when we look at all, because malaria today is going down. All these disease like measles, diseases we can now prevent with vaccine, are also going down, while these are not making progress: acute respiratory disease, diarrhoea, and childbirth complication. But, we need to know that malnutrition is often underpinning all these deaths, and we need to look at that, too.

What about Senegal? We say that Senegal has done well. Why? Because we have seen that we have a child mortality rate decreasing from 121 to 72 in five years. A lot of researchers have said that this is very important, because it took to India a quarter of a century to make the same reduction. This is just to say that something has happened, and I will develop it later. The infant mortality, the mortality of those who are younger, has also decreased from 61 to 47. If you look at the map, you will see how this is going down, and we are expecting for 2015 to be at 44 and to reach the Millennium Development Goals. It is the same thing when you look at the causes of child death—the more important is neonatal, and I will insist on that, because it is where we need to make more progress. But how did we do? We improved immunization coverage, we had a lot of success in the fight against malaria; we also use a lot of health promotion, particularly at community level, but we have also a lot of progress in water and sanitation coverage. And more important is also the financing: the country has put more money, but also the international community has put a lot of money on vaccination and also in the fight against malaria. I think we have GAVI, who have done a lot for vaccine, but we have also the Global Fund and the U.S. Presidential Initiative, the World Bank, the UNITAID – all have put a lot of money in countries, and Senegal has benefitted a lot from this money. We will go quickly, just to show the immunization coverage is going all up in Senegal. For malaria, what we have seen is that the morbidity and the mortality are going down, but mostly at the moment where we have put ACTs, the treatment, and also the insecticide treated net, the long-lasted net—it is a new technology—and this has helped a lot the people in Africa, and particularly children under-five. We see today that we have decreased almost completely the number of cases, but also the mortality. Health promotion focuses more on women, and this is also something very important in Senegal. What we can say is that neonatal mortality is a problem we have, and what we would like to see is that we would like to focus and have a specific plan to reduce neonatal mortality. Because, we have seen very well that amongst all these children under-five dying, those between 0 and 28 days have the highest mortality rate, and it is where we need to do something if we want to reach the Millennium Development Goals. For that, we will need to improve pregnancy and care delivery, because this is also something important. I need to say that in Senegal the maternal mortality is not going down; it is still really high. We know that this has an impact also on child mortality. This is something that we need to work on. We need also to support a network for new born, because this is a lot of work to do at community level but also in the hospital, etc. We would like to develop a strategic plan for 2013 to 2015 to accelerate the work we are doing. We have a lot of technology that we are starting to put in place, and this will help us to ensure that all these children will be saved, and most of them will be saved before 2015.

What I am saying today is something very different than what we have heard since the beginning, because here is a real problem and a real life in the developing country. But we know that we need to use research; we need to use new technologies if we really want to accelerate what we are doing. Here I would like to say that we are doing our best to ensure that we will be achieving the Millennium Development Goals, particularly those on health. We would like to see children from Senegal to be with the children of other countries in the North, looking at their future, and having hope that they will survive; and they will be the people of tomorrow. Thank you.