Save the Children applaud The Lancet’s
leadership in continuing to advocate for
increased global support for the unfinished
agenda of childhood survival.1
With 10·6 million children younger than
5 years still dying of preventable causes
annually, Joy Lawn and colleagues2
clearly set out the causes and distribution
of 4 million of these deaths, which
occur in the neonatal period of life (the
first month). They also clearly show that
Millennium Development Goal (MDG) 4
will not be achieved without addressing
health system interventions that promote
maternal and neonatal health.
The launch of the neonatal series was
extremely well timed, considering that
the Commission for Africa report,3 published
on Mar 11, fails to highlight the
plight of this marginalised group.
Both Richard Horton4 and Lawn and
colleagues2 discuss the importance of
increasing resources and political will to
support cost-effective interventions to
promote neonatal health; however,
demand-side factors also need to be
addressed. Our research report entitled
Unnecessary evil: user fees for health care
in low income countries5 indicates that
paying for services is a major barrier to
health-service use, and pushes poorfamilies into poverty. Evidence from
Uganda shows that if services are made
free at the point of access, use by children
increases by 70%.
Save the Children UK supports the
Commission for Africa’s position
against user fees but believes it should
have gone further and called for free
universal essential health care in Africa.
More operational research on pro-poor
health-financing mechanisms and
health systems research is needed to
ensure 10·6 million children do not continue
to die annually when we have the
interventions to prevent their deaths.
I declare that I have no conflict of interest.
Save the Children , 1 St John’s Lane, London
EC1M 4AR, UK
1 The Lancet’s neonatal survival series.
neonatal_survival (accessed May 16, 2005)
2 Lawn JE, Cousens S, Zupan J. 4 million neonatal
deaths: When? Where? Why? Lancet 2005; 365:
3 Commission for Africa. Our common interest:
report of the Commission for Africa. http://
introduction.html (accessed Apr 26, 2005).
4 Horton R. Newborn survival: putting children at
the centre. Lancet 2005; 365: 821.
5 Save the Children. Unnecessary evil: user fees for
health care in low income count