Upstream barriers to child mortality reduction: the case of Sub Saharan Africa

Bernadette Ann-Marie O'Hare, Innocent Makuta, Levison Chiwaula, Naor Bar-Zeev

Research output: Contribution to journalArticlepeer-review


Aims With only two years to go before the 2015 deadline for the Millennium Development Goals (MDGs), Sub Saharan Africa (SSA) is off-track on MDG number four (MDG4); reducing child mortality. We aimed to examine the upstream barriers to achieving this goal, especially lack of sufficient financial resources. We specifically looked at the contribution of financial resources lost through illicit financial flows (IFF), corruption and debt service to the insufficient progress on child mortality reduction in the region.

Methods We used country-level data from all SSA countries from 2000 to 2011 to calculate the average resources lost annually through IFF, corruption and debt service from as a percentage of all potential resources. We used GDP-under five mortality elasticity to calculate the extra gains, at country- level, in annual rate of reduction (ARR) in under-five mortality if these outflows did not occur.

Results About 25% of all potential resources in SSA (or equivalently, 33% of GDP) have been lost through IFF, corruption and debt service. The ARR for SSA as a whole is 3%, this would would have been 12.5% higher.

The ARR, at country-level, would have been 8% to 15% higher than the observed rates. For example, in Malawi, the ARR would have been 12.8% higher that the observed ARR. More countries would therefore achieve their targets by 2015 and more children’s lives would have been saved.

Conclusion Resources lost through IFF, corruption and debt services have slowed down progress by draining away finances for achieving MDG4 (and other goals). Post–2015 development agenda and strategies for child mortality reduction must embrace curtailing these outflows as a means for ensuring sufficient and stable availability of finances for these ends. IFF must be curbed by putting in place a legal framework that allows for a more transparent global financial system. Fighting corruption entails stronger political will to establish and /or strengthen the regulatory framework at national level. An increasing proportion of aid should be given as grants to reduce debt burden of these poor SSA countries.
Original languageEnglish
Article numberA123
JournalArchives of Disease in Childhood
Issue numberSuppl. 1
Publication statusPublished - 1 Jun 2014


  • Child Mortality
  • Upstream determinants


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