Reducing the under-five mortality rate in SSA has been painfully slow. The under-five mortality rate was 186 per 1,000 live births in SSA in 1990, and remained practically unchanged at 174 in 2002. On the other hand, in North Africa, the under-five mortality rate was 87 per 1,000 live births in 1990 and dropped significantly to 38 in 2003.

The success in North Africa may be directly attributed to focused strategies for combating preventable diseases such as polio, smallpox, and parasites, which cause one-half of the under-five deaths. In 2003, while 93 per cent of North Africa’s children received a full course of vaccinations, the figure for SSA remained at a dire 61 per cent.

Part of the problem lies in poor planning. African governments and their development partners continue to overlook the need to link health to other programmes. Too little is invested in facilities for the delivery of public health services and basic health education for communities. Despite a recent commitment by African governments to allocate 15 per cent of their annual budgets to health, most countries in SSA have not found it possible to remove fees for basic healthcare.

Another major issue is training and retention schemes for health workers, many of whom leave Africa for better pay and working conditions on other continents. It is estimated that to turn the health tide in Africa, especially with regard to the HIV/AIDS pandemic, the continent will require an additional one million health workers.