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A look at child and adolescent healthcare systems

While incremental progress has been recorded in various sectors of child and adolescent health across the globe, there is a real risk that nations might completely fail to meet the United Nation’s sustainable development targets. Consider this single fact: Over 8.6 million deaths occurred among children and adolescents (0-20 years) in 2019. A new Lancet series calls attention to the crisis in the children and adolescent sector, urging for a complete rehaul of the way things are being done now.

A series of four papers set out the current position, with the gains that have been made globally, but points out the stark variations in the global scenario, with some nations’ showing more marked improvements than others.

Series coordinator and author Zulfiqar Bhutta, from The Hospital for Sick Children (SickKids) Centre for Global Child Health, Toronto and the Aga Khan University, Karachi says: “We have less than eight years to meet the UN’s Sustainable Development Goals, and many child and adolescent health targets are off track. A holistic approach that supports children and their families from before birth through early adulthood is urgently needed to bring us back in line, building a foundation that will last a lifetime and improve health outcomes, economies, and society.”

Children are considered the bulwark of a nation’s future, and easing the passage for their growth and development is part of the process of not only ensuring human rights of individuals, but also guaranteeing a country’s hereafter.

The need for comprehensive care

The papers in the series take a broadspan, expansive view of the situation — exploring the determinants and building blocks of thriving, from preconception through foetal development up to 20 years of age. The first considers conditions of survival, growth, disability and education, focusing on the crucial periods in the lifecycle before adulthood that form the foundation for building human capital. It indicates that globally, an estimated 8.62 million deaths occurred between 28 weeks of gestation and 20 years of age in 2019.

Another paper studies the impact of early life poverty on growth and development of children. The authors use data from low and middle income countries to substantiate the negative effects of early life poverty on the survival, nutrition and cognitive development of children and adolescents.

The third paper, reviewing the evidence available, acknowledges that progress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, recording the advancements as contributing to a fall in child mortality and morbidity. However, there are huge inequities, and several children and adolescents do not thrive or survive because low-cost interventions are not deployed to their benefit. While calling for scaling-up of evidence-based interventions for children under five years, the authors also go on to highlight interventions for school-going children and the period of transition from childhood to adolescence. This includes recommendations to support mental health, address unintentional injuries, non-communicable diseases, and neglected tropical diseases.

Yet another paper looks at improving health and social systems for all children in low and middle income countries, and suggests structural innovations that could be employed to deliver quality services for them. The authors argue that “structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems.”

Effects of the pandemic

Naturally enough, the pandemic makes an appearance, read into the context of identifying the chinks in the armour or the challenges in delivering appropriate services to children and adolescents. “The COVID-19 pandemic showed us the devastating effects that gaps in care and education can have on children. Health and social systems must be better equipped to work together to address the emerging needs of children and families as part of the effort to rebuild equitable and resilient services,” according to Maureen Black from RTI International and the University of Maryland, Baltimore (U.S.).

Dr. Bhutta adds: “The challenges faced in responding to the needs of children and families during the COVID-19 pandemic should serve as a wake-up call to the global community, underlining the urgent need to transform the child and adolescent health agenda on a global scale.”

The series, while calling for efforts to reimagine the delivery of services that will help children thrive, mentions that a piecemeal approach, catering only to certain age groups may not be the best way to handle the crises.

Instead, the authors call for comprehensive care that spans nutrition, preventive health, education, economic, and community support across age groups from preconception through the age of 20. The close involvement of families, particularly in offering support right from the stage of pregnancy, continuing through the relevant years allowing the child to bloom, is also recommended strongly. It’s in the best interests of nations to take these recommendations in earnest, and ensure their future is taken care of in the present.

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