These sentiments were expressed at a presentation on the South African Child Gauge 2009/2010, which focuses on the theme of child health, to health professionals attending the Wednesday morning lecture on Wednesday, 10 November 2010, at the School of Child and Adolescent Health.

Published by the Children's Institute, a multi-disciplinary research institute in the Health Sciences Faculty, the Child Gauge annually reviews the situation of children in the country. Key findings from the fifth issue make sobering reading: despite putting in place a comprehensive range of laws, policies and programmes, South Africa is failing to translate children's constitutional rights to health into positive health outcomes for children.

Estimates by the Actuarial Society of South Africa show that the under-5 mortality rate has increased from 66 out of every 1 000 live births in 1990, to 73 live births in 2006. This suggests that it is highly unlikely that South Africa will achieve the Millennium Development Goal target of 20 deaths per 1 000 live births by 2015.

Commissioning editor Lori Lake explained that the leading causes of under-5 mortality are mostly preventable: HIV, which contributes to 35% of these deaths, neonatal causes, and childhood infections. Malnutrition is also a contributing factor in young child deaths, while injuries are the leading cause of deaths among older children.

The presentation showed that solutions require interventions both within and outside of the health care system. Poor health outcomes have their roots in poverty, poor living conditions and poor access to services. Two-thirds of children are living in households with a monthly per capita income of R570 per person. This means government departments and other duty-bearers need to work together to ensure that all children have access to adequate housing, water and sanitation, as well as access to health care facilities and sufficient nutritious food and social assistance when care-givers are too poor to provide for them sufficiently.

But there are other important interventions that can improve child health. Prof Louis Reynolds, a Child Gauge contributor, stressed the importance of community-based health services to strengthen responses to maternal, neonatal and child health at a local level. He also pointed to a lack of leadership within the public health care system and the need for 'activist' paediatricians to advocate for a strengthened health care system and collective action to address the broader social determinants of health.

The 2009/2010 Child Gauge team was led by Marice Kibel, Emeritus Professor of Child Health. Visit www.ci.org.za to download or order a copy, or to sign up for the Institute's Child Rights and Child Law course for Health Practitioners.