International cooperation in childhood health (first part). Causes and determinants of health in developing countries

Each year ten million children under five die in the world. Although the mortality in low income and medium income countries dropped at the end of the 20th century, this reduction has decelerated. Moreover, the difference between poor and rich countries is more marked than it was in 1990. Many Agencies, Authorities and Organisations such as the European Union, the Spanish Agency for International Co-operation (AECI), the Governments of the autonomous communities and the majority of town councils and NGOs have no specific action policies to prevent child morbidity and mortality. Others, such as the WHO, UNICEF or children?s NGOs do have such a policy. This work considers the health situation and child mortality in the world and describes its direct and indirect determinants in order to try and find a way of achieving the ambitious goal of the millennium, to reduce the number of deaths among children under five by two thirds by the year 2015. The second part of this work studies the different strategies (selective, integrated and social) designed to improve this situation and its effectiveness up to now. It emphasises the fact that children in the third world do not have access to an Integrated Health System with good preventive and curative Primary Care and it insists that donors give their support to a good strategy to enable the receiving nations to develop a public health program at a district level. All this should be carried out without reducing the specific aid programs or actions which will undoubtedly help to alleviate this grave situation.