The scandal of infant mortality

24,000 children under the age of five continue to die each day

In the year 2000 at the United Nations, 189 governments made a firm agreement to reduce child mortality by two thirds by 2015. This sounds like Whitehall-speak so I'll tell you straight what this really means.

Each day 24,000 children under the age of five die. In this day and age, notwithstanding the recession, this is appalling. The agreement made in 2000 was one of eight pledges or Millennium Development Goals and this one was number 4 (MDG4). Next year there will be a review but I can tell you we are falling woefully short. Two thirds of the way towards the 2015 deadline only a third of the target has been met.

This is not just a story about raising aid spending. The biggest scandal lies in the degree to which money is being spent in the wrong areas and on the wrong priorities. We need higher spending but we also need smarter spending to save the most lives.

Firstly, children under two years of age need adequate nutrition. More than a third of all under-five deaths are related to malnutrition. Malnourished children are more vulnerable to disease and less able to fight off infections. Community level programmes to encourage and maintain breastfeeding need to be supported to ensure that newborns can benefit from the proven nutritional value of their mother's milk. Alongside this, families need a better understanding of nutrients and the best foods available locally to ensure children grow up healthy. Well nourished children are less prone to disease so investing in nutrition pays dividends by cutting health costs in the long run, as well as allowing children to grow up and achieve their full potential.

Secondly, maternal health needs to be improved. Women's health is a neglected area in many developing countries and of all the Millennium Development Goals, the goal to improve maternal health, MDG5, is furthest off track. Over half a million women still die each year from pregnancy and childbirth-related complications and the health of mothers and their children is inextricably linked. Increasing the number of women delivering with a skilled birth attendant as well as increasing the numbers receiving postnatal care can dramatically reduce maternal deaths. Better maternal nutrition is also key to improved maternal and child health, including low-cost supplements during pregnancy and additional nutritious food. Gaps between pregnancies of at least two years contribute to healthier mothers and children who are at lower risk of complications during pregnancy and beyond.

Finally, effective prevention and treatment programmes must target the main childhood killers. Pneumonia, diarrhoea, malaria and HIV and AIDS together account for over half of under-five deaths. The prevention of these diseases need to be placed at the centre of efforts to achieve MDG 4, but programmes to improve child health must also look beyond the killer diseases to address the indirect causes such as water, sanitation and hygiene. Clean water, sanitation and hygiene have a key role to play in preventing ill health in children, hand washing with soap can reduce deaths from diarrhoea by 45% and pneumonia by more than 20%.

Improved maternal health, good nutrition and basic prevention measures - such as water & sanitation - at the household and community level are among the most important factors shaping the life chances of children - if these 3 areas are addressed then the poorest countries will be well on the way to achieving MDG 4 to reduce child deaths.

None of this will happen without politicians realising that we care that thousands of children will die today, even if they do live many thousands of miles away. Please help us.

Kate Eardley is health policy adviser with World Vision UK. She previously worked in health and development for The Salvation Army, living for 2 years in rural Zambia and 6 months in Congo Brazzaville.