Although there has been some improvement, far too few of Africa’s children survive birth and the first year of their lives. In Africa as a whole, the infant mortality rate decreased from 90 deaths per 1 000 live births in 1990 to 54 deaths per 1 000 live
births in 2014. In 1990, the under-5 mortality rate (per 1 000 live births) in Africa was 146; in 2012 it had decreased to 65. While significant progress has been made since the adoption of the African Children’s Charter, the rate is still unacceptably high.The major causes of infant mortality in Africa are preventable.Asphyxia among infants can be prevented if more skilled birth attendants are available; malaria can be contained if universal distribution of insecticide-treated mosquito nets is achieved; and appropriate antibiotics can prevent pneumonia. Many early child deaths could be prevented with access to simple, affordable vaccinations, in line with the Global Vaccine Action Plan (GVAP) 2011-2020. In 2016, African Ministers of Health, Finance, Education, Social Affairs and Local Governments adopted the Declaration on Universal Access to Immunisation as a Cornerstone for Health and Development in Africa (Immunisation Declaration), committing themselves to continued investment in immunisation programmes.

A high maternal mortality rate has a direct bearing on the prospects of neonatal survival. While the average maternal mortality ratio for African countries has decreased from 870 per 100 000 live births in 1990 to 460 in 2013, the African rate is still much higher than anywhere else in the world. Systemic and socially-embedded causes contributing to this situation include low contraceptive prevalence rates; high adolescent birth rates; limited ante-natal care coverage; and a high unmet need for family planning. Sustained improvement to child and maternal survival require improvements to the health care system, including physical access to health facilities (as measured by walking distance). According to the African Children’s Charter (article 14), not only is the enjoyment by every child of the right to the best attainable health a central concern, but it also spells out specific obligations, for example that the State must ensure the reduction of infant mortality rates. Since May 2009, when the AU had launched the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) to accelerate action towards improving maternal and newborn health and survival across the continent, 44 AU member States have launched national campaigns. The AU’s Africa Health Strategy 2016-2030 calls for universal health coverage by 2030, and for ‘ending preventable maternal, new born and child deaths and ensure equitable access to comprehensive, integrated sexual, reproductive, maternal, neonatal, child and adolescent services, including voluntary family planning’.

As far back as 2001, AU member States adopted the Abuja Declaration and Plan of Action on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, in which they committed themselves to increase their health budget to at least 15% of the state´s annual budget. Few States have subsequently reached that target.

By 2040:

• No child dies a preventable death.
• Mother-to-child-transmission of HIV is eliminated.
• Children living with HIV are identified and provided with anti-retroviral treatment and are sustained on treatment to achieve viral load suppression.
• Every child is vaccinated against vaccine- preventable diseases, in particular diphtheria, tetanus, whooping cough, measles, polio and tuberculosis.
• The effect of malaria and other preventable illnesses on children is curbed.
• Nutritional supplementation, in particular of Vitamin A, is available to every child.
• Children are educated about HIV, AIDS and sexuality, with a focus on the prevention of HIV transmission.
• Exclusive breastfeeding is generally accepted and practised.
• Maternal mortality is significantly reduced.
• All children have access to and make use of quality, primary health care services; the treatment and prevention of HIV and AIDS, tuberculosis, malaria, pneumonia and diarrhea are prioritised.