As a high-level forum assessing the progress on global health in relation to the millennium development goals concluded in Abuja, Nigeria, last week, the rhetoric of success repeated by those charged with ending the needless deaths of millions of the world's children masks their own deep-seated failure to grapple with critical institutional weaknesses in their own ranks. A commentary in this week's issue of THE LANCET provides an analysis of UNICEF, its decade-long failure to create and implement a strategy for child survival (the fourth Millennium Development Goal) and a call to action as the UN secretary-general, Kofi Annan, begins the process to appoint a new leader in 2005.

UNICEF's new leader will be appointed by Kofi Annan next year. The process of selecting a new executive director for UNICEF is flawed. Lancet Editor Richard Horton comments: "There are no agreed criteria by which the global political or health community can judge a candidate to lead UNICEF. This discredited process threatens to damage the integrity of the UN system and, more importantly, it may well prove disastrous for the future of child health".

In June 2003 THE LANCET published a series of articles which highlighted the shocking reality of global child health. The series sought to explain one very simple question: where and why are 10 million children dying every year? The answer--most deaths occur in 6 countries; two-thirds are preventable--elicited a widespread response, although not from UNICEF. Indeed, under UNICEF's present executive director, Carol Bellamy, the agency has lost its way over the most important part of its mission--to ensure the fundamental right of the child to survive.

Dr Horton continues: "UNICEF clearly has a pivotal role to lead the world's efforts to make children a global priority. Under Bellamy's leadership UNI
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
8-Dec-2004