South Africa is one of 12 countries that has failed to reduce child mortality since 1990, according to the 2009/10 SA Child Gauge released on Tuesday.

Children were paying the price for the country's failure to progress towards the Millennium Development Goals (MDGs), which aimed to reduce poverty, hunger and disease by 2015 and to ensure children's rights to survival, health and development, it said.

The gauge is produced annually by the Children's Institute, University of Cape Town, to monitor government and civil society's progress towards realising the rights of children.

The 2009/10 issue was hosted jointly with Unicef South Africa.

The report found that while South Africa was making progress on a number of MDGs, the targets for reducing child hunger, HIV, tuberculosis and child mortality were not being met.

Unicef deputy country representative Malathi Pillai said that child and maternal health outcomes were worse today then in 1990.

Unicef estimated that under-five mortality had risen from 56 deaths per 1000 live births in 1990 to 67 in 2008.

Pillai said that integrated primary healthcare services were key to addressing health needs of children.

"South Africa is a middle income country and yet we haven't reached our MDGs... ," she said.

"The fact is that South Africa puts a very large percentage of its GDP [gross domestic product] into the development sector, 8,7% of the GDP into the health sector."

Of this, 3,7% went into the public sector and 5% to the private sector.

Founding director of the School of Public Health at the University of the Western Cape, David Sanders said South Africa was failing its children.

"The bottom line is that we are failing our children, all of us, child health workers, policymakers, people in government."

He said that it was not only the health sector that was failing, but other sectors were also failing the country's children.

Over one in three children did not have access to basic sanitation or adequate drinking water on site, said Sanders.

The growth of nearly one in five children was stunted, according to the most recent national food consumption survey in 2005.

Mortality audits by the Child Healthcare Problem Identification Programme indicated that more than 60% of children who died in hospital between 2005 and 2007 were underweight, he said.

Inequalities persisted between rich and poor, black and white, rural and urban areas.

Head of the Division of Community Paediatrics at the University of Witswatersrand, Haroon Saloojee, said the "poor health status of South Africa's children is less the consequence of resource constraints, and more the result of inefficient management and use of available resources..."

Saloojee said that this was "primarily owing to poor leadership, poor organisation and the absence of accountability".

He said that lacklustre leadership and low morale contributed to the poor quality of basic services.

The gauge found that improving child health outcomes required concerted action from both within and outside the formal healthcare system. Poverty needed to be alleviated and inequalities eliminated.

Policies were being developed to strengthen the delivery of community-based services for mothers and children, and to train and support community health workers, it said.

Director of Management Sciences for Health in SA, Nomathemba Mazaleni said community-based services were important in improving healthcare for children.

Community health workers were being trained, in rural areas where clinics were faraway, in preventing and treating childhood illness, and were trained to recognise when to seek emergency care, she said.

Given sufficient funding, these initiatives should have a positive impact on child health.