Children are five times more likely to die in countries where there is a shortage of health workers, Save the Children warned yesterday.

The charity has drawn up an index ranking the best and worst countries for a child to fall ill in – with Chad and Somalia at the bottom and Switzerland and Finland at the top.

Save the Children said children living in the bottom 20 countries – with just over two health workers for every 1,000 people – are five times more likely to die than those further up the index.

The UK ranks 14th overall, with Ireland third and other countries in the top 20 including Norway, Belarus and the US. Among the bottom 20 are Lao People’s Democratic Republic (Laos), Ethiopia and Nigeria.

The index includes 161 countries, and measures not only how many health workers there are but also their reach and impact. It also tracks the proportion of children who receive regular vaccinations and mothers who have access to life-saving emergency care at birth.

Released ahead of the UN General Assembly in New York later this month, the index highlights countries including Sierra Leone where millions of children could die because of a lack of trained health workers, Save the Children said.

The charity is highlighting a global shortage of more than 3.5 million doctors, nurses, midwives and community health workers which it said means vaccines cannot be administered, life-saving drugs cannot be prescribed and women cannot get expert care during childbirth.

It also means easily-treated illnesses, such as pneumonia and diarrhoea, can become deadly.

Save the Children chief executive officer Justin Forsyth said: “A child’s survival depends on where he or she is born in the world.

“No mother should have to watch helplessly as her child grows sick and dies, simply because there is no-one trained to help.

“World leaders must tackle the health worker shortage and realise that failing to invest in health workers will cost lives.

“Even the poorest countries in Africa can make real progress if they stick to their pledge of investing 15 per cent of their budgets in health.”

Save the Children said analysis of the rankings showed that children living in the most remote areas are least likely to see a health worker.

In Ethiopia, which ranks 158th out of 161, just under 70 per cent of women say a clinic is too far away, while in Sierra Leone (144), Uganda (145) and Niger (152) more than half of all women surveyed say the clinic is too far for them to reach.

The results also showed that female health workers are crucial in countries such as Afghanistan, Nepal and Ethiopia – which all fall in the bottom 20 – where women cannot see a male health worker for cultural reasons.

It said efforts to increase the number of female health workers in Afghanistan (147) has helped reduce child mortality.

Analysis also showed low-income countries can cut child mortality rates, Save the Children said. It said Bangladesh (143) and Nepal (151) had both invested in community health workers and are on track to reach a goal of cutting child deaths by two-thirds.

The target is one of the Millennium Development Goals – eight international development goals that all 193 UN member states and at least 23 international organisations agreed to achieve by the year 2015.

They include eradicating extreme poverty, reducing child mortality rates, and fighting disease epidemics such as Aids.

But Save the Children said more midwives are needed to keep up progress in both Bangladesh and Nepal, despite their improvements.

The charity said it is lobbying world leaders at the UN General Assembly, which starts on September 20, to end the health worker crisis, saying rich nations must step up health funding, which is two-thirds short of what is needed globally.

It said commitment from developing countries is crucial - in 2001 countries across Africa pledged to spend 15 per cent of their national budgetson healthcare, but only eight have.

Save the Children called on governments, donors and partners to: Recruit more health workers with appropriate skills; make better use of existing workers to reach the most vulnerable children; to make sure all health workers are paid a fair wage; and to deliver more funding for healthcare, and in a more effective way.

The bottom 20 countries

1. Chad (161 ranking overall)
2. Somalia (160)
3. Lao People’s Democratic Republic (159)
4. Ethiopia (158)
5. Nigeria (157)
6. Central African Republic (156)
7. Equatorial Guinea (154)
8. Timor-Lesta (154)
9. Niger (152)
10. Guinea (152)
11. Nepal (151)
12. Yemen (150)
13. Papua New Guinea (149)
14. Guinea-Bissau (148)
15. Afghanistan (147)
16. Liberia (146)
17. Uganda (145)
18. Sierra Leone (144)
19. Bangladesh (143)
20. Madagascar (142)

The top 20 countries

1. Switzerland
2. Finland
3. Ireland
4. Norway
5. Belarus
6. Denmark
7. Sweden
8. Cuba
9. Uzbekistan
10. Germany
11. Russian Federation
12. France
13. Czech Republic
14. UK
15. United States
16. Kazakhstan
17. Australia
18. New Zealand
19. Lithuania
20. Qatar