Coverage story: how to deliver better child survival

More than 10 million children die every year, mostly in developing countries. Strategies exist that could prevent nearly two thirds of these deaths. So why are children still dying? A report by the Multi-Country Evaluation of IMCI Study Group highlights obstacles to the delivery of effective interventions.

Integrated management of childhood illness (IMCI) is a strategy for improving child health and development by delivering a combination of essential interventions. The study group assessed performance of the strategy in 12 countries and drew broader lessons for delivering child health activities.

There is some good news: average child mortality rates fell from 93 per 1000 live births in 1990 to 83 per 1000 live births in 2000. But the gap between what could be done to reduce child mortality and what is actually being done is growing. Coverage of child health interventions, such as immunisation, have either fallen or stagnated over the last decade, especially in sub-Saharan Africa. Poor coverage is a result of weaknesses in both the provision of and demand for services.

Looking specifically at IMCI, the study group found that:

• Introduction of IMCI does not lead to general improvements in the health system, which suffers from broader constraints.
• There is not enough effort devoted to implementation, especially strengthening health systems and changing key behaviours at the family and community level.
• More financial investment is needed to address health system constraints and remove obstacles to effective implementation of IMCI.
• The obstacles to scaling up IMCI are common to other child survival activities, such as immunisations, insecticide-treated materials for malaria prevention and nutritional programmes.

Using case studies, the report identifies common features of successful public health programmes, which:

• are well planned, implemented and assessed
• target at a few diseases
• are small in scale
• adapt to local epidemiological and community circumstances
• involve training and encouragement of primary healthcare workers
• use outreach to expand coverage
• apply principles of quality assurance.

Reducing child mortality and achieving the millennium development goal for child survival depend on whether effective and sustainable interventions can be delivered to high proportions of children and mothers. The researchers make a distinction between interventions and the strategies for delivering them. The researchers highlight five ways to improve delivery:

• collect data at the subnational level on local epidemiological profiles, health system capacity and community preferences
• choose effective interventions for community and health facility levels based on these data and other locally-defined key criteria, including the feasibility of achieving high, sustained and equitable coverage
• assess alternative delivery strategies
• tailor supply to meet demand and respond to needs
• strengthen national health systems, including manpower, drug and vaccine management and supply, information systems, and referral processes.

Source(s):
‘Reducing child mortality: can public health deliver?’, The Lancet 362: 159-164, by J. Bryce et al, 2003

Funded by: Rockefeller Foundation; World Health Organisation; Bill and Melinda Gates Foundation; USAID

id21 Research Highlight: 26 May 2004

Further Information:
Jennifer Bryce
Department of Child and Adolescent Health and Development
World Health Organisation
1211 Geneva
Switzerland

Contact the contributor: brycej@who.int

World Health Organisation

Other related links:
'Managing childhood illness: how effective is IMCI in Tanzania?'

'Young, poor and sick: socioeconomic inequities and child health in rural Tanzania'

'Hitting the mark: can under five mortality be cut by two thirds?'

'Danger in disguise – spotting the warning signs of severe childhood illnesses'

'Decisions, decisions – adapting the IMCI approach for Kenyan paediatric hospitals'

See id21's collection of links relevant to maternal and child health.