Integrated approach to child survival achieving important results

May 18 2005

An integrated approach to child survival designed to deliver a package of lifesaving health services for children in hard to reach communities has shown remarkable results, UNICEF Executive Director Ann M. Veneman announced at the World Health Assembly.

After three years of increasing coverage in basic health interventions, UNICEF estimates that child deaths will have dropped by an average of 20 per cent across the 16 districts where the programme was fully implemented, and by 10 per cent where it was partially applied.

“The early results of this initiative are remarkable,” said UNICEF Executive Director Ann M. Veneman, speaking at the plenary session of the World Health Assembly here. “They have exceeded expectations, and shown us just what can be achieved over a short period of time through sound science using an integrated approach.”

The programme, called Accelerated Child Survival and Development (ACSD), was initiated in around 100 districts within 11 countries in West Africa beginning in 2002.

ACSD takes the most effective health interventions for children, newborns and pregnant women and bundles them in an integrated, cost-effective package. The package includes immunizing children and pregnant women, delivering life-saving micronutrients, encouraging breastfeeding, supplying oral re-hydration salts for diarrhoea and bed nets for protecting children and women from malaria. The various interventions are widely embraced and in use around the world; the new approach packages and delivers them in more effective ways.

Funded by the Canadian government and initiated by UNICEF, the ACSD model involved the expertise and partnership of multiple players on the ground, including governments and health ministries, WHO, the World Bank, numerous non-governmental groups, local community leaders, and others. The model relies on the involvement of everyone who has a role in women’s and children’s health.

How It Works

One of the essential facets of ACSD is its focus on extending health coverage to underserved communities, using community outreach efforts to deliver services closer to where people actually live. Outreach services are also accompanied by programs to educate families in home-based healthcare practices for their children.

UNICEF said close and continuous monitoring of the actual uptake of “tracer” interventions, such as bed net use, has contributed significantly to the success of the programme. Continuous measurement allows project managers to identify and fix bottlenecks such as inadequate access, low demand, or insufficient compliance.

“Performance contracts” negotiated at the local level with each partner involved in the programme – from health ministries to small grassroots NGOs – has helped ensure follow-through; the contracts explicitly stated what each partner was accountable for.

UNICEF said another important reason for the effectiveness of the initiative is that rather than attempt to develop a new structure, it works within the existing efforts of governments to upgrade their own health systems and approaches.

ACSD was implemented most intensely in 16 districts in Senegal, Mali, Ghana and Benin, where the under-five mortality rate dropped an estimated 25, 21, 17 and 16 per cent.

The programme focused on districts that were the hardest to reach, often with the highest mortality rates, and proved that significant progress is possible against the odds.

In Ghana, for instance, ACSD projects were implemented in the upper east region. The use of insecticide treated bed nets (ITN’s) rose from under 5 per cent to over 75 per cent in those areas. In parts of Mali and Senegal, a similar project increased bednet use to over 80 per cent. The rates of death and disease began to turn down, while in the rest of the country they either stagnated or deteriorated.

The project originated with a $30 million donation from the Government of Canada, which asked only that UNICEF develop an innovative project that would reduce child mortality by at least 15 percent and cost less than $1,000 per life saved. In areas where ACSD was fully implemented, child mortality is estimated to have improved by 20 percent for an added cost of about $500 per life saved – exceeding both objectives.

“We are grateful to Canada for its leadership and support, as well as to the governments in West Africa whose commitment made these results possible,” Veneman said.

Plan to Expand

Every year nearly 11 million children under age five die from preventable causes, with nearly 5 million of those deaths occurring in sub-Saharan Africa. In order to reach the Millennium Development Goal of a two-thirds reduction in child mortality by 2015, three million child deaths per year will need to be averted in sub-Saharan Africa.

After studying what has worked in the pilot programme, UNICEF has set the goal of expanding ACSD to cover many more African children.

“We believe that we can reach 60 percent of children across sub-Saharan Africa by 2009 with these integrated community-based interventions,” Veneman said. “This will mean saving the lives of an additional 1 million children every year in that region alone.”

UNICEF’s estimates for child mortality reduction are based on an internationally agreed, peer-reviewed model that uses standard efficacy rates for individual interventions and observed coverage rates of those interventions.