U.N. program has little effect in reducing deaths among children in Bangladesh, study finds

Jul 31 2009

"The U.N. unveiled a multimillion dollar strategy a dozen years ago to save children worldwide, but a new [Lancet] study has found the program had surprisingly little effect in Bangladesh, one of the world's poorest countries," the Associated Press reports.

Since 1997, when the WHO and UNICEF launched the Integrated Management of Childhood Illness (IMCI) Program to help reduce the numbers of deaths in children under age 5 from diarrhea, pneumonia, measles and malnutrition, more than 100 countries have adopted the program, drawing upon "millions" in aid, according to the news service.

The three main components of the IMCI strategy are health worker training, health system improvement --including access to drugs -- and training the community in the importance of child hygeine and immunization.  "In Bangladesh, international researchers found the strategy improved the skills of health workers and convinced more people to seek treatment when they got sick" and increased the prevalence of breast-feeding while decreasing the numbers of children suffering from stunted growth by 20 percent (Cheng, 7/30). "Despite improvements in intermediate indicators, the study shows no evidence of significant accelerations in reductions of mortality in children younger than 5 years in the IMCI area compared with the comparison area," the study authors conclude (Arifeen et al., 8/1).

In a Lancet comment, Trevor Duke of the Royal Children's Health explains, "In many countries, during the early period of strong donor funding of IMCI in the mid-to-late 1990s, governments, donors, and international agencies made little effort to incorporate IMCI training in schools and colleges of nursing, community health, and medicine. For IMCI to evolve into a sustainable part of the health culture, programme simplification and increased support for local health-training colleges and existing systems for maternal and child health must occur." He continues, "An estimated $5-8 billion in additional development aid for maternal, newborn, and child health per year would enable the scale-up of the child survival interventions in more than 40 of the poorest countries in the world" (Duke, 8/1).

According to the AP, Philip Stevens, a director at the International Policy Network, "said the U.N. should first prove its strategies work. 'If a private company produced results like this, it would rapidly go out of business. Yet in U.N. land, failure is used as a justification to ask for more money to do more of the same.'"

This study was funded by the Bill & Melinda Gates Foundation, WHO's Department of Child and Adolescent Health and Development and USAID (7/30).