Reducing child mortality: Can public health deliver?

Jennifer Bryce, Shams El Arifeen, George Pariyo, Claudio F. Lanata, Davidson Gwatkin, Jean Pierre Habicht

Research output: Contribution to journalReview articlepeer-review

Abstract

This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even falling in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up.

Original languageEnglish (US)
Pages (from-to)159-164
Number of pages6
JournalLancet
Volume362
Issue number9378
DOIs
StatePublished - Jul 12 2003
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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