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% <5 children receiving 6+ child survival interventions, by wealth quintile and country

% <5 children receiving 6+ child survival interventions, by wealth quintile and country. Bottom inequity. Top inequity. Arch. Dis. Child. Fetal Neonatal Ed. 2007;92;F361-F366. Problems with data. Tendency to apply “spin” to existing data DHS data of variable quality

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% <5 children receiving 6+ child survival interventions, by wealth quintile and country

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  1. % <5 children receiving 6+ child survival interventions, by wealth quintile and country Bottom inequity Top inequity

  2. Arch. Dis. Child. Fetal Neonatal Ed. 2007;92;F361-F366

  3. Problems with data • Tendency to apply “spin” to existing data • DHS data of variable quality • Neonatal mortality is systematically under-reported • Impossible to monitor progress • Disincentive to improve data quality • Quintile analysis in Africa (little variation between low and high income household assets)

  4. Worldwide measles deaths – mostly children under five – plummeted by 68 per cent, from 757,000 in 2000 to 242 ,000 in 2006. In sub-Saharan Africa, measles deaths fell by more than 91 per cent. The Millenium Development Goals Report, 2008

  5. Policy - general Economics • Reimbursement of transport costs • Allocate resources at district level according to disease burden Geography • building housing for rural staff • road improvements • Provision of water favouring the poor Ethnicity • Training providers who speak indigenous languages Wagstaff, A. et al (2004) ‘Child Health: Reaching the Poor’, American Journal of Public Health; 94:5

  6. Policy – health interventions • Improved service delivery organisation • Supportive financial structures • Cash payments for use of services • Mass campaigns (Ghana and Zambia for ITN) • Social marketing (Tanzania for ITN) • Strong effort to achieve universal coverage Gwatkin, D. Bhuiya, A. Vitoria,C. (2004) ‘Making Health Systems More Equitable’, Lancet, v364

  7. Conclusions • MDG4 is a major opportunity to improve child survival, globally • Emphasis on country-level goal achievements should be discouraged • Africa should not be seen as a failure if significant progress is being made • Three major risks of the MDG4 process are: • Increasing inequity in child survival • Sudden decline in intensity of efforts at 2015 • Generation and perpetuation of poor quality data

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