Child health: reducing inequities

Abstract

Worldwide, evidence-based interventions are being implemented in an effort to drive down child mortality and there are some signs that they are working. In The Lancet last week, researchers reported a remarkable decrease in mortality in Niger. The South African Medical Research Council has now released data showing that the national mortality rate in children younger than 5 years fell from 74 per 1000 livebirths in 2004, to 42 in 2011. However, few countries are on course to meet the targets set by Millennium Development Goal 4. Indeed, the total number of child deaths has increased in 13 countries. Most maternal and child health programmes do not reach the world's poorest families; it is believed that efforts to do so cannot be successful, cost effective, and equitable. Yet if interventions could reach these families, overall nutrition and health would improve and the lives of millions of children could be saved. This week, a new Series shows what causes inequities in child health, suggests improvements, and assesses cost-effectiveness. In the first report, Mickey Chopra and colleagues review past studies and conclude that altering intervention delivery in countries of low and middle income can improve coverage. For example, training community workers instead of health professionals to deliver services can increase the number of individuals who benefit and potentially reduce child mortality. Carlos Carrera and coworkers model mortality and stunting outcomes of an equity-focused approach. Although they rightly warn that there are limitations to their model, the findings are promising. For the same investment, a focus on the poorest communities could lead to larger reductions in child mortality and stunting than would a mainstream approach—especially in countries of lowest socioeconomic status. Although knowledge gaps remain, the results cannot be ignored. To make real headway in efforts to reduce child mortality and improve the health and nutrition of all children, policy makers must focus on the poorest and most marginalised families. The success of such an approach in Niger shows what it can achieve. Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutritionImplementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels—ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Full-Text PDF The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: a modelling approachProgress on child mortality and undernutrition has seen widening inequities and a concentration of child deaths and undernutrition in the most deprived communities, threatening the achievement of the Millennium Development Goals. Conversely, a series of recent process and technological innovations have provided effective and efficient options to reach the most deprived populations. These trends raise the possibility that the perceived trade-off between equity and efficiency no longer applies for child health—that prioritising services for the poorest and most marginalised is now more effective and cost effective than mainstream approaches. Full-Text PDF A tipping point for child survival, health, and nutritionIn the final push toward the 2015 Millennium Development Goals (MDGs), there is growing evidence that the world is making ever faster progress on reducing maternal and child deaths. The annual rate of decline for maternal mortality has risen from 2% in 1990–2000 to 3·4% in 2000–10.1 Similarly, the rate of decline in under-5 mortality has drastically accelerated in the past decade—from 1·8% per year during the 1990s to 3·2% between 2000 and 2011.2 This success has spurred governments, civil society organisations, faith-based groups, and individual advocates to launch Committing To Child Survival: A Promise Renewed, a global effort to accelerate action on maternal, newborn, and child health during the next two decades. Full-Text PDF