Measuring the impact of health interventions on mortality in developing countries: why bother?

Abstract

Measuring the mortality impact of health interventions is not straightforward; there is now ample evidence of this. So why bother? Clearly, the utility, sensibility and feasibility of measuring the mortality impact of health interventions depend on many factors, which makes it difficult to offer simple prescriptions. The failure of those demanding measurement to appreciate this has led, on the one hand, to the proliferation of largely unsubstantiated claims on the achievements of health interventions and, on the other hand, to disillusionment about the prospects of demonstrating any impact on mortality. It is not difficult to account for the complexity of this area nor the current state of uncertainty. Progress has largely reflected developments in its three components—mortality measurement, health research and programme evaluation. It is thus not surprising to find the almost exclusive emphasis on measuring impact on infant and child mortality; in developing countries, child health is given a high priority in the allocation of resources by governments and donor agencies, and the techniques for estimating child mortality are generally more advanced.