Modeling Resource Allocation for Child Survival

Abstract

A framework is presented to provide a direct assessment of health interventions designed to raise the probability of child survival in a hypothetical community. The underlying belief is that direct interventions are a practicable means of improving the rate of child survival in developing countries. In spite of technical feasibility resource constraints restrict the adoption of projects; health programs must thus also be examined with respect to economic feasibility. Questions that arise include the cost-effectiveness of curative vs. preventive care; acess to vs. direct health services; the choice of appropriate population targets; the relative importance of nutrition interventions and identifying constraining resources as well as estimating the benefits to be derived from additional resources. Salient features of the proposed model include the use of interactive simultaneous equations to model the causes of death in a setting of multiple diseases the clear distinction between preventive activities affecting morbidity and curative activities affecting case fatality rates and the separation of the early childhood period into age subgroups with distinct morbidity characteristics. The optimization model also distinguishes between program use and program availability and operates in such a manner as to set intervention levels that tend to equilibrate use and availability. The 3 types of structural equations in the model generate the rates for 1) intervention use 2) marginal disease incidence and 3) fatality. The interventions selected for a hypothetical resource-poor community are promotion breastfeeding latrines water well-baby clinics tetanus immunization iron fortification tablets for all women and outpatient services for infants in the 1st 28 days. The parameters are specified through the use of a set of survey questions administered to medical and professional practitioners. Results indicate that inpatient care and hospital deliveries are not cost-effective and are not adopted by the optimization program until community resources reach high levels. Promotion is given strong emphasis by the allocation model. Nutrition interventions emerge as deserving special emphasis and timing as crucial to the cost-effectiveness of prenatal care. The optimization results indicate the importance of early detection of pregnancy to reduce low birth weight deliveries. The reduction in child mortality with the optimum use of resources is dramatic at low resource levels and diminshes as resources become more abundant. Similarly the value of the constraining resources falls as the general level of resources increases.