OF THE 20 million children born each year in Africa, 4 million will die before their fifth birthdays.<sup>1</sup>Over half of these deaths are directly attributable to one or more diseases in the following groups: diseases preventable by immunization (including measles, neonatal tetanus, and pertussis), diarrhea, malaria, and acute lower respiratory tract infection.<sup>2</sup>In a longitudinal study of mortality in Kivu, Zaire, 424 (68%) of 624 deaths in children under 5 years of age were related to these four groups of diseases.<sup>3</sup> As part of the US Agency for International Development's technical assistance to Africa, the Combatting Childhood Communicable Diseases (CCCD) project works with 10 African countries to strengthen their national capacity to reduce childhood morbidity and mortality and improve child health. These countries are the Central African Republic, Burundi, Cote d'Ivoire, Guinea, Lesotho, Liberia, Nigeria, Swaziland, Togo, and Zaire. This article reports on program experience during