Accelerating progress in achieving the millennium development goal for children through community-based approaches

Abstract

The Millennium Development Goal 4 (MDG4) calls for the reduction in under-five mortality by two-thirds between 1990 and 2015. Only 16 of the 68 countries with 97% of the world's child deaths are on track to achieve this. This paper reviews the current evidence regarding proven interventions for reducing child mortality in high-mortality, resource-poor settings. All of these interventions require implementation within communities rather than implementation confined to only those attending health facilities with strong community participation in order to be effective. The evidence strongly suggests that facility-based interventions require a strong community-based component in order to improve child mortality in the surrounding population. We provide specific information about common community-based approaches used in the implementation of interventions with documented improvements in child mortality. A stronger emphasis on community-based approaches will be needed in order to accelerate progress in reaching MDG4. This report arises from an ongoing review of assessments of the effectiveness of community-based primary health care (CBPHC) in improving child health sponsored by the Working Group on CBPHC of the American Public Health Association.

Keywords:

• child survival
• community-based
• primary health care
• evidence

Acknowledgements

Funds to cover the expenses of this review were provided by UNICEF, the Department of Child and Adolescent Health and Development of the World Health Organisation, the CORE Group (Collaboration and Resources for Child Health)/USAID and Future Generations. The American Public Health Association and its International Health Section staff provided support by administering the funds for the review. Future Generations also provided office space, administrative support and part of Dr. Henry Perry's time. The World Bank permitted one of its public health consultants (Dr Bahie Rassekh) to participate as a member of the Study Team. The members of the Task Force contributed significant volunteer time as did many of the reviewers. Students at several universities, most notably the Johns Hopkins University, assisted with the review, and Johns Hopkins also provided library support. Those organisations which provided financial support had no role in the execution of this review. The authors would like to express their appreciation to the reviewers who provided helpful comments and suggestions.