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Challenges in Monitoring Child Survival Interventions by Wealth Quintile and Country

This article discusses the problems with data quality and reporting, and the need for improved monitoring of child survival interventions by wealth quintile and country. It highlights the significant progress made in reducing measles deaths, particularly in sub-Saharan Africa. The policy recommendations include reimbursement of transport costs, allocating resources based on disease burden, improving infrastructure, and training providers to cater to different ethnicities. The conclusion emphasizes the importance of focusing on country-level achievements and addressing the risks of increasing inequity, declining efforts, and poor data quality in achieving the Millennium Development Goal 4.

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Challenges in Monitoring Child Survival Interventions by Wealth Quintile and Country

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  1. % <5 children receiving 6+ child survival interventions, by wealth quintile and country Bottom inequity Top inequity

  2. Arch. Dis. Child. Fetal Neonatal Ed. 2007;92;F361-F366

  3. Problems with data • Tendency to apply “spin” to existing data • DHS data of variable quality • Neonatal mortality is systematically under-reported • Impossible to monitor progress • Disincentive to improve data quality • Quintile analysis in Africa (little variation between low and high income household assets)

  4. Worldwide measles deaths – mostly children under five – plummeted by 68 per cent, from 757,000 in 2000 to 242 ,000 in 2006. In sub-Saharan Africa, measles deaths fell by more than 91 per cent. The Millenium Development Goals Report, 2008

  5. Policy - general Economics • Reimbursement of transport costs • Allocate resources at district level according to disease burden Geography • building housing for rural staff • road improvements • Provision of water favouring the poor Ethnicity • Training providers who speak indigenous languages Wagstaff, A. et al (2004) ‘Child Health: Reaching the Poor’, American Journal of Public Health; 94:5

  6. Policy – health interventions • Improved service delivery organisation • Supportive financial structures • Cash payments for use of services • Mass campaigns (Ghana and Zambia for ITN) • Social marketing (Tanzania for ITN) • Strong effort to achieve universal coverage Gwatkin, D. Bhuiya, A. Vitoria,C. (2004) ‘Making Health Systems More Equitable’, Lancet, v364

  7. Conclusions • MDG4 is a major opportunity to improve child survival, globally • Emphasis on country-level goal achievements should be discouraged • Africa should not be seen as a failure if significant progress is being made • Three major risks of the MDG4 process are: • Increasing inequity in child survival • Sudden decline in intensity of efforts at 2015 • Generation and perpetuation of poor quality data

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