Knowledge into action for child survival

This paper works out a strategy for translating available knowledge of the child mortality problem - in all its dimensions - into action. A clue to this way forward, the authors suggest, is the fact that there are really no new epistemological challenges here: the main killers of children today are diarrhoea, pneumonia, and malaria, just as they were in 1980. However, they point to gaps in evidence that demand the following actions:

• Epidemiology - countries need to seek out and apply available information about the causes and distribution of child deaths to child survival programming efforts, while also carrying out new data collection and monitoring efforts.
• Child survival interventions - existing interventions need to be aggressively applied - and continually assessed - and progress needs to be made on developing interventions not yet available, such as vaccines for pneumonia, diarrhoea, and malaria.
• Delivery strategies - in order to ensure that interventions begin reaching the children and mothers who need them, country-level programme personnel must conduct in-depth field research and develop monitoring methods (and build the capacity to use them).
• Inequities - indicators, methods, and guidelines must be developed; capacity must be built in equity measurement and monitoring at all levels.

Four prerequisites, the authors claim, are required in order to transform knowledge into effective action to reduce child mortality:

1. Leadership - strong and unified leadership must be restablished at international, national, and subnational levels.
2. Strong health systems - "Although private initiatives can and should contribute, the longer-term goal must be systems of public health that are capable of defining needs, generating resources, managing programmes and people, delivering cost-effective services, and gathering and using data to improve the effect of their efforts."
3. Adequate and targeted resources (human and financial) - the yearly costs of scaling up known interventions would be about US$1 billion for vaccinations, US$4 billion for treatment of childhood illnesses, and US$2.5 billion for malaria prevention and treatment for all age groups. This is less than the estimated US$17 billion spent annually on pet food in North America and Europe. Mechanisms must be developed, the authors say, to track such child survival investments. Further, "New ways must be identified to build local capacity, and counteract the brain drain that is depriving low-income and middle-income countries of many of their most capable citizens."
4. Awareness and a commitment to action that goes beyond the public health community to mobilise all citizens, including parents, teachers, rock stars, prominent athletes, and politicians. Messages should be clear and simple, and should be communicated consistently through all available channels.

The paper concludes with a formal call to action. The authors urge specific actions to prioritise child survival on the part of international agencies; worldwide initiatives; governments, ministries of health, and bilateral and mutilateral partners; and academic institutions. In general, they say that commitment needs to be followed by: establishing a process that leads to development of true leadership worldwide; collaborating in efforts to strengthen country capacity and health systems in general, with necessary financial and technical support; continuing development of guidelines that put poor children and their mothers at the centre of efforts to increase coverage of known interventions; and developing systems for monitoring coverage, equity, and progress.

For their part, the authors pledge to convene a series of meetings, every 2 years, to provide opportunities for those concerned about child survival to exchange experiences, monitor progress, and ensure accountability on the part of countries and their partners. In conclusion, they state, "We hope readers will respond to this call to action by advocating for change within their institutions, countries, and communities. In addition, we welcome open discussion in a forum established by The Lancet and open to all at The Lancet (debate@lancet.com)."

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This paper is part of a 5-part series on child survival published by The Lancet. Click here to access an overview of that series.

Source:

Summarised and reprinted with permission from Elsevier (The Lancet, 2003, Vol No 362, pages 323-27). Click here for the Lancet Home Page.