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International Health

Independent Evaluation of the Accelerated Child Survival and Development (ACSD) Program
Critical Recommendations for Child Survival Programs

“The best medicine is worthless if it doesn’t reach the patient,” says Jennifer Bryce, EdD, a senior scientist in the Department and chief researcher on IIP’s evaluation of the ACSD Project. “Our analysis of real-world situations from the ACSD project offers concrete guidelines for program implementation at scale that, if heeded, can save children’s lives.”

IIP researchers at a community meeting in BeninBACKGROUND
UNICEF’s Accelerated Child Survival and Development (ACSD) Program operated in 11 West African countries between 2001 and 2005. The project aimed to increase coverage for proven interventions in

  1. immunization
  2. case management of childhood illnesses, and
  3. antenatal care to reduce child mortality.

From 2006 to 2008, IIP researchers led the retrospective evaluation. The objective of the study, funded by the Canadian International Development Agency (CIDA), was to provide valid and timely evidence to child health planners and policy makers about the effectiveness of the project in reducing child mortality and improving child nutritional status, as a basis for strengthening child health programming in the future.

The evaluation was limited to focus areas in Benin, Ghana and Mali where ACSD worked to deliver a full set of interventions. The study used data from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys to compare changes in coverage for 14 ACSD interventions, nutritional status (stunting and wasting), and mortality in children younger than 5 years in the ACSD focus districts with those in the remainder of every country (comparison areas).

FINDINGS
An article on the evaluation was recently published by the Lancet. The analysis showed that child survival was not accelerated in Benin and Mali focus districts because coverage for effective treatment interventions for malaria and pneumonia were not accelerated, causes of neonatal deaths and undernutrition were not addressed, and stock shortages of insecticide-treated nets restricted the potential effect of this intervention. Dr. Bryce sums up the major problems discovered:

“Huge opportunities for saving more lives were missed. The program didn't prioritize the top killers of kids: pneumonia, malaria, and diarrhea.”

RECOMMENDATIONS
From these findings IIP researchers developed four recommendations for future programs:

  1. active promotion of country policies supporting community case management for pneumonia and malaria, and the incorporation of zinc into the management of diarrhea
  2. incorporation of simulation models to estimate potential lives saved into program planning exercises nationally to ensure that decision makers have access to up-to-date information about local causes of child deaths and reliable evidence for intervention effectiveness
  3. definition and implementation of stronger compensation, motivation, and supervision approaches for community-based workers
  4. strengthening the nutrition component of country programs.

IIP’s powerful evaluation has already had an effect in the field. One prime example comes from an article by AP medical writer Maria Cheng. She reports that according to UNICEF’s chief health officer, Dr. Mickey Chopra, the organization has already changed how “health workers in 46 countries diagnose and treat malaria, pneumonia and diarrhea in response to the study's findings. Health workers now have medicines to treat those conditions quicker, after UNICEF was briefed on the study results...”

Dr. Kate Gilroy, ACSD co-principal investigator and assistant scientist in the Department, sums up the importance of this type of independent evaluation in which IIP specializes:

"As investment to reach Millennium Development Goals grows, implementation research becomes increasingly important to identify the best, most cost-effective strategies to deliver life-saving interventions. This study commissioned by UNICEF and CIDA shows how independent evaluations can improve programming and ultimately save lives."

For more information, including the final reports from each focus country, see IIP’s website.

--Brandon Howard, September 2010