UNICEF’s efforts to fight child mor­tal­ity came into ques­tion in a recent study done by the health pub­li­ca­tion The Lancet. The study said that UNICEF’s efforts did decrease child mor­tal­ity in the nations it con­cen­trated on, but it did decrease in other nations as well.

From this IRIN story we read more about the study and quotes of defense from UNICEF officials.

The UN Children’s Fund (UNICEF) “accel­er­ated child sur­vival pro­gramme” in 11 West African coun­tries did not save sig­nif­i­cantly more lives than in areas that were not tar­geted, says an eval­u­a­tion pub­lished in The Lancet this week — but ana­lysts say this does not mean UNICEF was doing the wrong things.

“They did the right things,” Jen­nifer Bryce, eval­u­a­tor and researcher at Johns Hop­kins Bloomberg School of Pub­lic Health, told IRIN. “They did what is fea­si­ble to do quickly and out­side of health sys­tems… Where there was dis­ap­point­ment and missed oppor­tu­nity was that they did not do more.”

Focus­ing on Benin, Ghana and Mali, the eval­u­a­tion analysed the impact of UNICEF’s US$27 mil­lion child sur­vival pro­gramme imple­mented between 2001 and 2005.

Find­ings showed mor­tal­ity in under-fives decreased by 13 per­cent in Benin, 24 per­cent in Mali and 20 per­cent in Ghana, but that the decreases in the for­mer two were no greater than in non-project areas, while no com­par­i­son data was avail­able for Ghana.

One rea­son for this is that UNICEF pushed Health Min­istries, donors and aid agen­cies in the coun­tries involved to adopt sim­i­lar approaches to child sur­vival, which led mor­tal­ity rates to drop else­where too, Mickey Chopra, UNICEF’s head of health, told IRIN.

“In most instances there was a dra­matic decline in child mor­tal­ity. These are very poor coun­tries and this was not a time of eco­nomic pros­per­ity or declin­ing poverty, so the inter­ven­tions were the things that really made the dif­fer­ence,” Chopra told IRIN.

UNICEF imple­mented the project in some of the hardest-to-reach and worst-off areas of tar­geted coun­tries, Chopra pointed out.

Other crit­i­cisms of UNICEF’s approach include an insuf­fi­cient empha­sis on under-nutrition, and inter­ven­tions to address neona­tal deaths (mor­tal­ity of babies aged 28 days and under).

UNICEF did not push Health Min­istries hard enough to change their pol­icy on allow­ing com­mu­nity vol­un­teers to treat chil­dren suf­fer­ing from pneu­mo­nia, diar­rhoea and malaria — the three biggest child killers in West Africa. Chang­ing this could dras­ti­cally reduce child mor­tal­ity rates, said eval­u­a­tor Bryce.

“Chil­dren can­not wait for child health days to be treated… They need a trained per­son right then and there, when they are sick.”

Proven inter­ven­tions include giv­ing chil­dren antibi­otics for pneu­mo­nia, zinc and oral rehy­dra­tion salts for diar­rhoea, and artemisinin-based com­bi­na­tion ther­apy and bed nets for malaria.

Learn­ing lessons

UNICEF has lis­tened and responded to these lessons, said Bryce. “They really responded to the results, even up to the high­est level.”

The agency has changed tack, work­ing with oth­ers to lobby min­istries to shift their pol­icy on com­mu­nity health worker respon­si­bil­i­ties to admin­is­ter treat­ment, said UNICEF’s Chopra, and pol­icy change is under way in 46 African coun­tries, includ­ing Mali, Malawi and Ethiopia.

Neo-natal mor­tal­ity is now more cen­tral to child sur­vival inter­ven­tions, and UNICEF is among many donors to push nutri­tion up the agenda.

Com­puter models

The most excit­ing change to emerge out of child sur­vival analy­sis in recent years, said Bryce, is the devel­op­ment of com­puter mod­els that can accu­rately analyse causes of child mor­tal­ity and the effects of dif­fer­ent inter­ven­tions. This allows experts to input dif­fer­ent response sce­nar­ios — upping mosquito-net pro­vi­sion while scal­ing back on HIV inter­ven­tion for instance — to ascer­tain which would save the most lives.

“With this tech­nol­ogy, you don’t have to have donors dri­ving the agenda… You can have the causes of death dri­ving it,” said Bryce.

Expo­sure risk

The pub­li­ca­tion of the evaluation’s frank find­ings of the weak­nesses of UNICEF’s pro­gramme have wor­ried some that UNICEF and other aid agen­cies will refrain from pub­lish­ing less-than-glowing eval­u­a­tion results in the future. “After the past few days why would any­one ever want to pub­lish an eval­u­a­tion?” asked Bryce.

But that would be a mis­take, said Chopra. Aid agen­cies and donors have promised to be more trans­par­ent about their aid efforts in a bid to make the often-murky sec­tor more accountable.

“We com­mis­sioned this eval­u­a­tion and we didn’t block pub­li­ca­tion… We have a respon­si­bil­ity to share these lessons… We’re com­mit­ted to con­tinue to learn how to improve the work we do… and are com­mit­ted to putting our find­ings in the pub­lic domain.”

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