The need for scaling up research on effective strategies for delivering child-survival interventions

Abstract

Considerations as to the feasibility with which child survival interventions can be delivered at high levels of population coverage, have been described as a central criterion of interventions intended to reduce child mortality. 1 Accordingly, over two-thirds of child deaths have been demonstrated to be preventable through the delivery of effective and lowcost health interventions, the integrated delivery of which, have also been suggested to be among the most effective strategies for improving child survival. 2 Despite this, and as the countdown to the Millenium Development Goals 2015 has intensified, commensurate admonitions to identify and augment the scale at which highly effective delivery channels for delivering child survival interventions, have remained far less vigorous. This has also been the case despite the fact that at present, the prospects that many countries have of falling short of achieving the fourth millennium development goal, of reducing child mortality by two-thirds -between 1990 and 2015, has become ever more likely. 3 It was within this context that the 2008 Lancet Series on the Rebirth and Revision of Alma Ata, which staunchly advocated for a renewal of interest in the importance and potential of primary health care for improving maternal, newborn, and child health (MNCH), delineated four major factors contributing to the failure of the delivery of effective MNCH interventions at scale. 4 This list identified the lack of a universally agreed upon minimum set of interventions that should be delivered to all women, newborns and children who require them; inadequate attention to demand creation for these interventions at the community level; shortages of well-trained staff and community health workers; and the failure to allocate the necessary resources to ensure the functionality of first level health facilities (including the forging of stronger links between facility-based staff and communitybased workers) -as the main reasons for this drawback. 4 Yet still, despite this acute awareness of the factors impeding the improved delivery of interventions, investments in maternal, newborn, and child health interventions have lost out over the past few decades and have been pitifully low despite the magnitude of the health burden, the availability of cost-effective interventions, and the potential gains for such investments. 5 Such gains include considerable reductions in neonatal and child morbidity and mortality, medium and long-term cost savings by national governments and health systems, and the averting of developmental complications, which may result from the neglect of unameliorated pediatric illnesses. Similarly, within the context of investments in neonatal survival interventions research, Martines et al. asserted that research into intervention delivery strategies was a priority for achieving universal coverage of effective health interventions. 6 These findings, therefore make it unjustified that investments in child health research which focus on new interventions, have far exceeded...