UNICEF program aimed at curbing deaths in West Africa falls short of goals, study finds

A $27 million UNICEF program that aims to decrease disease-related child deaths in West Africa did not meet its goal of reducing death rates by at least 25 percent at the conclusion of 2006, according to a Lancet study published on Tuesday, the Associated Press reports. "The U.N. children's agency pursued strategies like vaccinating children, giving them vitamin A pills and distributing bednets to protect against malaria from 2001 to 2005 in parts of 11 countries," according to the article. 

For the study, researches looked at three countries in the Accelerated Child Survival and Development (ACSD) program: Benin, Mali and Ghana. AP writes: "In Benin, child deaths fell by 13 percent after the UNICEF program started. But in areas of Benin where the program wasn't used, the death rate dropped by nearly double: 25 percent. In Mali, child deaths fell by 24 percent in districts where the UNICEF program was set up, and 31 percent in districts it wasn't. No comparable statistics were available for Ghana, though malaria and diarrhea treatment dropped significantly after the UNICEF program started. The study was paid for by UNICEF, the Canadian government, which funded more than half of UNICEF's West Africa program, and other partners."

Study author Jennifer Bryce, of the Johns Hopkins Bloomberg School of Public Health, noted that UNICEF implemented ACSD in districts with high child death rates, which meant the agency was working in regions with particularly weak health systems. This could explain why it failed, she said. According to Bryce, child deaths decreased in places where the program was implemented and in regions where it was not. "Similar UNICEF strategies were used in all parts of the three countries, not just those in the special program, which was supposed to be more intense and more comprehensive," the news service reports.

"'Huge opportunities for saving more lives were missed,' Bryce said. She said the UNICEF program didn't prioritize the top killers of kids: pneumonia, malaria, and diarrhea. To treat those conditions, Bryce said trained health workers are needed, not just programs that distribute vitamin supplements and bednets." After UNICEF was briefed on the findings before the study's publication, the agency made changes to the way health workers in 46 countries treat and diagnose diarrhea, malaria and pneumonia, Mickey Chopra, head of health operations for UNICEF, said (Cheng, 1/11).

Lancet published a related Comment as well as an Editorial (.pdf), which calls for evaluation to "become the top priority in global health." The editorial concludes: "Evaluation matters. Evaluation is science. And evaluation costs money. It's time that the global health community embraced rather than evaded this message" (1/12).