African framework for design and implementation of child survival interventions : focused interventions for impact strengthened systems for sustainability

This document recommends strategic directions for USAID child survival interventions for the remainder of the 1990s, and reviews progress made on the goals established in USAID"s 1987 Child Survival Strategy for Africa. The implementation approaches described in this document have been derived directly from the experience of USAID"s child survival program in Africa. They include continued emphasis on successful focused interventions -- immunization, improved child nutrition, control of diarrheal diseases, child spacing, malaria and HIV/AIDS prevention and control, and management of acute respiratory infections. At the same time, however, USAID will focus increasingly on strengthening health systems, depending on countries" needs and the Agency"s comparative advantages. In addition, USAID will: support efforts to increase public demand for child survival services and community involvement in health management and financing; promote public-private partnerships between governments and private providers and NGOs; emphasize the role of policy dialogue managed by host country government; and support decentralization of health services (while avoiding the tendency to "balkanize" a country among donors). In the interest of sustainability, USAID will require long-term commitments on the part of host governments and donors, and will incorporate the multiple approaches to implementation that are required to promote sustainability -- including strengthening management capacity, implementing cost recovery systems, and promoting host country ownership -- at the design stage of projects. The framework suggests a subregional approach, given the limited financial resources available to the program and the reality that communicable diseases such as cholera and HIV/AIDS cannot be controlled successfully at the national level only. This approach takes advantage of the benefits of sharing experiences and lessons learned across countries, as well as the excellent TA available to USAID at the subregional level. (Author abstract, modified)