Community-Based Strategies for Promoting Child Survival

However, the majority of child deaths are still caused by readily preventable or treatable conditions. Ninety-seven percent of these deaths occur in 68 countries, with only 16 of these countries on track to achieve Millennium Development Goal (MDG) 4 by 2015. MDG 4 calls for a two-thirds reduction in child mortality based on 1990 levels. Among the 16 countries on track, only one is an African country, Eritrea. New initiatives and approaches are needed in areas where child mortality levels remain high, health systems are weak, and resources are limited. The current evidence base for community-based interventions is largely derived from small demonstration projects, short-term randomized controlled trials, and efficacy studies of single interventions. However, a recent comprehensive review of the effectiveness of community-based primary health care in improving child health has identified four key community-based service delivery mechanisms that are common to virtually all successful health programs. These mechanisms include routine systematic visitation of all homes, facilitator-led participatory women's groups, recognition, referral, and treatment of serious childhood illness by mothers and/or trained community agents, and health service provision at outreach sites. Routine systematic visitation of all homes makes it possible to identify those in need of basic services and to provide everyone in the program population with essential health education and selected key services. Facilitator-led participatory women's groups provide the opportunity for further empowerment and education about healthy behaviors, danger signs of serious illness, proper care of the newborn, and non-health issues that are a priority to the community. These groups also provide a vehicle for counseling about breastfeeding, birth spacing, infant feeding, hand washing, prevention and treatment of diarrhea, signs of childhood pneumonia, and danger signs during pregnancy and childbirth. Recognition, referral, and treatment of serious childhood illness by mothers and/or trained community agents is also an effective strategy. Community-based workers can learn to recognize the signs and symptoms in children of neonatal sepsis, malaria, pneumonia, severe diarrhea, and severe malnutrition, and they can teach these signs and symptoms to mothers. Successful programs were also identified in which community health workers treated these conditions or taught mothers how to treat them. Health service provision at outreach sites is another key strategy. This approach makes it possible to provide health services to remote or underserved populations, and to reach those who may not have access to health facilities. The World Health Organization and UNICEF have recently recommended that all pregnant women receive two home visits during the prenatal period, one home visit during the first 24 hours after birth, and at least one (and preferably two) more visits during the neonatal period. These visits should include education about proper nutrition, promotion of antenatal care, education about danger signs during pregnancy and childbirth, promotion of immediate breastfeeding, prevention of hypothermia, and measurement of the weight of newborns to identify low-birth weight. Home visitation is also an effective means of providing counseling about breastfeeding and appropriate complementary feeding, hand washing, prevention and treatment of diarrhea, detection and need for early treatment of childhood pneumonia, and birth spacing. The literature illustrates several effective approaches to facilitating participatory women's groups, including the use of a participatory action-learning cycle, formation of "Care Groups," and education sessions led by community mobilizers. The review identifies considerable evidence regarding the effectiveness of training and supervising community-based workers to teach pregnant women and their families about danger signs during pregnancy and childhood illness.