[Development Fund for Africa --] impact of child survival activities in Africa : a report on AID's progress in reducing infant and child mortality and illness in 17 child survival priority countries

An estimated 4.3 million (about 20%) will die before their fifth birthdays, unless adequate health care can be provided. In 1981, A.I.D. initiated activities in 12 African countries to combat the common diseases which become fatal for children in Africa (measles, whooping cough, tetanus, diarrheal illnesses, and malaria) with the launching of the African Child Survival Initiative -- Combatting Communicable Childhood Diseases (ACSI-CCCD) project. Another 5 countries were added in 1985. A.I.D. activities in all 17 child survival (CS) priority countries in Africa work at three levels: (1) Immediate targeted delivery of vaccinations and oral rehydration therapy (ORT) -- it is estimated that these two simple, safe technologies alone could cut the infant and child mortality rate in half. (2) Institutionalization of short-term projects into host country health programs -- the CCCD project, for example, trains health workers to better diagnose and treat childhood diseases. (3) At the broadest level, A.I.D. continues to address the problem of poverty by supporting efforts to increase economic growth -- under the new Development Fund for Africa (DFA), there is more flexibility to address the socioeconomic factors -- poverty, illiteracy and inflation -- that contribute to under-five mortality. This report presents initial evidence of progress in reducing infant mortality rates through vaccinations, ORT, and other CS interventions. A.I.D.'s principal worldwide CS goal is to lower mortality to 75 infant deaths per 1000 live births by 1990. It is clear that this goal will not be realized in Africa. Nevertheless, the goal remains an indicator of what the stakes are. If the target were reached by the year 2000, it is estimated that 3.3 million children's deaths would be prevented that year alone in Africa. Kenya has already achieved the goal of 75 deaths per 1,000 live births. Of the remaining 16 CS countries, it is expected that 6 may achieve the target by 1995: Burundi, Cote d'Ivoire, Lesotho, Senegal, Togo, and Zaire. This is good progress considering that the target presents a significant challenge to African nations. Compared to Africa's 1980-85 rate of 118 infant deaths per 1,000 live births, Asia's rate was about 100, while Latin America and the Caribbean's was 63. Expanded immunization rates promise further gains. Measles coverage has increased in all but two CS priority countries and has more than doubled in several cases. Kenya, Lesotho, and Swaziland have a good chance of reaching and maintaining the Agency's immunization target of 80% coverage by 1990. By 1995, Malawi, Senegal, Burundi, Cote d'Ivoire, and Rwanda will enter the probable category, making a total of 8 countries which could meet the 80% target by 1995. What is important to recognize, but what is not illustrated by the data on immunization target attainment, is the significant improvement in the quality of the services that is being obtained. Data from 12 of the countries show significant changes: correct temperature storage for vaccines increased from 60% to 90% and use of a sterile needle and syringe for each injection increased from 50% to 90%. These qualitative improvements have tremendous impact on the major objectives of CS -- reducing disease and saving lives. A.I.D.'s goal for improving CS through expanded use of ORT is for 100% of the population to have access to a trained provider of oral rehydration salts, and for 45% of diarrheal cases to be treated with ORT. Lesotho has already achieved 100% access to ORT; ORT Units have been established in 16 of 18 hospitals (89%) and local production of ORS has doubled. In Malawi, Swaziland and Togo, 100% of health facilities are now using ORS. In Burundi, Cote d'Ivoire, Liberia, Rwanda, and Zaire the proportion of facilities using ORS ranges from 54% to 77%. The greatest challenge is institutionalizing such interventions. Faced with the conflict between severe budgetary pressure and the need to address basic health needs, African governments must be creative, looking at alternatives o free public health care. They must not only find ways to increase revenues, including in- creasing reliance on user fees, but also effectively reallocate revenues to services that can efficiently reduce mortality and morbidity. To improve the survival of tomorrow's children, therefore, A.I.D. must support these efforts to improve health delivery systems as a whole as well as those interventions which reduce mortality among infants being born today. (Author abstract)