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APHA Scientific Session and Event Listing

Recorded presentation

James G. Ricca, MD, MPH, Child Survival Technical Support Project, ORC Macro, 11785 Beltsville Dr., Calverton, MD 20705, 301-572-0317, james.g.ricca@orcmacro.com

Purpose / Background: Although there is much evidence on effectiveness of technical child survival interventions, there is little evidence of the effectiveness of delivery systems. USAID's Child Survival and Health Grants Program currently supports 32 US-based NGOs implementing 78 child health projects in 39 countries in collaboration with local MOH and NGO partners. Typical projects run 4-5 years with an average of 40,000 under five beneficiaries, covering at least one health district. Projects use a variety of community-centered delivery mechanisms aimed at behavior change, increasing access, and improving first level health service quality.

Methods: Data was abstracted from all thirteen final project reports submitted in 2004-2005. Coverage increases derived from community surveys were calculated for each of 15 evidence-based child survival interventions. To identify projects with the most impact and cost-effectiveness, the Bellagio Study Group methodology developed for the 2003/2005 Lancet child survival articles was used to estimate the number of lives saved during project period. In-depth analyses of successful projects were done through review of documents and interviews with managers.

Results: The majority of the 13 projects analyzed had high impact at low cost. The seven most successful projects were predicted to save an average of 1,000 lives each. They did not differ significantly from less successful projects in terms of number of beneficiaries (46,000 vs. 42,000); cost per beneficiary per year ($4.70 vs. $4.30); or number of interventions (6.3 vs. 5.9). However, the most successful projects tended to have more well-developed community empowerment strategies. These built community structures to deliver multiple interventions, saving a life for less than $1,000 each. These approaches will be analyzed.

Recommendations: There are few rigorous studies on effectiveness of service delivery mechanisms in low and middle income countries. The most common large scale delivery approaches implement one or few interventions. USAID-supported NGO projects use alternative mechanisms and show that a community empowerment approach can create community-based platforms on which multiple interventions can be delivered cheaply at moderate scale. Current CSHGP projects are also beginning to test this approach at larger scale. This analysis of effective NGO empowerment approaches shows that such strategies can be cheap and effective and should be further evaluated.

Learning Objectives: