USAID-supported NGO child survival projects consistently demonstrate high impact at low cost with community-based approaches

Purpose / Background: USAID's Child Survival and Health Grants Program (CSHGP) currently supports 38 US-based NGOs implementing 69 child health projects in 38 countries in collaboration with local MOH and NGO partners. Each project costs about $2 million, lasts five years, covers from one to as many as ten districts, and reaches an average of 40,000 children under five (range: 5,000-200,000). Projects use community-centered delivery mechanisms. Past analyses of selected projects have shown that they significantly lowered child mortality and were highly cost-effective.

Methods: The impact analysis described at last year's APHA conference was extended to all 40 CSHGP projects ending from 2004-2007. Data from community surveys was abstracted from final evaluation reports for coverage changes for each of 15 evidence-based child survival interventions. The Bellagio Study Group's method developed for the 2003/2005 Lancet child and neonatal survival articles was used to convert project outcome data to estimates of child mortality impact.

Results: The mean reduction in child mortality was estimated to be 15% (range: 1% - 45%). Almost all projects were in the highly cost-effective range set by WHO (less than $100 per DALY saved). The majority of the impact was attributable to community-based rather than facility-based interventions. An in-depth analysis showed that community-based programming approaches were effective in a variety of settings - small or moderate scale, urban or rural project area, high or moderate baseline mortality.

Recommendations: Despite the impact achieved by community-based child survival programming, funding for NGOs through CSHGP has been flat for the last decade. Donors need to increase their funding for and emphasis on such community-based programs if Millennium Development Goal 4 (reduce child mortality by two thirds) is to be achieved.