Determinants of recent mortality (child mortality) change and effects of institutional level factors in countries on, above and below the Millennium Development Goals (MDGs) target: The experience of Ethiopia, Bangladesh & Kenya

The past century witnessed a dramatic decline in under-five mortality in almost all countries of the world, regardless of initial levels, socio-economic circumstances and development strategies. However, in a number of African and South-Asian countries, the rates are still high. Even in countries where they are relatively low, there is scope to reduce them further. In an environment where resources to improve health are limited, isolating the factors with the potential to achieve the greatest impact is essential. Previous attempts to do this treated individual level socio-economic determinants of child health and health system variables on the same level and generally showed little or no influence of health systems. The analyses have also largely been focused on cross-sectional determinants rather than of the determinants of change per se, which are crucial for resource allocation and targeted intervention. In this study, we focus on three countries, Ethiopia—a country on target to meet the Millennium Development Goals (MDGs), Bangladesh—which is performing above target, and Kenya—which is unlikely to achieve the target—and analyze the effects of health system level factors and the determinants of mortality change in these three different settings. Using a system of regressions that allows different determinants to influence health at different levels, we can now show that both health system and socio-economic factors are strongly linked to child mortality. Results from regression decomposition technique, also illustrate that socio-economic factors remain important in determining outcomes, but they also influence the use of services.