UNICEF’S Accelerated Child Survival and Development Program (ACSD)

rhamilton's picture

UNICEF’S Accelerated Child Survival and Development Program (ACSD) has been applied to selected focus districts in several West African countries. A retrospective analysis of the impact of this initiative in Benin, Ghana and Mali has just been published¹. The results are disappointing. Between 2001 and 2005 child (0-5yrs) mortality did decrease in the focus groups of all 3 countries, but in Benin and Mali, no significant advantage was conferred by the ACSD interventions when analysed against data from comparison groups. In Ghana comparison groups were not available. Improvements in expanded immunization coverage and in antenatal care were significant in response to the interventions but, unfortunately, care for children with malaria or pneumonia did not improve.

In a thoughtful accompanying comment Stefan Peterson asks what went wrong². He considers various options and stresses the urgent need for new approaches including prospective strategies in the assessment of complex interventions in changing health systems. That’s a tall order but one that is badly needed in this increasingly important research field.

Unfortunately current funding levels for implementation research are very low. The needs are great, the stakes and the budgets are high so it is important to get it right. A brief editorial in the same issue of Lancet has it right-“Evaluation matters. Evaluation is science. And evaluation costs money”³. Any comments?

1. Peterson S., Assessing the Scale-Up of Child Survival Intervention, Lancet 2010: 375:530-531
2. Bryce J., Gelroy K., Jones G., et al, The Accelerated Child Survival and Development Programme in West Africa, Lancet 2010: 375:572-582
3. Editorial: Evaluation: the top priority for global health, Lancet 2010:375:526

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