In support of the United States Agency for International Development's (USAID) strategic plan in reducing child mortality with a view to achieving zero preventable child deaths, IHME is conducting quantitative analyses to determine an ambitious, yet tractable timeline and goal. Toward this policy effort, IHME researchers are investigating the expected trajectory of achieving zero preventable child deaths, examining different scenarios to determine the impact of macro drivers of trends in child mortality. Ultimately, IHME will produce a series of alternative scenarios for USAID’s priority countries under which zero preventable child deaths could be achieved.
1. Analysis of the expected trajectory of the number of child deaths under a “business as usual” scenario and the pace of progress required to achieve no preventable child deaths in a generation
- Based on the available IHME time series of child mortality from 1970 until present and predictions of fertility rates based on United Nations Population Division estimates, estimate the trend in child mortality assuming recent trends in the last five years continue.
- Establish the death rate for “no preventable child deaths” based on high-income country child death rates, excluding preventable causes. Convert the no preventable child deaths death rate into a number of deaths based on fertility predictions.
- Country by country, assess the pace of progress and therefore the acceleration of the pace of progress required to achieve no preventable child deaths from 1970 to present, and compare this pace of progress to the historical distribution of the pace of progress. The outcome of this approach would be an assessment of how much acceleration is needed in each country. Additionally, convert the no preventable child deaths death rate into a number of deaths by country based on fertility predictions.
2. Analysis of the key macro drivers of trends in child mortality
- Build an econometric model of the drivers of trends in child mortality, including fertility reduction, expansion of maternal education, income per capita, technology change, HIV prevalence, health system access, improved drinking water and sanitation access, time-invariant country-specific factors, and time-varying country-specific factors most likely attributable to policy choice. These models would be developed for different age groups (neonatal, postneonatal, and 1 to 4 years) as there are likely different determinants of the pace of progress. Estimation would be based on the period 1975 to 2010 based on data availability for both child mortality and key covariates. If possible this basic model would be elaborated to capture the impact of development assistance for health (DAH) to government and non-governmental sectors as well as government share of budget going to health. This would allow assessment of likely trends in DAH on the trends in child mortality. In addition, we hope to be able to analyze the relative fraction of under-5 mortality reduction attributable to the direct impact of changes in health interventions versus indirect impacts of socioeconomic changes. The results of the analysis of these direct and indirect impacts are of course dependent on model performance and available data. Time series information on the coverage of some key child health interventions is not available for long periods of time, limiting the capacity to incorporate all major interventions in an econometric analysis.
- Use the econometric model to generate a better forecast for each country using progress in primary school enrollment to forecast progress in maternal education, International Monetary Fund medium-term forecasts for income growth, past trends in technology shifts, and past trends in health system access. This country-by-country analysis would provide one scenario based on recent trends for key drivers in each country.
- The gap between this forecast and the goal of no preventable child deaths would be the basis for assessing what types of policies, such as family planning promotion, increased education, and better healthcare access, need to be implemented to make progress.
3. Development of alternative scenarios for USAID priority countries to achieve accelerated progress in reducing child mortality
- Using the econometric model parameters estimated from data from 1975 to 2010, various scenarios would be developed to identify the resources required from governments and donors to achieve the goal of no preventable child deaths. It is likely that paces of progress of around 8% per year would be required over a 25-year period. Achieving these targets will require accelerated progress for maternal education, enhanced technical progress through innovation, increased government investment, and DAH for child health. If it is feasible to identify appropriate variables, we will study the relationship between expenditures on research and development and pace of technical progress. However, if no exogenous determinants of the pace of technical progress can be identified, we can use the variation in the pace of progress over time to establish some plausible bounds for the fastest pace that is possible.
- Through a discussion with USAID, we will develop scenarios that are country-specific for the changes that would be required to achieve the desired outcomes. Given USAID's interest in both the five-year time horizon and the 25-year generational objective, the scenarios could be elaborated for USAID's priority country list, providing objectives for five and 25 years. These scenarios, if achieved in each priority country, would identify a range of strategies that could lead to the required declines in child mortality to achieve the generational goal.
This project has a direct impact on USAID’s policy by providing the necessary evidence for an achievable goal in preventing child deaths.
This project's goal is to provide a strong evidence base to help define an achievable goal for preventing child deaths worldwide.
- Jhpiego (an affiliate of Johns Hopkins University)