The Accelerated Child Survival and Development programme in west Africa: a retrospective evaluation

Background: UNICEF implemented the Accelerated Child Survival and Development (ACSD) programme in 11 west African countries between 2001 and 2005 to reduce child mortality by at least 25% by the end of 2006. We undertook a retrospective evaluation of the programme in Benin, Ghana, and Mali. Methods: We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys to compare changes in coverage for 14 ACSD interventions, nutritional status (stunting and wasting), and mortality in children younger than 5 years in the ACSD focus districts with those in the remainder of every country (comparison areas), after excluding major metropolitan areas. Findings: Mortality in children younger than 5 years decreased in ACSD areas by 13% in Benin (absolute decrease 18 deaths per 1000 livebirths, p=0·12), 20% in Ghana (21 per 1000 livebirths, p=0·10), and 24% in Mali (63 per 1000 livebirths, p<0·0001), but these decreases were not greater than those in comparison areas in Benin (25%; absolute decrease 36 deaths per 1000 livebirths, p=0·15) or Mali (31%; 76 per 1000 livebirths, p=0·30; comparison data not available for Ghana). ACSD districts showed significantly greater increases than did comparison areas in coverage for preventive interventions delivered through outreach and campaign strategies in Ghana and Mali, but not Benin. Coverage in ACSD areas for correct treatment of childhood pneumonia, diarrhoea, and malaria did not differ significantly from before to after programme implementation in Benin and Mali, but decreased significantly in Ghana for malaria (from 78% to 53%, p<0·0001) and diarrhoea (from 39% to 28%, p=0·05). We recorded no significant improvements in nutritional status attributable to ACSD in the three countries. Interpretation: The ACSD project did not accelerate child survival in Benin and Mali focus districts relative to comparison areas, probably because coverage for effective treatment interventions for malaria and pneumonia were not accelerated, causes of neonatal deaths and undernutrition were not addressed, and stock shortages of insecticide-treated nets restricted the potential effect of this intervention. Changes in policy and nationwide programme strengthening may have benefited from inputs by UNICEF and other partners, making an acceleration effect in the ACSD focus districts difficult to capture. Funding: UNICEF, Canadian International Development Agency, Coordenação de Aperfeiçoamento de Pessoal do Nível Superior (Brazil), and Fulbright Fellowship.