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  1. 1
    Peer Reviewed

    Reducing child mortality: Can public health deliver?

    Bryce J; el Arifeen S; Pariyo G; Lanata CF; Gwatkin D

    Lancet. 2003 Jul 12; 362(9378):159-164.

    This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even falling in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up. (author's)
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  2. 2
    Peer Reviewed

    A new global framework for immunization monitoring and surveillance.

    Dabbagh A; Eggers R; Cochi S; Dietz V; Strebel P

    Bulletin of the World Health Organization. 2007 Dec; 85(12):904.

    Each year, despite the availability of low-cost interventions such as vaccines that could prevent millions of deaths, nearly 11 million children worldwide die before the age of five. Failure to reach the Millennium Development Goal 4 (MDG 4) for child survival will result in an estimated 40 million children's lives lost by 2015. As nearly a quarter of global under-five mortality is attributable to vaccine-preventable diseases (VPD), vaccination can contribute significantly to attaining the MDG 4. An unprecedented array of life-saving vaccines is now available or in late stages of development. However, the decision to invest in vaccine introduction must be evidence-based and requires reliable data. Vaccine-preventable disease surveillance and programme monitoring provide the scientific and factual database essential for informed decision-making and appropriate public health action. In 2005, WHO and UNICEF published the Global Immunization Vision and Strategy 2006-2015 (GIVS), which defines the strategies and goals that will maximize the impact of immunization. One of the key components of achieving the GIVS goals is the need for strong systems for disease surveillance and programme monitoring. Recent developments, such as the availability and accessibility of new vaccines for the world's poorest countries, the need to achieve and sustain the global polio eradication goal, the new goal of reducing measles mortality by 90% by 2010, the new International Health Regulations and the threat of emerging or pandemic diseases, make a renewed and more comprehensive approach to surveillance and programme monitoring a necessity. To address this need, WHO, together with its global immunization partners, developed a Global Framework for Immunization Monitoring and Surveillance (GFIMS). (excerpt)
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