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Analysis Strategic Review of Child Health

Future directions for reducing inequity and maximising impact of child health strategies

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2684 (Published 30 July 2018) Cite this as: BMJ 2018;362:k2684

Strategic review of child health

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  1. Sarah L Dalglish, consultant1,
  2. Joanna J Vogel, technical officer1,
  3. Geneviève Begkoyian, chief of child survival2,
  4. Luis Huicho, researcher3,
  5. Elizabeth Mason, honorary fellow4,
  6. Elisabeth Dowling Root, associate professor of geography and epidemiology5,
  7. Joanna Schellenberg, professor of epidemiology and international health6,
  8. Abiy Seifu Estifanos, head of reproductive health unit7,
  9. Rajani Ved, executive director8,
  10. Fernando C Wehrmeister, assistant professor9,
  11. Guilhem Labadie, public health expert1,
  12. Cesar G Victora, emeritus professor9
  1. 1Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
  2. 2Unicef, Beirut, Lebanon
  3. 3Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia Lima, Peru
  4. 4Institute for Global Health, University College, London, UK
  5. 5Department of Geography and Division of Epidemiology, Ohio State University, Columbus, Ohio, USA
  6. 6Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  7. 7School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  8. 8National Health Systems Resource Center, New Delhi, India
  9. 9International Center for Equity in Health, Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
  1. Correspondence to: S L Dalglish sarah.dalglish{at}gmail.com

Current global child health strategies have reduced wealth based inequities in care seeking for childhood illness, but we need much greater emphasis on equity in strategy design and implementation, say Sarah L Dalglish and colleagues

Key messages

  • Equity oriented child health policies are cost effective, improve coverage faster, and result in greater gains in child health

  • Global strategies have contributed to reducing inequities in child health over the past 20 years

  • Greater emphasis on equity in strategies’ design and implementation could have led to greater improvements

  • Future strategies must emphasise intersectoral action to tackle social determinants, targeted coverage of interventions, and sustainable financing to support poor families

  • Top-down leadership and bottom-up demand are needed to drive policy changes that benefit marginalised populations

Over the past two decades, the world has made considerable progress in reducing under 5 mortality, but not all children have benefitted, and stark inequities in coverage of interventions persist in nearly all countries.12 Integrated Management of Childhood Illness (IMCI) was designed by Unicef and the World Health Organization to reach all children in countries with under 5 mortality rates greater than 40 per 1000 live births and has been implemented in over 100 countries since the mid-1990s. In 2012 WHO and Unicef introduced integrated Community Case Management (iCCM) as a complementary strategy to IMCI to extend case management to children living in underserved areas (box 1). Although IMCI lacks an explicit mechanism to reach children unable to access health facilities owing to poverty, marginalisation, or lack of coverage, iCCM has a stated equity goal of reaching underserved children.3

Box 1

What are IMCI and iCCM?

Integrated Management of Childhood Illness (IMCI)—introduced by WHO and Unicef in the mid-1990s, aims to reduce death, illness, and disability and to promote improved growth and development among children under 5. IMCI includes both preventive and curative …

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