Counting the cost of child mortality in the World Health Organization African region

Background: Worldwide, a total of 6.282 million deaths occurred among children aged less than 5 years in 2013. About 47.4 % of those were borne by the 47 Member States of the World Health Organization (WHO) African Region. Sadly, even as we approach the end date for the 2015 Millennium Development Goals (MDGs), only eight African countries are on track to achieve the MDG 4 target 4A of reducing under-five mortality by two thirds between 1990 and 2015. The post-2015 Sustainable Development Goal (SDG) 3 target is "by 2030, end preventable deaths of new-borns and children under 5 years of age". There is urgent need for increased advocacy among governments, the private sector and development partners to provide the resources needed to build resilient national health systems to deliver an integrated package of people-centred interventions to end preventable child morbidity and mortality and other structures to address all ...

My life, my support, my choice

In March 2015 National Voices and Think Local Act Personal issued the report titled My Life, my support, my choice, which outlines what children and young people with complex lives want coordinated care to look like. The document uses the term "complex lives” to include all children and young people who are likely to need care and support from multiple services throughout their life. The report reveals that central to their needs and preferences is the right to live the way they want, so the publication also looks at what exactly children and young people want from their lives. It does this by including a series of ‘I Statements’. For example, “I am confident that my voice is clearly heard, as distinct from those of the adults around me”. The report also outlines many interesting case studies of services which are better at reflecting the preferences of children and young ...

Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial

Background: One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis.

Methods: The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15–24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An ‘ingredients approach’ estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off ...

National Framework for Children and Young People’s Continuing Care

This Framework (reviewed) is intended to provide guidance for clinical commissioning groups (CCGs) when assessing the needs of children and young people whose complex needs cannot be met by universal or specialist health services. CCGs have a legal responsibility for securing to a reasonable extent the health care which an individual needs, and this guidance is about the process which should be followed for the equitable discharge of that responsibility for children and young people with complex needs. This revision takes account of the new structures of NHS commissioning created by the Health and Social Care Act 2012 and the new integrated approach to the commissioning of services for children and young people with special educational need or disability (SEND) which the Children and Families Act 2014 introduced. In particular, where a child or young person has a SEND, which will often be the case, then CCGs and local authorities ...

Community participation for transformative action on women's, children's and adolescents' health

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to ...

A systematic review of strategies to increase access to health services among children in low and middle income countries

Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries exist. Failure to access healthcare is an important contributor to child mortality in these settings. Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes.

There are some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home.

Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

Policy analysis on why women and children in low- and middle- income settings are still disadvantaged by access to appropiate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street- level bureaucracy theory, this article explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana´s community-based PHC implementation to the disadvantage of women and children accessing and using health services. 

Families as Partners: Co-design of a localised model of care for children with medical complexity living in rural Australia and evaluation using the Paediatric Integrated Care Survey (PICS)

The number of children with medical complexity (CMC) residing in regional Australia is growing, challenging the health system to provide equitable care. Families of CMC experience problems in accessing appropriate care locally and they have high out-of-pocket costs and family disruptions because of long travel distances to access care in metropolitan paediatric hospitals.  The Murrumbidgee Local Health District (MLHD) in collaboration with the Sydney Children’s Hospitals Network (SCHN) partnered with families and local services to co-design a Model of Care (MoC) which better reflects the needs of CMC, their families and local services. The MoC was co-designed with families, local healthcare providers and the tertiary paediatric network.

The Development of a Logic Model to Guide the Planning and Evaluation of a Navigation Center for Children and Youth with Complex Care Needs

Most systems across health settings and sectors are not well integrated and do not provide the needed supports, resources, or access caregivers and families require to properly care for their child with complex care needs (CCNs). NaviCare/SoinsNavi is a research-based navigation center aimed to help facilitate more convenient and integrated care to support the needs of children, youth, and their families using a patient navigator to offer personalized family-centered care

Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity?

“Integrated care” is often used to describe concepts such as coordinated and seamless care instead of the often fragmented and episode care that patients receive. Integrated care reflects the aspirations of modern health care systems and receives significant academic attention. 

This review is about what extent integration is an intervention in need of evaluation or simply a key health system outcome, as has been proposed for the medical home.

Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan

Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents the findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan.

Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya

Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored.

Lessons in the Design and Initial Implementation of the System on Prevention, Early Identification, Referral, and Intervention for Delays, Disorders, and Disabilities in Early Childhood in the Philippines

Approximately 1 in every 10 children has a disability and in developing countries, fewer than one out of 10 of them go to school (1) (2). Persons with disabilities experience overlapping deprivations that contribute to marginalization, significant discrimination, and ultimately, exclusion in societal participation, perpetrating the vicious cycle of disability and poverty (3) (4).

Early childhood is the time when the impact of disability into adulthood can be maximally mitigated. It is, therefore, crucial for identification to be carried out at the earliest possible instance and appropriate intervention is provided.

In the Philippines, efforts are underway to implement a system on prevention, early identification, referral, and intervention for delays, disorders, and disabilities in early childhood in select subnational areas. This is a project that is being implemented through the national Early Childhood Care and Development Council and the Department of Health with support from UNICEF and Humanity and Inclusion.

Important ...

Malaria amongst febrile children: call for a pediatric malaria assessment tool

In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. A pediatric malaria assessment tool incorporating socio-demographics, symptoms and physical exam findings may guide investigations to reduce unnecessary testing and provide better patient-centred care.

Integrated care for children living with complex care needs: navigating the long and winding road

An increasing number of children are living with complex care needs resulting from multiple concurrent conditions. Due to these conditions, various health problems can arise and necessitate screening, prevention, and treatment at different ages during childhood. Each child has an individual constellation and combination of health problems, which implies that multiple health and social care providers across various sectors are required to address these health problems.