Study finds UNICEF program in West Africa fails

A UNICEF program that spent $27 million to decrease child deaths from disease in West Africa has failed, according to a new study that found a higher survival rate in some regions that weren't included in the program.

The U.N. children's agency pursued strategies like vaccinating children, giving them vitamin A pills and distributing bednets to protect against malaria from 2001 to 2005 in parts of 11 countries.

The aim was to reduce the death rate by at least 25 percent by the end of 2006.

An analysis of the program in Benin, Ghana and Mali found children in areas where it wasn't in effect had a better chance of surviving past age 5 than children who were covered by it. The study was published online Tuesday in the British medical journal Lancet.

It is one of the few studies to evaluate whether U.N. health programs really save lives. Related work published last year found that it wasn't clear what the world had gotten from U.N. initiatives that cost nearly $200 billion over the past two decades, and that some programs may have been counterproductive.

Jennifer Bryce of the Johns Hopkins Bloomberg School of Public Health and colleagues analyzed data from national questionnaires to compare changes in areas targeted by UNICEF's "Accelerated Child Survival and Development" program with those that weren't.

UNICEF chose districts with high child death rates to implement its program. That could explain why it failed, since the agency was working in regions with especially bad health systems, Bryce said. She said child deaths fell both in regions where the program was implemented and those where it wasn't. Similar UNICEF strategies were used in all parts of the three countries, not just those in the special program, which was supposed to be more intense and more comprehensive.

The program didn't pay health workers or focus on the leading killers of children.

In Benin, child deaths fell by 13 percent after the UNICEF program started. But in areas of Benin where the program wasn't used, the death rate dropped by nearly double: 25 percent.

In Mali, child deaths fell by 24 percent in districts where the UNICEF program was set up, and 31 percent in districts it wasn't. No comparable statistics were available for Ghana, though malaria and diarrhea treatment dropped significantly after the UNICEF program started. The study was paid for by UNICEF, the Canadian government, which funded more than half of UNICEF's West Africa program, and other partners.

"Huge opportunities for saving more lives were missed," Bryce said. She said the UNICEF program didn't prioritize the top killers of kids: pneumonia, malaria, and diarrhea.

To treat those conditions, Bryce said trained health workers are needed, not just programs that distribute vitamin supplements and bednets.

Mickey Chopra, UNICEF's health chief, said the agency has changed how health workers in 46 countries diagnose and treat malaria, pneumonia and diarrhea in response to the study's findings. Health workers now have medicines to treat those conditions quicker, after UNICEF was briefed on the study results before publication.

Little effort has gone into finding out if global health initiatives work, yet billions of dollars are poured into them every year.

"I don't think any argument can be made from these findings for cutting back on aid to Africa," said William Aldis, a former World Health Organization official who worked in Africa. "What's needed is more attention to what works in difficult settings."

Some experts said UNICEF needed to strengthen poor countries' infrastructures before handing over the cash.

Without reinforcing health systems, "UNICEF's strategy was blindly optimistic," said Philip Stevens, of the London think tank, International Policy Network. He said UNICEF should have made the grant money dependent on delivering results. "It's hardly surprising the program was a complete flop."

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On the Net:

http://www.lancet.com

http://www.unicef.org