Retrospective Evaluation of the Accelerating Child Survival and Development Project (ACSD)

OVERVIEW

The ACSD project was implemented by UNICEF in 11 West African countries between 2001 and 2005 with support from the Canada International Development Agency. The aim of ACSD was to increase coverage for proven interventions in (1) immunization, (2) the case management of childhood illnesses, and (3) antenatal care to reduce child mortality.

UNICEF commissioned IIP-JHU to conduct an independent retrospective evaluation of the ACSD project. The objective was to provide valid and timely evidence to child health planners and policy makers about the effectiveness of the ACSD project in reducing child mortality and improving child nutritional status, as a basis for strengthening child health programming in the future. From 2006 to 2008, IIP reviewed documentation of ACSD implementation, evaluated intervention coverage using standard international indicators and measured impact, focusing on under-five mortality in Benin, Ghana and Mali.

FINDINGS

Results on coverage showed that there were no increases for most of the ACSD interventions in Benin, but that there were significant increases in international coverage in Ghana and Mali for almost all interventions delivered through outreach and campaign strategies that did not require continual provision of services from a trained cadre of workers. Although important reductions of under-five mortality were measured in the intervention areas, the reduction was not significantly different from the overall, nation-wide reduction.

KEY MESSAGES FROM THE EVALUATION

  • ACSD contributed to important advances in national policies.

  • ACSD approaches CAN lead to rapid increases in coverage.

  • Acceleration of mortality declines required focus on the primary causes of child death, sufficient time and reasonable expectations.

  • Breakdowns in commodities, supervision or funding can halt progress and must be avoided.

  • Community-based workers must be adequately supported.

  • Careful monitoring with local capacity to use results is difficult but essential.

  • Evaluation improves programs.