title: Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?
abstract: Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.
authors.affiliation: Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Samana
authors.initials: S
authors.lastname: Ali
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Talaha M
authors.initials: TM
authors.lastname: Ali
authors.forename: Batool Azra
authors.initials: BA
authors.lastname: Haider
authors.forename: Arjumand
authors.initials: A
authors.lastname: Rizvi
authors.forename: Pius
authors.initials: P
authors.lastname: Okong
authors.forename: Shereen Z
authors.initials: SZ
authors.lastname: Bhutta
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003150:Community Health Workers / Q000458:organization & administration* / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D006293:Health Promotion / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008428:Maternal Mortality / Q000639:trends*; D011320:Primary Health Care / Q000145:classification / Q000458:organization & administration / Q000706:statistics & numerical data*; D012196:Review Literature as Topic