Primary Health Care Coverage and Child Mortality in Sub-Saharan Africa

Area of Science:

• Global Health
• Public Health
• Pediatrics

Background:

• Primary health care (PHC) is crucial for universal health coverage and reducing under-5 mortality.
• Declining development assistance for health funding poses a threat to essential PHC services.

Purpose of the Study:

• To assess the association between effective PHC coverage and child mortality in Mozambique, Gabon, and Ethiopia over 20 years.
• To forecast potential child deaths by 2035 if PHC services are reduced due to funding cuts.

Main Methods:

• A cohort study analyzed data from 37,583 children (118,911 child-year observations) using Demographic and Health Surveys (2007-2022).
• An effective PHC coverage index was developed to measure service provision and access.
• Multivariable Poisson regression and microsimulation forecasting were employed for analysis.

Main Results:

• Increased PHC coverage was dose-responsively associated with decreased child mortality, with a 58% reduction for high coverage.
• Despite variations in coverage levels across countries, higher PHC access correlated with lower mortality rates.
• An estimated 373,108 (95% UI: 313,152–444,244) preventable child deaths may occur between 2025-2035 if PHC is dismantled.

Conclusions:

• PHC is strongly associated with reduced child mortality in sub-Saharan Africa.
• Expansion of PHC services is recommended, especially given current trends in health funding.
• Maintaining and strengthening PHC is vital to prevent a rise in child deaths.