Estimating the impact of donor programs on child mortality in low- and middle-income countries: a synthetic control analysis of child health programs funded by the United States Agency for International Development.

BACKGROUND: Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes. METHODS: This study uses the synthetic control analysis method to estimate the impact of one donor's funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016. RESULTS: In the study period (2000-16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of - 2 to - 38). This finding was consistent with several sensitivity analyses. CONCLUSIONS: The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.

Drinking water insecurity: water quality and access in coastal south-western Bangladesh.

National drinking water assessments for Bangladesh do not reflect local variability, or temporal differences. This paper reports on the findings of an interdisciplinary investigation of drinking water insecurity in a rural coastal south-western Bangladesh. Drinking water quality is assessed by comparison of locally measured concentrations to national levels and water quality criteria; resident's access to potable water and their perceptions are based on local social surveys. Residents in the study area use groundwater far less than the national average; salinity and local rainwater scarcity necessitates the use of multiple water sources throughout the year. Groundwater concentrations of arsenic and specific conductivity (SpC) were greater than surface water (pond) concentrations; there was no statistically significant seasonal difference in mean concentrations in groundwater, but there was for ponds, with arsenic higher in the dry season. Average arsenic concentrations in local water drinking were 2-4 times times the national average. All of the local groundwater samples exceeded the Bangladesh guidance for SpC, although the majority of residents surveyed did not perceive their water as having a 'bad' or 'salty' taste.

Rural public health financing: implications for community health promotion initiatives.

BACKGROUND: Public health in rural areas has distinctive features, often shaped by state-level infrastructure and organization and financing of public health activities. Variation in the way funds are distributed can influence the ability of local health departments and nongovernmental organizations serving rural communities to conduct public health functions. PURPOSE: The purpose of this article was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed through states to the local level and identify infrastructure-related barriers that local health departments and nongovernmental organizations may face in securing these funds. METHODS: Thirty semistructured interviews were conducted with individuals at the state and local levels responsible for managing funds and implementing initiatives in selected disease areas across six states, using a standardized protocol through which select funds were followed from the state to the local level. RESULTS: Respondents report that states do not get sufficient Centers for Disease Control and Prevention funding for diabetes, cancer, and injury prevention to distribute effectively to the local level. Local funding, when provided, tends to be allocated through competitive mini-grant processes that are often difficult for rural communities to access because of infrastructural challenges. Mini-grant amounts are often too limited to build local program capacities and often awarded to communities with existing capacities.