THE IMPACT OF PRIMARY HEALTH-CARE SERVICES ON UNDER-5 MORTALITY IN RURAL NIGER

Background. Despite large investments in basic primary health care in sub-Saharan Africa over the past two decades, quantifying the contribu tion of national programme efforts to the reduction of infant/child mo rtality in the region has proven difficult. This study takes advantage of the phased implementation of the national Rural Health Improvement Program in Niger and conveniently timed survey data to reassess progr amme impact on under-five mortality during the 1980-1985 period. Metho ds. Health service use and under-five mortality rates for children bor n in the 5 years prior to the 1985 survey are compared for three group s of villages: villages served by a dispensary, villages served by vil lage health teams (VHT), and villages without access to modem primary care services. Multi-level regression analyses using both household- a nd community-level variables are undertaken in estimating the magnitud e of effects. Results. Children residing in villages proximate to heal th dispensaries were approximately 32% less likely to have died during the study period than children without access to modem health service s. Village health teams were not, however, associated with significant ly lower mortality probabilities. Formal tests for endogeneity indicat ed that these effects were not the result of non-uniform/non-random al location of resources. Conclusions. The findings are largely supportiv e of the key premise underlying selective primary health care interven tions-that packages of basic services can be effectively mounted natio nally in poor countries and have a significant impact over a short tim e period. In Niger, less than optimal implementation of VHT appears to have reduced the magnitude of the impact achieved.