Assessing the impact of health programmes using household surveys in Mali

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Abstract
Health planners are turning more frequently to the data collected in large-scale household demographic and health surveys for information on health needs, and for assessment of the impact of health interventions. Measuring the effects of the use of health services on the mortality of young children is a complex scientific problem because of the wide range of potential confounding variables. Using data from a household demographic and health survey in 1985,in the twin towns of Mopti and Sevaré in central Mali, this paper shows the extent to which antenatal care, assistance at birth, immunization and access to water supplies and sanitation of different types affect early childhood mortality. The effects of antenatal care and immunization on mortality are clearly positive. The risks of dying by the type of assistance at birth are complex because of strong selection effects. No clear relationship between mortality and water and sanitation arrangements emerged. The most important finding is the strong positive effect of pregnancy monitoring on child survival, a striking result given the modest health services then available to mothers. The problem of distinguishing ‘programme’ and ‘non-programme’ effects remains.

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