Accelerating progress in achieving the millennium development goal for children through community-based approaches.

The Millennium Development Goal 4 (MDG4) calls for the reduction in under-five mortality by two-thirds between 1990 and 2015. Only 16 of the 68 countries with 97% of the world's child deaths are on track to achieve this. This paper reviews the current evidence regarding proven interventions for reducing child mortality in high-mortality, resource-poor settings. All of these interventions require implementation within communities rather than implementation confined to only those attending health facilities with strong community participation in order to be effective. The evidence strongly suggests that facility-based interventions require a strong community-based component in order to improve child mortality in the surrounding population. We provide specific information about common community-based approaches used in the implementation of interventions with documented improvements in child mortality. A stronger emphasis on community-based approaches will be needed in order to accelerate progress in reaching MDG4. This report arises from an ongoing review of assessments of the effectiveness of community-based primary health care (CBPHC) in improving child health sponsored by the Working Group on CBPHC of the American Public Health Association.