The Impact of Primary Health Care on Child Mortality Amid the Humanitarian Crisis in Sub-Saharan Africa: An Integrated Retrospective and Forecasting Analysis from 2007 to 2040
1
Health Impact Assessment and Evaluation, Barcelon Institute for Global Health, Barcelona, Spain
2
Utrecht University, Utrecht, Netherlands
3
Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Bahia, Brazil
4
Instituto Nacional de Saúde, Maputo, Mozambique
5
University of California (UCLA), Los Angeles, United States
6
Institute for Health Policies Studies (IEPS), Rio de Janeiro, Brazil
7
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
8
Ministry of Health, Adís Abeba, Ethiopia
9
Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
10
College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
11
London School of Economics & Political Science, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Primary Health Care (PHC) is recognized as pivotal for achieving Universal Health Coverage (UHC) and reducing under-five mortality rates (U5MR), however, current declines in international development assistance for health (DAH) threaten to stall or reverse the U5MR progresses of the last years. We estimated the impact of the effective PHC coverage on U5MR in three diverse Sub-Saharan countries over the last two decades and forecasted U5MR trajectories through 2040 according to alternative PHC scenarios.
METHODS:
We developed an effective PHC coverage index (PHC-index) based on several PHC services provision and access dimensions. The PHC-index impact on child mortality was estimated using a two-ways fixed-effects multivariable Poisson regression models with robust errors, adjusted for all relevant confounding factors at the individual, regional and national level, and developing extended sensitivity and triangulation analysis for causal inference. We also integrated this evaluation with validated microsimulation forecasting model, encompassing nearly three million children per year.
RESULTS:
Increasing PHC coverage was strongly associated with U5MR decreases in a dose-response manner, reaching a 58% reduction (RR:0.420; 95%CI:0.193-0.916) for consolidated high coverage. PHC coverage reductions due to DAH defunding will lead to considerably higher U5MR in comparison with a Universal PHC coverage scenario in 2040: 57.2% (95%UI:56.1–58.4) higher in Mozambique, 57.6% (95%UI:55.5–59.6) in Gabon, and 57.6% (95%UI:56.7–58.6) in Ethiopia, amounting 1,871,833 (95%UI:1,607,602–2,175,827) excess child deaths across the 2025-2040 period.
CONCLUSIONS:
PHC substantially reduced U5MR in SSA over the past two decades and should be expanded rather than diminished due to the current drastic DAH defunding.
Primary Health Care (PHC) is recognized as pivotal for achieving Universal Health Coverage (UHC) and reducing under-five mortality rates (U5MR), however, current declines in international development assistance for health (DAH) threaten to stall or reverse the U5MR progresses of the last years. We estimated the impact of the effective PHC coverage on U5MR in three diverse Sub-Saharan countries over the last two decades and forecasted U5MR trajectories through 2040 according to alternative PHC scenarios.
METHODS:
We developed an effective PHC coverage index (PHC-index) based on several PHC services provision and access dimensions. The PHC-index impact on child mortality was estimated using a two-ways fixed-effects multivariable Poisson regression models with robust errors, adjusted for all relevant confounding factors at the individual, regional and national level, and developing extended sensitivity and triangulation analysis for causal inference. We also integrated this evaluation with validated microsimulation forecasting model, encompassing nearly three million children per year.
RESULTS:
Increasing PHC coverage was strongly associated with U5MR decreases in a dose-response manner, reaching a 58% reduction (RR:0.420; 95%CI:0.193-0.916) for consolidated high coverage. PHC coverage reductions due to DAH defunding will lead to considerably higher U5MR in comparison with a Universal PHC coverage scenario in 2040: 57.2% (95%UI:56.1–58.4) higher in Mozambique, 57.6% (95%UI:55.5–59.6) in Gabon, and 57.6% (95%UI:56.7–58.6) in Ethiopia, amounting 1,871,833 (95%UI:1,607,602–2,175,827) excess child deaths across the 2025-2040 period.
CONCLUSIONS:
PHC substantially reduced U5MR in SSA over the past two decades and should be expanded rather than diminished due to the current drastic DAH defunding.
| eISSN: | 2654-1459 |
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