Child survival: research and policy.

In recognition of the global need to improve health conditions national governments and international agencies are reevaluating health service strategies. Community-based care has been viewed by the international health community as the key strategy to make health services accessible. Only 2 kinds of community-level initiatives are currently undertaken by most health ministeries. One consists of extending curative and preventive services to communities through the use of minimally trained paramedical personnel. The other concentrates on providing a few simple but effective health technologies. The latter approach is criticized for being too supply-oriented and tending to ignore the social constraints. This article examines the conceptual framework of cross-disciplinary communication; the biomedical perspectives; the social science perspectives; data collection; and mathematical models. Since both pregnancies and diseases are consequences of biosocial interactions a fruitful approach to a study of the causes of either fertility or mortality in populations would consist of defining and measuring these interactions. Ordinarily biomedical scientists give little attention to socioeconomic determinants of disease except to note them as background variables. Nutritional problems can only be properly dealt with using a multidisciplinary approach. Both macro- and micro-level social science research are discussed. Anthropological research is important to define more precisly what behavior influences the proximate determinants of child survival and what the motivating factors are. The advantages and disadvantages of longitudinal observation and single-round surveys are presented. More direct collaboration between researchers and program managers in the operational phase of programs is needed to test and improve models that may guide health policies and programs in the future. Biomedical science advances have made it possible for the vast majority of newborns will survive childhood but whether this is achieved will depend to a considerable degree on social circumstances.