Saving Lives by Design: Harvard/UCSF study documents tenfold difference in under-five mortality after launch of ultra-rapid health system
A study evaluating the NGO Muso’s health system redesign in Malawi documented a nearly tenfold difference in child mortality, the largest and fastest decrease ever recorded.
The initiative included various features to optimize for speed.If health systems are redesigned to reach every child within the few days of symptom onset, could that stop most under-five deaths in the world’s poorest communities?
MASS’s experience designing health infrastructure has demonstrated the value of architecture. Could design improve health outcomes by facilitating access to care and optimizing for speed?
A study published last year
(see attached) by researchers at Harvard and the University of California San Francisco, in partnership with the Malian Ministry of Health, evaluated the effectiveness of the NGO Muso’s new health system redesign. The study documented a nearly tendfold difference in child mortality rates following Muso’s implementation of Community Health Worker active case finding, user fee removal, infrastructure development, community mobilization, and prevention programming.
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To Muso’s knowledge, the study documents the largest and fastest difference in under-five mortality ever recorded. Their intervention asks the following question: what happens if health systems are redesigned to optimize for speed? If a health system could reach every child within the few days of symptom onset, could that stop most under-five deaths in the world’s poorest communities?
MASS’s experience designing health infrastructure has demonstrated the value of effective design to increase ease of care, infection control, and patient dignity, among others. Could architecture improve health outcomes by facilitating access to care and optimizing for speed?
The Harvard/UCSF/Mali MoH study, published in the journal PLOS ONE, found a baseline rate of child mortality of 155/1000 in the area of the intervention—Yirimadjo, Mali, an area of 56,000 people. When mortality was re-measured three years later, the rate of death for children under age five was 17/1000. And it documents remarkable findings. During the study period, the number of home and clinic patient visits in the area increased approximately ten-fold. The rate of early treatment for malaria—within 24 hours of a child’s first symptom—nearly doubled. And as mentioned above, the study documents, to Muso’s knowledge, the largest and fastest difference in under-five mortality ever recorded.
It has important limitations--it is a single-site study and does not include a control group. But if these results could be replicated at scale globally, millions of children's lives could be saved annually. As a global community, we could achieve and surpass MDG 4.