Document Type

Working Paper

Publication Date



This report presents the child mortality impact of a trial of primary health-care service-delivery strategies in rural Ghana. After adjustment for sociodemographic factors, under-five mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. Reductions were observed in infant (6 percent), early child (20 percent), and late child (41 percent) mortality. Community involvement and training of a local health volunteer were associated with an 11 percent increase in mortality, primarily driven by a 124 percent increase in early child mortality. Areas with both nurses and volunteers experienced a 7 percent increase in mortality, with small increases in all age groups. In a comparison area, under-five mortality fell by 5 percent during the same time period. These results suggest that convenient, accessible professional medical care can reduce child mortality in impoverished African settings. They raise questions, however, about the benefits to children’s survival of relying on community volunteers.