Child Survival Action (CSA) hosted a webinar to discuss its Global Results and Accountability Framework in January 2025. This framework aims to eliminate preventable child deaths and ensure countries stay on track to meet the Sustainable Development Goal (SDG) 2030 under-five mortality target. The event featured expert panelists who shared insights on how stakeholders can utilize the framework for effective planning, strategy adjustment, and resource mobilization. 

Download the slide deck and access the recording here 

The Urgency of Action 

Dyness Kasungami from JSI highlighted that 59 countries need to accelerate action to meet the SDG child mortality target, with the majority located in Africa. Of these, 38 off-track countries report that over 50% of child deaths occur between one and 59 months of age. This pressing reality underscores the importance of CSA’s efforts in supporting countries to reduce mortality rates through a structured, results-driven approach. Dyness outlined five key actions under CSA: 

The CSA Results and Accountability Framework 

The CSA Results and Accountability Framework is designed for both advocacy and action, providing a structured approach for tracking child health outcomes and mobilizing resources. Kate Gilroy, senior technical advisor at JSI, presented the framework , emphasizing its role in helping countries align child survival strategies with global best practices. 

A key principle of the framework is leveraging existing data to minimize reporting burdens while ensuring reliable measurement. It aligns with global initiatives such as Every Woman Every Newborn Everywhere (EWENE) and builds on established impact measurement approaches and validated indicators. The CSA framework is continuously evolving to incorporate new targets, enhance implementation milestones, and strengthen accountability mechanisms. It focuses on: 

• Impact Indicators: Under-five mortality rates, mortality within the one-to-59-month age range, and prevalence of stunting and wasting. 
• Outcome/ Coverage Indicators: Nutrition practices, immunization and management of childhood illnesses such as pneumonia, diarrhea, and malaria. 
• Contextual Indicators 
• Equity and Quality of Care Measures: Addressing disparities in child survival and ensuring high-quality healthcare services. 
• Implementation Milestones: 5 milestones related to governance, accountability, national plans and financing the service delivery systems, community engagement, data and evidence and partnership. 

Sierra Leone’s Experience: A Case Study in Implementation 

Sierra Leone, one of the countries with the highest under-five mortality rates, identified six major bottlenecks during stakeholder meetings: ineffective leadership, supply chain issues, inadequate engagement of the private sector, gaps in service delivery, challenges in community outreach, and limitations in quality data use for decision-making. The country is actively addressing these challenges through targeted interventions and strategic objectives aimed at elevating child survival as a national priority. Dr. Lynda Farma-Grant, Program Manager for Child Health at the Ministry of Health in Sierra Leone, presented the country’s journey in adopting the CSA framework.  

Key achievements as per the Child Survival Action (CSA) framework include the development of a costed annual workplan for Child Health, updated annually, and the provision of monthly progress updates on Child Survival to senior management through the Child Health Technical Working Group (TWG). Child Health Focal Points have been appointed in all hospitals and districts, with other ongoing efforts to strengthen child health systems and collaboration across programs and directorates. 

Takeaways from Sierra Leone’s implementation include: 

• Utilization of existing data systems like DHIS2 and Demographic Health Surveys to inform child survival strategies. 
• Identifying key mortality drivers—such as malaria, pneumonia, and malnutrition—and designing targeted interventions. 
• Strengthening health systems through leadership, community engagement, and integration of child health programs. 
• Introducing child death audits at hospitals to analyze causes of mortality and improve healthcare responses. 

Sierra Leone has prioritized data-driven decision-making and stakeholder collaboration to improve child health outcomes. There is also an ongoing effort to implement the Child Survival Action Plan nationwide and identify champions for CSA at national and district levels. Challenges in aligning and supporting systems across various programs and directorates remain key priorities.  

 Moving Forward: Strengthening the Framework for Greater Impact 

As CSA continues to evolve, engagement from governments, policymakers, and global health organizations remains critical. By leveraging data-driven strategies and fostering cross-sectoral collaboration, countries can accelerate progress toward ending preventable child deaths. The webinar also addressed ongoing efforts to refine the CSA framework, including: 

• Expanding the learning agenda to improve measurement of child health equity and quality of care. 
• Enhancing implementation milestones based on country-specific needs. 
• Aligning CSA indicators with existing global initiatives to reduce duplication and streamline data collection.