A recent transformative study shines a critical light on child mortality rates within the South Asian Association for Regional Cooperation (SAARC) countries, illuminating the intricate interplay between economic development, healthcare investment, and immunisation programs. This comprehensive investigation delves into the determinants of under-five mortality rate (U5MR), a pivotal indicator of child health influenced by multifaceted socio-economic and healthcare dynamics. By harnessing data spanning two decades from SAARC nations, the research offers unprecedented insights into how factors like per capita GDP, government health expenditure, and vaccination coverage shape the survival prospects of millions of children in this geopolitically significant region.
One of the most striking conclusions from this analysis is the nuanced role economic growth plays in reducing child mortality. While an increase in per capita GDP (PGDP) often correlates with enhanced health outcomes due to better resources and living standards, the study cautions against viewing GDP growth as a panacea. Economic progress, when unaccompanied by deliberate healthcare reforms and targeted investments, falls short of bridging the deep-seated disparities in access to quality medical services. This observation underscores the necessity of translating macroeconomic gains into tangible policy actions that directly improve healthcare delivery in underserved communities.
Health expenditure emerges as a pivotal variable that mediates the relationship between economic growth and child mortality reduction. Government healthcare expenditure (GHE), although showing variable impacts between different SAARC countries, constitutes an essential pillar for establishing the healthcare infrastructure crucial for sustainable child health advancement. Particularly in rural and marginalized sectors, adequate funding of health systems translates into improved availability of medical care, greater capacity for disease prevention, and enhanced support for maternal and child health initiatives. These investments are fundamental for converting economic inputs into measurable survival benefits.
However, amid the array of factors influencing U5MR, immunisation coverage—especially the administration of the first dose of the diphtheria-tetanus-pertussis vaccine (DTP1)—stands out as the most potent determinant in the fight against early childhood mortality. The study highlights how increasing DTP1 coverage acts as a critical intervention in identifying and reaching “zero-dose” children who remain completely unvaccinated. Expanding immunisation not only directly protects children from deadly vaccine-preventable diseases but also serves as an indicator of the reach and effectiveness of healthcare systems in accessing vulnerable populations. Thus, immunisation programs are positioned as strategic leverage points for achieving rapid and significant reductions in U5MR across SAARC countries.
The regional disparities in child mortality uncovered in the study present a stark contrast. Nations like Sri Lanka have made remarkable strides toward lowering U5MR, benefiting from stable governance, robust healthcare policies, and concerted immunisation efforts. Conversely, countries such as Pakistan and Afghanistan continue to grapple with persistently high mortality rates, reflecting ongoing challenges related to socio-political instability, healthcare inequities, and infrastructural deficiencies. These contrasts serve as cautionary reminders that broad-brush economic strategies are insufficient without nuanced, country-specific approaches tailored to unique demographic and systemic contexts.
Moreover, the research emphasizes that child mortality reduction cannot be achieved in isolation but requires integrated and coordinated policy frameworks. These must simultaneously address socio-economic determinants, expand and optimize immunisation coverage, and ensure adequate allocation of healthcare resources. Without such comprehensive strategies, progress risks being uneven or ephemeral, disproportionately benefiting wealthier or urban-centric populations while leaving vulnerable rural children behind. This dynamic underscores the ethical imperatives of equity and inclusion as cornerstones in public health planning within the SAARC region.
The study’s urgent call to action resonates beyond academia and policy circles, inviting international organizations, donors, and civil society actors to mobilize resources and technical expertise. Building resilient healthcare infrastructures capable of scaling immunisation programs and delivering essential child health services demands sustained commitment and collaboration. Given the global health landscape shaped by the Sustainable Development Goals (SDGs), particularly the goal to end preventable child deaths by 2030, the findings present both a challenge and an opportunity for the international community to support SAARC countries in this endeavor.
Technical considerations within the research also point to significant limitations and avenues for future inquiry. For instance, while DTP1 serves as a robust proxy for immunisation system performance, the exploration of other vaccine coverages—such as DTP2, DTP3, BCG, Polio, and Hepatitis B—could yield deeper understanding of the vaccine-preventable disease landscape and its nuanced impact on U5MR. Incorporating these additional immunisation metrics may illuminate patterns of vaccine uptake, dropout rates, and coverage equity that are currently unexplored.
Beyond immunisation, the study acknowledges the absence of key variables such as skilled birth attendance, child nutrition indicators, breastfeeding practices, and sanitation levels—factors well established in global health literature as critical determinants of child survival. The lack of consistent and comprehensive data across SAARC countries constrained their inclusion, highlighting a pervasive challenge in health data infrastructure. Addressing this data gap is imperative for future research to construct more comprehensive, multifactorial models that accurately reflect the complex epidemiology of under-five mortality in the region.
Afghanistan’s exclusion from the dataset due to prolonged conflict underscores how socio-political instability hampers reliable health data collection and system strengthening. This exclusion also reflects broader geopolitical challenges that must be considered when designing and implementing child health interventions. Consequently, enhancing health information systems, even amid fragility and crisis, emerges as a foundational priority for improving child health outcomes and enabling evidence-based policy.
Methodologically, the study faced constraints linked to the short time series of available data and limited availability of strong instrumental variables, which restricted the employment of advanced econometric techniques such as Instrumental Variables (IV) or system Generalized Method of Moments (GMM). These methodological limitations affect the ability to robustly address potential endogeneity issues, such as reverse causality between healthcare inputs and child mortality outcomes. Future research expanding the temporal scope and employing causal inference methods, including panel cointegration or vector error correction models, could yield more definitive insights into the direction and magnitude of these relationships.
The interplay of economic growth, health expenditure, and immunisation coverage revealed through this research underscores a critical synergistic effect rather than isolated influences on child mortality. This triad of factors, when leveraged collectively, holds the promise of driving dramatic improvements in child survival rates. However, the heterogeneity observed across the SAARC countries indicates that policy interventions must be contextually calibrated, prioritizing enhancements in immunisation outreach alongside sustained investments in health system capacity and socio-economic development.
From a policy perspective, the research advocates for a paradigm shift towards equitable healthcare delivery systems that prioritize marginalized populations. This entails not just expanding financing but also enhancing the efficiency and quality of service delivery. Targeted immunisation campaigns, robust supply chain management, community engagement, and health workforce strengthening must be integral components of comprehensive child health strategies. Addressing social determinants such as poverty, education, and sanitation in tandem with healthcare interventions can further amplify results.
In conclusion, this study serves as an urgent beacon for SAARC leaders, international donors, and health policymakers, underscoring the pressing need to intensify efforts against child mortality. The evidence presented compels stakeholders to rethink traditional approaches that overly rely on economic growth as a singular lever. Instead, it promotes embracing a multidimensional strategy that places immunisation at the forefront, buttressed by sustained healthcare investments and socio-economic equity initiatives. If these challenges are met with coordinated action, the hope for achieving the Sustainable Development Goals and creating a future where every child has an equal chance to thrive becomes attainable.
The findings presented—not only augment the academic dialogue on child mortality determinants in low- and middle-income countries but also have profound real-world implications. Effectively translating these lessons into policy and practice will be critical for altering the trajectory of child health in South Asia, transforming fragile health systems into resilient engines of survival and well-being. Given the region’s demographic weight and global interconnectedness, success here will reverberate worldwide, marking a key milestone in the global quest to eradicate preventable child deaths.
This pioneering research by Fernando, Sudangama, Adikari, and colleagues represents a significant advancement in our understanding of the complex drivers behind U5MR in the SAARC context. By meticulously dissecting the roles of GDP, government health expenditure, and vaccination, it provides a data-driven roadmap towards optimized public health strategies that can save lives. Moving forward, expanding datasets and methodological rigor—as outlined by the authors—will be essential for refining these insights and guiding policy with ever-greater precision.
The study’s implications extend beyond the borders of South Asia, offering transferable lessons to other regions grappling with similar challenges of health inequity, weak infrastructure, and fragmented immunisation services. In an era where global health is increasingly prioritized, understanding and addressing the multifactorial causes of child mortality remains a global imperative. This work contributes seminal knowledge vital for achieving those aims, with the ultimate goal of ensuring that every child, irrespective of geography or socio-economic status, can survive and flourish in a healthier world.
Subject of Research: Determinants of under-five mortality rate (U5MR) in SAARC countries, focusing on the impact of economic growth, healthcare expenditure, and immunisation coverage.
Article Title: Driving down child mortality in the SAARC: the impact of GDP, healthcare, and vaccination.
Article References:
Fernando, A., Sudangama, N., Adikari, D. et al. Driving down child mortality in the SAARC: the impact of GDP, healthcare, and vaccination. Humanit Soc Sci Commun 12, 1485 (2025). https://doi.org/10.1057/s41599-025-05764-1
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