Promoting Child Survival
A woman and baby in Mali (Photo credit: REACH Network)
Every year, nearly 5 million children under 5 years old die, many from preventable illnesses like pneumonia, diarrhea, and malaria. Most of these deaths occur in sub-Saharan Africa. The crisis is most severe in West and Central Africa, where 1 in 10 children do not live to see their fifth birthday.
Since its founding, the Gates Foundation has committed to fighting the greatest global inequities, including child mortality. In May 2025, Bill Gates reaffirmed his commitment to child survival by announcing that one of the foundation’s aspirational pillars of the next twenty years would be “No Mom, child, or baby dies of a preventable cause.” One initiative that is achieving impressive results in support of this noble aspiration is REACH.
REACH (Resiliency through Azithromycin for Children) is a low-cost and highly effective initiative to increase child survival through mass biannual drug administration of azithromycin (AZ). Health workers deliver azithromycin - a safe, affordable, and widely used antibiotic that helps prevent deadly infections - to children aged 1-59 months in Nigeria, Mali and Niger, three countries with among the highest burdens of child mortality on the continent. REACH offers a promising strategy to support these countries to achieve their national child health goals.
REACH has already supported 4 million children, and it could reach up to 10 million in the near future. The program targets children in the most remote and impoverished areas, where the mortality burden is highest, and is integrated into health services – such as antenatal care, nutrition, and vaccination campaigns - adding to the toolkit of interventions that promote child health.
REACH has demonstrated a reduction in child mortality by as much as 18% in the most vulnerable areas. For nearly a decade, robust research has tracked its impact and safety, including monitoring for antimicrobial resistance. With strong evidence base and proof of concept now established, Nigeria, Mali, and Niger, championed by their Ministries of Health, are scaling up REACH in collaboration with the foundation, the REACH Network, and other partners.
The foundation contracted with Adduna Health Partners to develop a landscaping strategy and implementation plan to develop compelling narratives and to identify and secure other funders and partners who may be interested in joining to support this important program.
By reducing child and infant mortality, REACH has already proven to be an effective intervention to reduce preventable deaths in West Africa. With adequate funding, REACH has the potential to expand to new geographies to reach more children, strengthen local health systems, and ultimately, to save tens of thousands of children's lives.