Les progrès du 4e objectif du millénaire pour le développement (OMD), globalement et les exemples d'application au Maghreb: Quoi de neuf ?

The first part of this article examines the global progress towards target A of the fourth Millennium Development Goal. This target is to reduce by two thirds the under-five mortality rate between 1990 and 2015. Accepting such a target implies de facto that most child deaths could be avoided. Recent sources are examined and the UN-IGME data set is used for the comparison as being the one favoured by the United Nations. Child deaths are falling but not quickly enough, particularly in Southern Asia and sub-Saharan Africa. In this part, a search of the literature for Algeria, Libya, Mauritania, Morocco and Tunisia, the five countries composing the Maghreb is performed, and shows that four of these countries are in good progress and possibly on track. The main concern, both globally and for four Maghreb countries is that the share of neonatal death is rising. This brings on new challenges, because the means for addressing this issue differ from, validated policies such as vaccination, or diarrhea control. Scaling up low-cost interventions will be a priority. In the second part an in depth description of the process in Algeria is made. This has included successive steps, starting from independence. Through a combination of interventions at community level and at health care points regular, sustainable progress has been achieved. These have included vaccination, family planning, skilled attendance at birth, infrastructure development, human resources, free access to care and prevention, and improved statistics of birth and death. The new challenges related to the growing share of neonatal mortality are discussed. It is acknowledged that neonatal survival requires, at population level, modern medical care. This means the problem is fundamentally different from post neonatal mortality where socio-economic development is the main determinant. A perinatal programme has been established in Algeria. Kangaroo Mother Care has been introduced in Algeria more than a decade ago and has been a success story. © 2012 Springer-Verlag France.SCOPUS: ar.j