Development and use of the Lives Saved Tool (LiST): a model to estimate the impact of scaling up proven interventions on maternal, neonatal and child mortality

The Journal’s April supplement included many informative articles about the Lives Saved Tool (LiST), such as how modelling and calculations are built into the tool, actual calculations of effect sizes in the software and recent applications of various LiST scenarios. We understand that LiST was developed to be used as part of a package of tools for programme managers or ministry of health personnel for planning, helping prioritize investments and evaluating existing programmes. Because of the potential power of this tool, how it gets used becomes a critical issue. Presently, we understand that LiST is primarily being used to advocate for new interventions or those with relatively low coverage. Its focus is on future marginal mortality gains. But the tool also has the capability to convey important information, not highlighted in the supplement, relating to more historically established interventions that typically show higher coverage—such as immunization and vitamin A. Past mortality reduction gains must not be taken for granted and indeed cannot be maintained without continued investments. The tool’s versatility, if fully exercised, could help users look at the bigger public health picture, assessing both future marginal mortality gains (lives saved) and past mortality reduction gains (by showing lives lost if gains are not maintained). Chopra et al. note that ‘certain interventions for which coverage is already high will not result in many lives saved and this discrepancy may be misunderstood: for example, immunization coverage is high in South Africa so very few lives would be saved by increasing from over 90% to our target of 95% coverage. However, if investment stopped and coverage fell, mortality would rise. This effect can also be modelled in LiST to ensure that misunderstandings do not arise.’