Seven countries around the world — three of them in Africa — have made faster than expected progress over the past 15 years in reducing deaths among children younger than five. These seven countries, Bangladesh, Cambodia, Ethiopia, Nepal, Peru, Rwanda and Senegal, were selected because they have all performed unexpectedly well in improving childhood health relative to their economic growth.

There are many factors at the root of their achievements, most notably, a strong integrated and co-ordinated health system built on primary health care. However, one cross-cutting factor stands out that we believe allowed them all to achieve significant health gains but which, so far, tends to be always overlooked: trust...

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