Elsevier

The Lancet

Volume 375, Issue 9730, 5–11 June 2010, Pages 2032-2044
The Lancet

Review
Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival

https://doi.org/10.1016/S0140-6736(10)60678-2Get rights and content

Summary

The Countdown to 2015 for Maternal, Newborn, and Child Survival monitors coverage of priority interventions to achieve the Millennium Development Goals (MDGs) for child mortality and maternal health. We reviewed progress between 1990 and 2010 in coverage of 26 key interventions in 68 Countdown priority countries accounting for more than 90% of maternal and child deaths worldwide. 19 countries studied were on track to meet MDG 4, in 47 we noted acceleration in the yearly rate of reduction in mortality of children younger than 5 years, and in 12 countries progress had decelerated since 2000. Progress towards reduction of neonatal deaths has been slow, and maternal mortality remains high in most Countdown countries, with little evidence of progress. Wide and persistent disparities exist in the coverage of interventions between and within countries, but some regions have successfully reduced longstanding inequities. Coverage of interventions delivered directly in the community on scheduled occasions was higher than for interventions relying on functional health systems. Although overseas development assistance for maternal, newborn, and child health has increased, funding for this sector accounted for only 31% of all development assistance for health in 2007. We provide evidence from several countries showing that rapid progress is possible and that focused and targeted interventions can reduce inequities related to socioeconomic status and sex. However, much more can and should be done to address maternal and newborn health and improve coverage of interventions related to family planning, care around childbirth, and case management of childhood illnesses.

Introduction

“Our world possesses the knowledge and resources to achieve the MDGs… falling short of the Goals would be an unacceptable failure, moral and practical.”

Ban Ki Moon

The UN Millennium Summit in 2000 set the stage for 189 governments and at least 23 international organisations to commit themselves to a broad set of health and development goals with defined targets to be achieved by 2015.1 The target of Millennium Development Goal (MDG) 4 is reduction of mortality in children younger than 5 years by two-thirds, and those of Goal 5 are reduction of the maternal mortality ratio by three-quarters and achievement of universal access to reproductive health. In 2010, two-thirds of the period for attainment of the MDGs has passed, with only 5 years remaining. In September, 2010, governments will reconvene in a special Summit of the UN General Assembly to assess progress and renew commitments to these goals.

The Countdown to 2015 for Maternal, Newborn, and Child Survival is an independent suprainstitutional initiative that was established in 2005. Its primary objective is to gather and present data for use by countries and the global health community to stimulate action on the health-related MDGs. The initiative is a collaboration of academics, UN agencies, non-governmental organisations, health-care professional associations, donors, and governments, with The Lancet as a key partner. Countdown specifically focuses on key evidence-based interventions that have been proven to improve maternal, newborn, and child health and survival. The work of Countdown addresses not only the fourth and fifth MDGs, but also MDG 1 through action on nutrition, MDG 6 on HIV/AIDS and malaria, MDG 7, which includes water and sanitation, and MDG 8 through a focus on partnership.

Section snippets

Evolution of Countdown

Countdown provides a common framework to track coverage of proven interventions and measures of mortality and nutrition in countries with the highest burden of mortality in mothers and children. In 2005, the first Countdown report included 60 countries and 17 interventions, and focused on child survival.2 The process thereafter evolved to focus on the continuum of care from prepregnancy through to pregnancy, childbirth, the postnatal period, and early childhood. At present, Countdown tracks

Tracking of intervention coverage

Countdown draws on four linked databases of coverage, health systems and policies, financial flows, and equity (figure 1) that combine data abstracted from existing global databases with new analyses relevant to maternal, newborn, and child health and survival. Detailed methods and data sources have been described previously.2, 3, 4, 11 Increasingly, Countdown is attempting to capture subnational data, although these data are difficult to ascertain in view of the sampling frames for national

Present status and progress

Table 1 summarises progress towards achievement of MDG 4 targets in the 68 Countdown priority countries. Consistent with other recent findings, 13 the Inter-agency Group on Child Mortality Estimation data show progress in reduction of child mortality, although distributed unevenly between countries. The global mortality rate in children younger than 5 years fell by 28%, from an estimated 90 deaths per 1000 livebirths in 1990, to 65 deaths per 1000 livebirths in 2008. On the basis of these

Improvement of equity and access to care

Countdown profiles include updated information about equity for 38 countries with a Demographic and Health Survey. In figure 7, mean coverage indices for the poorest and richest quintiles are shown as a floating bar for every country with a Demographic and Health Survey. As has been reported previously, in all countries analysed intervention coverage is substantially higher in mothers and children from rich families than in those from poor families. Notably, in groups of countries with similar

The role of health systems

Strengthening of health systems is crucial for effective delivery of reproductive, maternal, newborn, and child health care across phases of life and places of caregiving. In addition to coverage of key interventions, Countdown also tracks indicators of progress in strengthening of the main building blocks of health systems. Acute shortages and poor distribution of human resources continue to negatively affect the performance of health systems in many countries. Only 22% of the 68 Countdown

Financial flows for maternal, newborn, and child health

Resources remain a crucial gap, and both overall and government health spending have remained low in most countries. The median per head total health expenditure in 68 countries is a mere 80 international dollars (2007); only five Countdown countries are devoting 15% or more of their national budgets to health, and only five countries have household out-of-pocket expenditures of less than 15%.24 The goal is to move away from out-of-pocket payments through several approaches including

Implications

In the 2 years since the last Countdown report,4 19 million women of childbearing age and children younger than 5 years have died because of preventable disorders.16 Pneumonia, diarrhoea, and malaria still kill more than 3 million children every year, and our report shows that the long-established treatments for these infections still do not reach half of the children who need them. Newborn survival remains a challenge and demonstrable change might need a mix of strategies addressing maternal

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