A Decade of Tracking Progress for Maternal, Newborn and Child Survival: Lessons From Countdown to 2015 for Monitoring and Accountability in the SDG Era

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By: Mickey Chopra, The World Bank; Zulfiqar A. Bhutta, Centre for Global Child Health, Hospital for Sick Children (Canada) and Aga Khan University (Pakistan)

Zulfiqar Bhutta and Mickey Chopra are co-chairs of Countdown to 2015.

“Ten years from now, in 2015,” said the opening line of the first Countdown to 2015 report, published in 2005, “the governments of the world will meet to assess if we have achieved the Millennium Development Goals (MDGs), the most widely ratified set of development goals ever, signed onto by every country in the world.”

CDReport_2015_cover_webNow that day of reckoning has come. Today we launch the last Countdown to 2015 report of the MDG era—a final accounting of progress and remaining gaps in the 75 countries that account for more than 95% of all maternal, newborn and child deaths—to 1,000 technical and policy leaders at the Global Maternal Newborn Health Conference, and to a global audience of health policy makers, scientists, program implementers and advocates in every country still working to address and overcome a high burden of maternal, newborn and child death. Our report focuses on evidence-based solutions—health interventions proven to save lives—and on contextual factors that affect the equitable delivery of these interventions to women and children. Country profiles for 75 Countdown countries were published as a core part of the report, and updated equity profiles for 62 of those countries have been simultaneously posted online.

For MDGs 4 and 5, the verdict is mixed. More than half of the 68 countries—included in Countdown because they exceeded specified ‘threshold’ levels of child or maternal mortality—have succeeded in reducing mortality levels below those thresholds. At the same time, only 4 of the 75 Countdown countries—Cambodia, Eritrea, Nepal, and Rwanda—will achieve both MDGs 4 and 5. Vaccines and many malaria and HIV interventions have achieved significant improvements in coverage, but most other interventions — especially family planning, pregnancy and childbirth, and childhood disease management services that require a working health system — still fail to reach a third or more of the women and children who need them. Coverage has increased more for the poor than for the rich, shrinking the global equity gap, but systematic pro-rich and geographic inequalities still exist in virtually every country and for virtually every coverage indicator. Much work remains to be done to improve maternal, newborn and child health in the era of the Sustainable Development Goals.

Countdown’s experience over the past 10 years has established the importance and feasibility of a vibrant multi-stakeholder initiative, with independence and a strong technical component, in accelerating progress for the world’s women and children. It offers important lessons learned on monitoring and accountability that are highly relevant to the SDG era, including the pressing need to:

  • Establish clear, consistent baseline data
  • Solve the modelled mortality problem, particularly in regard to the maternal mortality ratio
  • Improve measurement and data collection
  • Ensure that common standards of measurement and reporting are used
  • Set relative targets to complement fixed targets for assessing country progress
  • Set targets that are aspirational but also achievable
  • Track specific coverage indicators and a composite coverage index
  • Choose indicators carefully, and balance focus with breadth

Our experience also reminds us that beneath the data lies a deeper truth, about millions of women, newborns and children who received the essential care they needed, and millions more who—tragically and infuriatingly—didn’t. As we come together at the GMNH conference in Mexico City, and work together in countries and villages around the world, let us never forget that the numbers we report represent real people. We—all of us—are accountable to them for keeping our promises.

Fifteen years from now, the governments of the world will meet to assess whether we, together, have done the work needed to achieve the Sustainable Development Goals. For Countdown, our old work ends, and that new work begins, with the report that we release today.