Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?
Abstract Background Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken i...
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| Format: | Article |
| Language: | English |
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BMC
2016-09-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-016-3401-6 |
| _version_ | 1819016606799364096 |
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| author | Corrina Moucheraud Helen Owen Neha S. Singh Courtney Kuonin Ng Jennifer Requejo Joy E. Lawn Peter Berman the Countdown Case Study Collaboration Group |
| author_facet | Corrina Moucheraud Helen Owen Neha S. Singh Courtney Kuonin Ng Jennifer Requejo Joy E. Lawn Peter Berman the Countdown Case Study Collaboration Group |
| author_sort | Corrina Moucheraud |
| collection | DOAJ |
| description | Abstract Background Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Methods Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). Results The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30–40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. Conclusions These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts. |
| first_indexed | 2024-12-21T02:50:19Z |
| format | Article |
| id | doaj.art-75ba09fdb6c943ef8216b9c7eb7db2fa |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-21T02:50:19Z |
| publishDate | 2016-09-01 |
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| series | BMC Public Health |
| spelling | doaj.art-75ba09fdb6c943ef8216b9c7eb7db2fa2022-12-21T19:18:27ZengBMCBMC Public Health1471-24582016-09-0116S2334910.1186/s12889-016-3401-6Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?Corrina Moucheraud0Helen Owen1Neha S. Singh2Courtney Kuonin Ng3Jennifer Requejo4Joy E. Lawn5Peter Berman6the Countdown Case Study Collaboration GroupUniversity of California Fielding School of Public HealthCentre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical MedicineCentre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical MedicineHarvard T.H. Chan School of Public HealthInstitute for International Programs, Johns Hopkins Bloomberg School of Public HealthCentre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical MedicineHarvard T.H. Chan School of Public HealthAbstract Background Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Methods Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). Results The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30–40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. Conclusions These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts.http://link.springer.com/article/10.1186/s12889-016-3401-6Millennium Development GoalsMaternal healthNeonatal healthChild healthReproductive healthCoverage |
| spellingShingle | Corrina Moucheraud Helen Owen Neha S. Singh Courtney Kuonin Ng Jennifer Requejo Joy E. Lawn Peter Berman the Countdown Case Study Collaboration Group Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? BMC Public Health Millennium Development Goals Maternal health Neonatal health Child health Reproductive health Coverage |
| title | Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? |
| title_full | Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? |
| title_fullStr | Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? |
| title_full_unstemmed | Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? |
| title_short | Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? |
| title_sort | countdown to 2015 country case studies what have we learned about processes and progress towards mdgs 4 and 5 |
| topic | Millennium Development Goals Maternal health Neonatal health Child health Reproductive health Coverage |
| url | http://link.springer.com/article/10.1186/s12889-016-3401-6 |
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