Countdown to 2015: a report card on maternal, newborn, and child survival
Richard Horton, The Lancet
The Lancet, Volume 371, Number 9620, 12 April 2008 [Free subscription required]
Website: http://www.thelancet.com/journals/lancet/article/PIIS0140673608605334/fulltext
“…..The four papers published this week—on coverage,1 equity,2 financing,3 and policy,4 informed by the two detailed country analyses from South Africa5 and Tanzania6—provide the most up-to-date and comprehensive scientific assessment yet of progress towards international goals for reducing maternal, newborn, and child mortality. They represent a substantial step forward in scope and outcomes from the first Countdown report, presented in London in 2005.7,8 Concerted global action on maternal, newborn, and child survival, together with a renewed commitment to reproductive health, all triggered by this unprecedented collaboration between scientists, agencies, and civil society, has mobilised a new era of international and country action to address these neglected aspects of human health.9
Coverage:
Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions
Countdown Coverage Writing Group on behalf of the Countdown to 2015 Core Group
http://www.thelancet.com/journals/lancet/article/PIIS0140673608605590/fulltext
Financing:
Countdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006
Giulia Greco, Timothy Powell-Jackson , Josephine Borghi and Prof Anne Mills
Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, London, UK
http://www.thelancet.com/journals/lancet/article/PIIS0140673608605619/fulltext
Health Policy
Assessment of the health system and policy environment as a critical complement to tracking intervention coverage for maternal, newborn, and child health
Countdown Working Group on Health Policy and Health Systems
http://www.thelancet.com/journals/lancet/article/PIIS0140673608605632/fulltext
Equity:
Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries
Countdown 2008 Equity Analysis Group
The Lancet, Volume 371, Number 9620, 12 April 2008
Website: http://www.thelancet.com/journals/lancet/article/PIIS0140673608605607/fulltext [Free subscription required]
Background
Increasing the coverage of key maternal, newborn, and child health interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. We have assessed equity and trends in coverage rates of a key set of interventions through a summary index, to provide overall insight into past performance and progress perspectives.
Methods
Data from household surveys from 54 countries in the Countdown to 2015 for Maternal, Newborn and Child Survival initiative during 1990–2006 were used to compute an aggregate coverage index based on four intervention areas: family planning, maternal and newborn care, immunisation, and treatment of sick children. The four areas were given equal weight in the computation of the index. Standard measures were applied to assess current levels and trends in the coverage gap measure by wealth quintile.
Findings
The overall size of the coverage gap ranged from less than 20% in Tajikistan and Peru to over 70% in Ethiopia and Chad, with a mean of 43% for the most recent surveys in the 54 countries. Large intracountry differences were noted, with a country mean coverage gap of 54% for the poorest quintiles of the population and 29% for the wealthiest. Differences between the poorest and the wealthiest were largest for the maternal and newborn health intervention area and smallest for immunisation. In 40 countries with more than one survey, the coverage gap had decreased by an average of 0.9 percentage points per year since the early 1990s. Declines greater than 2 percentage points per year were seen in only three countries after 1995: Cambodia, Mozambique, and Nepal. Country inequity patterns were remarkably persistant over time, with only gradual changes from top inequity (disproportionately smaller gap for the wealthiest) in countries with coverage gaps exceeding 40%, to linear patterns and bottom inequity (disproportionately greater gap for the poorest) in surveys with gaps below 40%.
Interpretation
Despite most Countdown countries having made gradual progress since 1990, coverage gaps for key interventions remain wide and, in most such countries, the pace of decline needs to be more than doubled to reach levels of coverage of these and other interventions needed in the context of MDG 4 and 5. In general, in-country patterns of inequality are consistant and change only gradually if at all, which has implications for the targeting of interventions.
This paper was produced by the Countdown 2008 Equity Analysis Group: J Ties Boerma (WHO, Geneva, Switzerland); Jennifer Bryce (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA); Yohannes Kinfu (WHO, Geneva, Switzerland); Henrik Axelson (Partnership for Maternal, Newborn and Child Health, Geneva Switzerland); Cesar G Victora (Universidade Federal de Pelotas, Pelotas, Brazil). All authors contributed to the conceptualisation, analysis, and drafting of the paper. The Equity Analysis Group is a subgroup of the Countdown 2008 Equity Working Group, which included Henrik Axelson, Stan Bernstein, Ties Boerma, Betty Kirkwood, and Cesar Victora (chair).
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