Of 68 priority countries, less than one quarter are on track towards reaching the millennium development goals on maternal and child mortality. Some countries, most notably China, have made serious progress; however, many more, largely clustered in sub-Saharan Africa, have seen no progress or reversals of progress. According to the authors of the Countdown Report Article in the Countdown Special Edition of The Lancet, released April 11, 2008.
The Millennium Development Goals (MDGs) were established by a large group of members of the United Nations as goals of achievement by the year 2015. There are eight major goals, including two related to the reduction of maternal (MGD4) and child mortality (MGD5.) This Article focuses on the 68 countries which encompass 97% of all maternal and child deaths worldwide, then analyzes various intervention methods that have been proven to improve maternal, child, and newborn survival rates.
Peter Salama, (UNICEF, New York, USA) and Jennifer Bryce (Johns Hopkins School of Public Health, USA), and colleagues from the Countdown Core Group explain that of the 16 countries that were on track to meet MDG4, seven of them were actually already on track when the countdown was launched in 2005. These include Brazil, Bangladesh, Mexico, and Indonesia. Six of the 16 were only included in the Countdown process in 2008. These include Eritrea, Peru, and Morocco. Only three of these countries had made demonstrable progress from “not on track” in 2005 to “on track” in 2008: China, Haiti, and Turkmenistan. The authors laud this achievement, especially in a country of China’s magnitude: “The achievement of China, as the world’s largest country, is important, as are encouraging signs that several countries, many of which are in East Africa, have reduced mortality in children under-5 since 2005.”
Concerning MDG5, related to maternal mortality, it was not definitively clear whether countries were on track. However, actual maternal mortality was high or very high in 56 of the 68 countries (82%), which would suggest that these countries were not on track.
Generally, interventions that could be routinely scheduled had much higher coverage than those relying on the constant availability of clinical services or on functional health systems. For instance, immunization and antenatal care had much better coverage than emergency care at birth and the care of ill newborns and children. Most rapid increases in coverage were found in immunization, which has been receiving serious investment in recent years. The researchers advise: Priority attention in health-system strengthening should be given to establishment of a functional continuum of care that encompasses women before pregnancy, pregnancy, childbirth, the postnatal period, and the first 24 months of a child’s life.”
The most recent estimates of mortality in children under five years may not accurately represent the effects of HIV prevalence, even though in some countries this effect has peaked and is actually beginning to drop. The authors say: “Expanded and sustained efforts are needed to scale up comprehensive programmes for prevention of mother-to-child transmission of HIV, including treatment for pregnant and postnatal women and treatment for paediatric HIV.”
According to the 2008 Countdown report, several items are already in place to accelerate the progress towards the health-related MDGs. These include a strong consensus on the interventions which should take priority, a commitment from countries and donors, programs already in place, and increased funding. A framework to cement agreement on these priorities is proposed by the authors in the Article, with a focus on improving health systems. “In the seven years until 2015, the next two years before the next Countdown Report will be the most crucial. With strategic decisions and investments, and a focus on partnerships for results, we have the opportunity to see unprecedented progress in these 68 countries. Or will the 2010 report show more of the same gaps and lives lost?”
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
Lancet 2008; 371: 1247-58
Written by Anna Sophia McKenney