Despite political and economic challenges, rapid reductions of maternal and child mortality and dramatic improvements in reproductive health and rights are possible, according to a report released at the Partners' Forum in Johannesburg. Success Factors for Women's and Children's Health highlights 10 countries who mobilized action across society, using data to drive decisions to address their unique circumstances. As a result, in the 10 "fast-track" countries, there were 2.4 million fewer child deaths and over 70,000 fewer maternal deaths by 2013 when compared to 1990 mortality rates.
The Success Factors studies, a collaboration of the Partnership for Maternal, Newborn & Child Health (PMNCH), the World Bank, World Health Organization (WHO) and the Alliance for Health Policy and Systems Research, highlighted 10 fast-track countries set to meet Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health). Ministries of health in these 10 countries - Bangladesh, Cambodia, China, Egypt, Ethiopia, Lao PDR, Nepal, Peru, Rwanda and Vietnam - convened multistakeholder meetings to review and document each country's progress.
"A better understanding of how some countries have been able to prevent maternal and child deaths can inform all partners' strategies to accelerate progress for women's and children's health," said Dr. Carole Presern, PMNCH Executive Director. "While every country has its own challenges, sustained political will and vision, evidence-based, high-impact investments, and strong partnerships across society can save lives and set a way forward for sustainable health and development."
While the mix of strategies and investments used to address high maternal and child mortality rates differed to meet local context and priorities, fast-track countries some shared some successful approaches. They invested in high-impact health interventions such as quality care at birth, immunization and family planning. They also made progress across multiple health-enhancing sectors such as prioritizing education, women's political and economic participation and access to clean water and sanitation. Economic development and good governance - including political commitment and control of corruption - underpinned progress overall.
"A great lesson learned from the success factors studies is that we can only truly make progress in women's and children's health by working across sectors," says Dr. Flavia Bustreo, WHO Assistant Director General. "For example in Bangladesh, birth registration went from 10% in 2006 to over 50% thanks to the introduction of mobile technology to allow digital registration. That means the government has now more updated and reliable data, and can better track who and where services are needed so they can be provided more efficiently. Of course the implications go beyond the health sector too - these children now have an identity and rights."
"We need more investment in policy and implementation research," says Dr. Abdul Ghaffar, Executive Director Alliance for Health Policy and Systems Research, "With evidence on effective policy strategies stakeholders can understand and decide where to make investments, alliances and partnerships within and beyond health sector."
Success Factor Report Country Highlights:
- Bangladesh has reduced under-five mortality by 65 percent and maternal mortality by 66 percent. These reductions are associated with improved coverage of essential interventions, such as immunization, oral rehydration therapy and family planning, particularly in underserved areas. Partnerships between government, NGOs and the private sector contributed to improved service delivery. Bangladesh also focused on increasing access to education for girls and gender equity, as well as improving road networks and access to information and communication technology.
- Cambodia saw a 75 percent reduction in maternal mortality between 1990 and 2010. Between 1995 and 2010 there was a 57 percent reduction in child mortality, associated with early access to immunizations, early and exclusive breastfeeding and improvements in socioeconomic conditions. In a particularly innovative use of communications, Cambodia leveraged the reach of mass media to launch a campaign promoting exclusive breastfeeding, which included a storyline in a popular TV soap opera.
- China decreased under-five mortality by 80 percent and maternal mortality by close to 80 percent. It has improved coverage of essential interventions and strengthened the health workforce by training more than 300,000 community workers to become general practitioners. China also made many improvements in sectors outside of health, including improving access to water and sanitation facilities.
- Egypt decreased under-five mortality by 75 percent and maternal mortality by 69 percent. This decrease is associated with increased coverage of high impact interventions such as family planning and immunization. An increased youth literacy rate (from 73 percent in 1996 to 86 percent in 2007) and an increased access to water and sanitation facilities were also associated with Egypt's success.
- Ethiopia has achieved a 47 percent drop in under-five mortality since 2000, associated with interventions to treat the most important causes of child mortality, such as immunizations and quality care at birth and improved socioeconomic conditions. Ethiopia has also made progress in improving access to safe drinking water and sanitation facilities, expanding road infrastructure and increasing access to primary and secondary education, however, Ethiopia still has one of the highest maternal mortality rates in the world at 676 deaths/100000 live births.
- Lao PDR reduced under-five child mortality rates by 56 percent and maternal mortality rates fell by 6.8 percent annually between 1990 and 2013. Gains are associated with improved coverage of essential immunizations, malaria prevention and treatment, birth spacing, early and exclusive breastfeeding and improved socioeconomic conditions. Reductions in maternal mortality are associated with a halving of the total fertility rate, and socioeconomic and education improvements. Improvements in education, access to improved water and sanitation, and poverty reduction have been central to mortality declines and better health.
- Nepal, has achieved a 66 percent reduction in child mortality and an 80 percent reduction in maternal mortality due to a progressive policy environment, a focus on increasing skilled birth attendance at health facilities and in the community, and strong political will. Education policies, improvements in transportation, communications and water quality and sanitation access were also cited as factors in Nepal's success.
- Peru is on track to achieve MDGs 4 and 5 with a 70 percent reduction in child mortality and a 65 percent reduction in maternal mortality between 1991 and 2013. Political stability and sustained economic growth allowed for social progress. Peru is taking steps to address cultural and geographical barriers preventing women and families from accessing health care.
- Rwanda has reduced child deaths by 50 percent since 1992. Between 1992 and 2010 maternal mortality decreased from 611/100 000 to 476/100 000 live births - a reduction of 22%. From an increase in MMR to 1071 per 100 000 live births in 2000, the period 2000 and 2010 saw a reduction of 55%. These gains are in part attributed to addressing a shortage of health workers, improving health infrastructure and reducing barriers to health care access. Rwanda has made progress across multiple health-enhancing sectors, prioritizing education, women's political and economic participation and nutrition.
- Viet Nam reduced under-five mortality by 60 percent, and maternal mortality by 70 percent. Gains are attributed to increased access to immunization, child survival and nutrition interventions as well as an increase in contraceptive prevalence and skilled birth attendance for women. Viet Nam has also made in progress in sectors outside of health, prioritizing access to clean drinking water and sanitation facilities, primary school enrolment and policies to tackle nutrition issues.
"Fast-track countries engaged communities to build local ownership and demand for quality health care services," says Dr Rafael Cortez, World Bank Senior Economist. "At the same time, these countries have improved their financing strategies, for example by focusing on results-oriented service delivery. They also invested in essential infrastructure to deliver and sustain services, especially in rural and remote areas."
"Fast-track countries are not complacent about the challenges that lie ahead," said Dr Sadia Chowdhury, Executive Director, BRAC Institute of Global Health in BRAC University, Bangladesh and lead researcher on the cross-country analysis. "But being able to identify some shared lessons on accelerating progress can inform strategies to sustain it. Key priorities for future action identified by many countries include promoting access to essential services in underserved areas to address equity, strengthening health service delivery including quality of care, especially around the time of birth and, improving multi-sector linkages."
The 2014 Success Factors report includes lessons learned across countries to ensure women and children have access to the interventions needed to survive and thrive. Lessons laid out in the report could inform countries' strategies to accelerate progress to achieve MDGs 4 and 5 as well as promote women's and children's health in the post-2015 era.