Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?

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. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3401-6) contains supplementary material, which is available to authorized users.

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PID https://www.doi.org/10.1186/s12889-016-3401-6
PID https://www.doi.org/10.1186/s12889-016-3401-6.
PID pmid:27633919
PID pmc:PMC5025828
URL http://nrs.harvard.edu/urn-3:HUL.InstRepos:29407803
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URL https://jhu.pure.elsevier.com/en/publications/countdown-to-2015-country-case-studies-what-have-we-learned-about
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URL https://doi.org/10.1186/s12889-016-3401-6
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025828/
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Author Jenny Ruducha, 0000-0001-7745-9002
Author Luis Huicho, 0000-0002-5272-5885
Author NS Singh, 0000-0003-0057-121X
Author Victora, CG, 0000-0002-2465-2180
Author Macharia, 0000-0002-4428-862X
Author Joy Lawn, 0000-0002-4573-1443
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Collected From OpenAPC Initiative; Europe PubMed Central; PubMed Central; eScholarship - University of California; ORCID; UnpayWall; Datacite; DOAJ-Articles; Crossref; Microsoft Academic Graph; Digital Access to Scholarship at Harvard; CORE (RIOXX-UK Aggregator)
Hosted By OpenAPC Initiative; Europe PubMed Central; SpringerOpen; eScholarship - University of California; BMC Public Health; Digital Access to Scholarship at Harvard; LSHTM Research Online
Journal BMC Public Health, 16, S2
Publication Date 2016-09-01
Publisher Springer Nature
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Language English
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keyword Public Health, Environmental and Occupational Health
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Source https://science-innovation-policy.openaire.eu/search/publication?articleId=dedup_wf_001::609726f6e95994386e6a6791bbb7a1ca
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Last Updated 21 December 2020, 21:57 (CET)
Created 21 December 2020, 21:57 (CET)