Countdown to 2015 and beyond: fulfilling the health agenda for women and children

Abstract

The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.

Figure 1. Correlation between CCI and U5MR

Includes 43 countries that have information on all eight indicators required for building the CCI and information on U5MR from the same survey. We used the most recent survey from each country, irrespective of when it was done.

Figure 2. Median national coverage of selected Countdown interventions, most recent survey, 2008 or later (%)

The grey dot indicates the point estimate for each country from the most recent available data source. IPTp=intermittent preventive treatment in pregnancy. ITNs=insecticide-treated nets. ORS=oral rehydration salts. *Analysis is based on countries with 75% or more of the population at risk of P falciparum transmission and 50% or more cases of malaria caused by P falciparum. Data are for 2012. Source: Immunisation rates, WHO, and UNICEF; post-natal visit for mother, Saving Newborn Lives analysis of Demographic and Health Surveys; improved water and sanitation, WHO and UNICEF Joint Monitoring Programme; all other indicators, UNICEF global databases, April 2014, based on Deomgraphic and Health Surveys, Multiple Indicator Cluster Surveys, and other national surveys. Reproduced from Requejo and colleagues.

Figure 3. Rapid gains for insecticide-treated nets

Change in coverage for children sleeping under an impregnated bed net and oral rehydration salts (ORS) for diarrhoea during about 5 years, for all Countdown countries with sufficient data. Source: UNICEF Global Databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and other national surveys.

Figure 4. Wealth inequalities in composite coverage index (CCI)

CCI according to wealth quintiles in 31 Countdown countries, ranked by the degree of absolute inequality. The horizontal bars link the poorest and wealthiest 20% of women and children. Longer bars represent greater absolute inequalities. Includes countries that had information on all indicators required for the CCI and at least 25 children in the denominator for each of these eight indicators, in every quintile. Only surveys from 2008 or later are included. Each country’s score on the CCI is shown in a series of dots, and countries are ranked from least (top) to greatest (bottom) inequity in absolute terms, indicated by length of the bar between the point estimates for the poorest and richest quintiles. Source: Demographic and Health Surveys and Multiple Indicator Cluster Surveys.