Explore the achievements and lessons learned from the Countdown to 2015 initiative in tracking maternal, newborn, and child survival progress.

Introduction

Over the past decade, significant strides have been made in the realm of maternal and newborn health, largely attributed to the Countdown to 2015 initiative. This global effort meticulously tracked progress in reducing mortality rates and improving health outcomes for mothers, newborns, and children. As we reflect on these ten years, it becomes imperative to understand the achievements, challenges, and lessons that have shaped the current landscape of maternal and child survival tracking.

The Genesis of Countdown to 2015

Launched in 2005, the Countdown to 2015 was conceived as a response to the Millennium Development Goals (MDGs), specifically MDG 4 and MDG 5, which aimed to reduce child mortality and improve maternal health, respectively. Originating from a collaboration among over 40 academic, international, bilateral, and civil society institutions, the initiative sought to provide a robust mechanism for monitoring progress, fostering accountability, and highlighting successes in the health sector.

Key Achievements

Significant Reductions in Mortality Rates

One of the most noteworthy accomplishments of Countdown to 2015 was the substantial decrease in maternal and under-5 mortality rates across many high-burden countries. According to the final report released in 2015:

The global maternal mortality ratio dropped by approximately 45% over two decades, decreasing from around 523,000 annual deaths to 289,000.
The under-5 mortality rate saw a dramatic decline of 53%, falling from 91 deaths per 1,000 live births in 1990 to 43 per 1,000 live births in 2015.

Countries like Cambodia, Eritrea, Nepal, and Rwanda showcased exemplary progress, achieving both MDG 4 and MDG 5 by meeting the necessary annual reduction rates in mortality.

Enhanced Coverage of Life-Saving Interventions

Countdown’s focused tracking highlighted increased coverage of essential health interventions. These include:

Immunizations: Coverage for vaccines such as DTP3 and measles showed significant improvements, often exceeding 80% median coverage across monitored countries.
Malaria Prevention: Initiatives like insecticide-treated nets (ITNs) for children and intermittent preventive treatment during pregnancy (IPTp) saw growing adoption, although coverage remained suboptimal in some regions.
HIV Interventions: There was a notable rise in the prevention of mother-to-child transmission of HIV, reaching 53% in the most recent periods surveyed.

Policy Adoption and Health System Strengthening

Countdown facilitated the adoption of supportive health policies and the strengthening of health systems. By 2014, numerous countries had implemented key policies such as:

Maternity Protection: Ensuring maternity leave and employment protection during pregnancy and the postnatal period.
Breastfeeding Promotion: Adhering to the International Code of Marketing for Breastmilk Substitutes to encourage exclusive breastfeeding practices.

Additionally, investments in health information systems have improved data availability, enabling more precise tracking and informed decision-making.

Persistent Challenges and Inequalities

Despite the progress, several challenges remained:

Socioeconomic Inequities

Countdown’s analyses consistently revealed robust pro-rich inequalities in health intervention coverage. Disparities were especially pronounced in interventions requiring access to fixed health facilities, such as skilled birth attendance and antenatal care. While some narrowing of the coverage gap was observed, the rich-poor divide remained a significant barrier to universal health coverage.

Data Quality and Coverage Gaps

Accurate and timely data collection posed ongoing challenges. Many regions relied on modelled estimates rather than direct measurements, particularly for maternal mortality. Furthermore, discrepancies between reported service contacts and actual delivery of comprehensive care necessitated improved monitoring tools and methodologies.

Funding Shortfalls

Although official development assistance (ODA) for maternal, newborn, and child health (MNCH) tripled from 2003 to 2012, reaching $6 billion, the financial resources remained insufficient. The rising focus on newborn health was encouraging, yet the allocation did not fully match the immense need, especially given that neonatal causes accounted for nearly half of under-5 deaths.

Lessons Learned

Importance of Multistakeholder Collaboration

The success of Countdown to 2015 underscored the value of collaborative efforts among diverse stakeholders. Academic institutions, governments, NGOs, and civil society collectively contributed to a unified monitoring framework that enhanced accountability and drove policy improvements.

Need for Comprehensive Monitoring

Effective tracking of maternal and child survival requires a multifaceted approach, encompassing intervention coverage, health system capacity, policy environments, and financial flows. The composite coverage index (CCI), developed by Countdown, emerged as a reliable metric for assessing overall health service delivery and equity.

Sustainability and Future Directions

As the global health agenda transitions to the Sustainable Development Goals (SDGs), the Countdown experience offers critical insights. Emphasizing measurable targets, enhancing data collection systems, and maintaining focus on equity will be essential for sustaining progress and achieving long-term health outcomes.

Conclusion

The Countdown to 2015 initiative has been instrumental in advancing our understanding and improvement of maternal and newborn health worldwide. While significant progress has been made, particularly in reducing mortality rates and expanding intervention coverage, persistent challenges such as socioeconomic inequalities and funding gaps must be addressed to ensure continued advancement. The lessons gleaned from Countdown provide a valuable blueprint for future efforts in maternal and child survival tracking, guiding global health initiatives towards a healthier, more equitable world for mothers and children.

Call to Action

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