Countdown Principles

Countdown’s activities are guided by five principles:

1. Focus on coverage

Timely data on intervention coverage are essential for good program management. Governments and their partners need up-to-date information on whether their programs are reaching targeted groups. Such coverage information must be supplemented with measures of intervention quality and effectiveness.

For interventions proven to reduce mortality, coverage is a useful indicator of progress. Increases in coverage show that policies and delivery strategies are reaching women and children. Failures to increase coverage — assuming that resources have been adequate and that planning has been good — are a cause for urgent concern. District, regional, and national managers and their partners should address low coverage rates by examining how interventions are delivered and removing bottlenecks or revising service delivery plans.

Countdown reports and country profiles provide the best and most recent information on country-level progress in achieving intervention coverage, and offer a basis for documenting accomplishments and revitalizing efforts where needed.

The CD2030 carries out analyses of data on intervention coverage and is expanding its work to include “effective coverage” which measures the quality of those services and the care that women, children and adolescents experience.

2. Focus on equity

Since its first report, Countdown has provided original analyses of inequalities of intervention coverage by wealth, sex of the child, place of residence and other social determinants. These analyses consistently show systematic pro-rich inequalities for virtually all coverage indicators. The gaps are wider for interventions that require access to fixed health facilities or repeat contacts with a health provider (such as four or more antenatal care visits and skilled attendance at birth) than for interventions that can be delivered through outreach strategies at the community level (such as immunization). The countries that have made rapid progress in coverage are those that have effectively reached the poorest families.

Data availability for equity analyses has improved, but much scope for progress remains. Repeated surveys using consistent measurement of equity stratifiers, such as wealth, gender, residence or ethnicity, are required to identify priority groups and track subnational progress over time.

Improving equity will be essential for achieving the Sustainable Development Goals by 2030. CD2030 aims to promote increased coverage levels for populations as a whole, ensuring that disadvantaged groups are not left behind.

The CD2030 Equity Technical Working Group carries out analyses of survey results from the 81 priority Countdown countries, and provides breakdowns of key reproductive, maternal, newborn, child and adolescent health indicators, including nutrition, according to different dimensions of equity. Countdown equity analyses include systematic breakdowns of key coverage indicators by wealth quintiles, woman’s education, woman’s age, sex of the child, urban/rural residence, and region of the country. The technical working group is also preparing analyses where feasible on ethnicity, migration, wealth deciles, disability and double disaggregation (i.e., involving two stratifiers such as the urban poor).

3. Build on existing goals and monitoring efforts

Countdown aims to sharpen and reinforce efforts already under way to support countries in meeting their commitments to global goals, and to further the effective use of information collected through existing monitoring mechanisms. Emphasis on measuring progress towards international goals and targets has rapidly increased the availability of intervention coverage data. Today’s maternal, newborn, child, adolescent and nutrition indicators reflect a united effort to define and measure indicators consistently, permitting the assessment of trends over time.

Countdown tracking complements and promotes country-level monitoring of women’s, children’s and adolescents’ health programs. Country-level monitoring focuses on ensuring that policies, plans and resources are in place, and that programs and strategies are implemented fully and adequately. Key outcomes for assessing program implementation include access, quality, coverage, and equity. Methods and indicators for monitoring purposes must provide timely information and must reflect country-level needs and decisions. Countdown aims to build on country-level data, attracting attention and resources for addressing service delivery barriers and to accelerate progress towards the health-related Sustainable Development Goals, particularly the goal of universal health coverage for RMNCH&N.

Countdown complements country-level monitoring efforts by focusing on indicators that are closer to impact and that can be measured in ways that permit cross-country comparisons and the estimation of global trends. Coverage indicators meet these criteria, as do many indicators of the impact of program activities on the nutrition and health status of women, newborns, children and adolescents. Efforts to identify and define indicators of policies, financial flows, and other drivers of intervention coverage that are sufficiently valid and reliable for global monitoring began in 2005 and continue in CD2030 through the work of the Coverage, Equity and Drivers Technical Working Groups.

4. Promote effective interventions

Countdown monitors coverage for interventions and approaches feasible for broad implementation in priority countries, and with proven effectiveness in improving maternal, newborn, child and adolescent health and nutrition.

5. Maintain a country and regional orientation

Countdown aims to help countries and their development partners achieve the health related goals and targets in the Sustainable Development Goal framework. A primary objective for CD2030 is building the sustainable capacity and competency of in-country researchers to conduct country-specific and multi-country research and analysis. CD2030 promotes in-country and regional research through its case studies, secondary analyses, and peer-reviewed publications.

While Countdown will not and should not supplant governments and their partners in their roles as policy makers and service providers, its role extends beyond monitoring — making public health science a basis for public health action. By bringing together diverse individuals with complementary experience, Countdown participants aim to spark and support new insights and concrete directions for improving the health and survival of women, newborns, children and adolescents.