22 September 2012
There is a growing sense of urgency that some of the poorest countries in the world will not reach 2015 targets for reproductive, maternal, neonatal, and child survival. The Lancet marked the 67th UN General Assembly meeting by publishing a series of new Countdown papers…
22 September 2012
At the opening of the 67th meeting of the United Nations General Assembly (UNGA), there was a growing sense of urgency that some of the poorest countries in the world will not reach their 2015 Millenium Development Goal (MDG) targets for reproductive health and maternal, neonatal, and child survival. The Lancet marked the convening of the UNGA by published a series of new Countdown papers that highlight how development aid is stalling; offer good news from Niger, where child mortality is substantially decreasing, and provide new data and analysis on equity of coverage for key MNCH interventions.
The article on official development aid (ODA) flows for MNCH reports that donor disbursements for maternal, newborn, and child health activities have substantially increased since 2003, but that they decreased slightly — the first decline since Countdown began tracking aid flows — between 2009 and 2010. This recent slowdown, and a longer-term slowing in the rate of funding increases, is worrying, and likely to partly result from the global financial crisis. Countdown authors noted the importance of continuing to track donor aid, in order to encourage accountability and to monitor performance in targeting aid flows to those in most need.
The Niger case study, led by a team of researchers including Agbessi Amouzou, PhD, of Johns Hopkins University, shows far greater reductions in child mortality in Niger than in its neighboring West African countries, with under-5 mortality rates dropping from 226 per 1,000 births in 1995 to 128 in 2009. Wasting declined by about half, mostly in children under two. During the same period, coverage for most child survival interventions increased. In 2009, an estimated 56,000 children under five were saved, 25 percent attributable to the introduction of bed nets treated with insecticides against mosquitoes which carry malaria; 22 percent to the correct care and treatment of diarrhea, malaria and pneumonia; 19 percent to better nutrition; 9 percent to vitamin A supplementation; and 12 percent to vaccination.
Government policies supporting free care for children and pregnant women, and decentralized nutrition programs have also been key to Niger’s success. The study provides invaluable evidence for other low-income countries as to how child health can be improved in a comparatively short space of time, at relatively low cost. According to Dr. Amouzou, “This study codifies, for the first time, policies, programmatic strategies, and what was actually done on the ground in Niger to achieve the dramatic reductions in child mortality and wasting that we’ve seen there in the last 10 years.”
The final Countdown paper published in this special Lancet issue discusses the ways in which changes in coverage for key maternal and child health interventions affect the equity of that coverage, based on analysis of national surveys from 35 Countdown countries. This equity study noted that pro-rich inequalities were very prevalent, and noted a number of interventions for which an increase in coverage in recent years coincided with a decrease in the coverage gaps between rich and poor. Rapid changes in overall coverage were therefore associated with improved equity. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles of the population. Equity should be accounted for, the authors conclude, when planning the scale-up of interventions and when assessing national progress.
Photo credits Adam Stoltman