Ten countries, including Nepal and Bangladesh in South Asia, have dramatically reduced mother and child deaths within two decades despite social and political challenges.
Action in just these 10 "fast-track" countries - Bangladesh, Cambodia, China, Egypt, Ethiopia, Lao PDR, Nepal, Peru, Rwanda and Vietnam – prevented 2.4 million child deaths and over 70,000 fewer maternal deaths between 1990 and 2013.
Just how these countries used data and evidence to improve healthcare delivery and save lives is documented in the report, 'Success Factors for Women’s and Children’s Health', which was released on Monday at the Partners’ Forum in Johannesburg.
Though India does not find place in the Success Factors study, it has registered some gains, bringing down infant deaths to 44/1,000 live births, from 47 in 2010 and 50 in 2009.
India is not moving fast enough to save mothers, though, with maternal deaths staying a high 212/100,000 live births, according to the Sample Registration System (SRS) data for 2007-09.
"While every country has its own challenges, sustained political will and vision, evidence-based, high-impact investments, and strong partnerships across society save lives. A better understanding of how some countries have been able to prevent maternal and child deaths can offer strategies to accelerate progress for women’s and children’s health worldwide," said Dr Carole Presern, Executive Director, Maternal, Newborn and Child Health (PMNCH).
Though mix of strategies and investments used to reduce mother and child deaths differed to meet local context and priorities across the 10 countries, some common approaches shared by all fast-track countries included high-impact health interventions such as quality care at birth, immunisation and family planning.
Simultaneously, prioritising education, women’s political and economic participation, and access to clean water and sanitation accelerated access to healthcare in all countries, as did economic development and good governance, including control of corruption.
In Bangladesh, for example, mobile technology was used to digitalise birth registration, taking it up from 10% in 2006 to over 50% in 2013.
"The government now has more updated and reliable data, and can better track who and where services are needed for more efficient delivery. The implications go beyond the health sector too – these children now have an identity and rights," says Dr Flavia Bustreo, WHO Assistant Director General.
The Success Factors study, a collaboration between Partnership for PMNCH, World Bank, World Health Organisation (WHO) and Alliance for Health Policy and Systems Research, said all 10 countries are set to meet Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health).
Best performers (Listed alphabetically)
Bangladesh: Reduced under-5 deaths by 65% and maternal deaths by 66% by providing immunisation, oral rehydration therapy to treat diarrhoea, and family planning services, particularly in underserved areas. Improved education for girls, road networks and access to information and communication technology.
Cambodia: 75% reduction in maternal deaths and 57% reduction in child deaths between 1990 and 2010 by improving immunisation, early and exclusive breastfeeding and innovative use of mass media, including using popular TV soap operas to promote exclusive breast feeding.
China: Lowered under-5 deaths by 80% and maternal deaths by close to 80% through improved coverage by training more than 3 lakh (300,000) community workers to become general practitioners.
Egypt: Lowered under-5 deaths by 75% and maternal deaths by 69% through high-impact services such as family planning and immunisation, increasing youth literacy rate from 73% in 1996 to 86% in 2007), and improving and an access to clean water and sanitation.
Ethiopia: Registered a 47% drop in under-5 deaths since 2000 through immunisation, quality care at birth and improved socioeconomic conditions, including roads, drinking water and sanitation, and increasing access to primary and secondary education. Ethiopia, however, still has one of the highest maternal death rates in the world at 676 deaths/100000 live births.
Lao PDR: Lowered under-5 child death rates by 56% and maternal deaths fell by 6.8% annually between 1990 and 2013 by improving immunisation coverage, malaria prevention and treatment, birth spacing, early and exclusive breastfeeding and improved socioeconomic conditions.
Nepal: Achieved a 66% reduction in child mortality and an 80% reduction in maternal deaths by increasing skilled birth-attendance at health facilities and in the community, and strong political will.
Peru: 70% reduction in child deaths and a 65% reduction in maternal deaths between 1991 and 2013 by addressing cultural and geographical barriers that prevented people from accessing healthcare.
Rwanda: Halved child deaths between 1992 and 2010 and lowered maternal death rates by 22%, from 611/1 lakh 100,000) live births to 476. From an increase in MMR to 1,071 in 2000, the period 2000 and 2010 saw a reduction of 55%. These gains were achieved by addressing a shortage health workers and improving infrastructure.
Vietnam: Reduced under-5 mortality by 60%, and lowered maternal deaths by 70% through increased access to immunisation, child survival and nutrition interventions as well contraceptive use and skilled birth-attendance for deliveries.
10 worst performers (Ranked, with the worst at the top)
Democratic Republic of Congo
Central African Republic