Countdown to 2015 Decade Report by nyut545e2

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									Countdown to 2015 Decade Report
Taking stock of maternal, newborn and child survival

Countdown collects and analyses data from the 68
countries that account for at least 95% of maternal and
child deaths. It produces country profiles that present        Key findings
coverage data for a range of key health services, including:
•	 Contraceptive use.                                          The 2010 Countdown
•	 Antenatal care.                                             Decade Report concludes
•	 Skilled attendance at delivery.                             that achieving MDGs 4 and 5 is
•	 Postnatal care.                                             still possible by the deadline year 2015,
•	 Child health.                                               but only a dramatic acceleration of political commitment
•	 Financial investments in maternal, newborn and              and financial investment can make it happen.
   child health.
•	 Equity of access, health systems and policy.                There is good news. Many countries are making
                                                               progress, reducing mortality and increasing coverage of
The 2010 report reviews progress over 2000–2010.               effective health interventions at an accelerating pace.

                                                               But the news is not all good. Many Countdown countries
                                                               are still off track for achieving MDGs 4 and 5 and are not
  The 68 Countdown Priority countries                          increasing coverage of key health interventions quickly
                                                               enough. Countdown countries in Sub-Saharan Africa
                                                               are especially far behind, although a few have shown
                                                               improvements.

                                                               The vast majority of maternal and child deaths are
                                                               preventable. But unacceptably large numbers of women,
                                                               newborns and children are still dying each year in
                                                               Countdown countries.

                                                               Key findings in the 2010 Decade Report are listed on the
                                                               reverse.



                                                                 Sample country profile


The Countdown initiative                                              DEMOGRAPHICS
                                                                      Total population
                                                                      Total under-five population
                                                                                                                  160,000
                                                                                                                   16,710
                                                                                                                                               Bangladesh
                                                                                                                                  Under-five mortality rate                             Causes of under-five deaths, 2008
                                                                                                                                                                                                                                              MATERNAL AND NEWBORN HEALTH

                                                                                                                                                                                                                                              Adolescent birth rate                                  133
                                                                                                                                                                                                                                                                                                                 Causes of maternal deaths                                 Coverage along the continuum of care

                                                                      Births                                        3,430
                                                                                                                                   150                                                                                                        Unmet need for family planning ( )                      17
                                                                      Birth registration                              10
                                                                                                                      54                                                                                                                      Antenatal visits for woman                              21
                                                                      Under-five mortality rate                                    120
                                                                      Infant mortality rate                           43                                                                Diarrhoea                                             Intermittent preventive treatment for malaria          NA*
                                                                                                                                    90
                                                                      Neonatal mortality rate                         33




Countdown to 2015: Tracking Progress in Maternal,
                                                                                                                                                                                                                                              C-section rate
                                                                      Total under-five deaths                        183            60                                                                                                                                                         8, 16, 5
                                                                      Maternal mortality ratio                       570            30                                                                                                        Early initiation of breastfeeding                       43
                                                                      Lifetime risk of maternal death                 51
                                                                                                                                     0                                                                                                        Postnatal visit for baby                                19
                                                                      Total maternal deaths                        21,000            1990     1995     2000   2005   2010        2015                                                                                                                                                                                                       0     20   40    60     80 100




Newborn and Child Survival was founded on a
                                                                                                                                                                                                                                               Antenatal care                                                    Skilled attendant at delivery                             Neonatal tetanus protection
                                                                      INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN
                                                                      NUTRITION
                                                                      Stunting prevalence                              43        Complementary feeding rate                 74                                                                    100                                                             100                                                       100
                                                                      Wasting prevalence                               17        Low birthweight incidence                  22                                                                     80                                                              80                                                        80




commitment by academics, governments, international
                                                                       Underweight prevalence                                     Exclusive breastfeeding                               Vitamin A supplementation                                  60                                                              60                                                        60

                                                                                                                                                                                                                                                   40                                                              40                                                        40

                                                                        100                                                        100                                                   100                                                       20                                                              20                                                       20

                                                                         80                                                         80                                                    80                                                         0                                                               0                                                       0




agencies, health care professional associations, donors
                                                                                                                                                                                                                                                                                                                                                                             1990               1995         2000            2005   2008
                                                                         60                                                         60                                                    60

                                                                         40                                                         40                                                    40

                                                                         20                                                         20                                                    20                                                   WATER AND SANITATION                                                                                                        EQUITY
                                                                          0                                                          0                                                     0
                                                                                           2004               2007                                                                         2005            2006          2007          2008    Water                                                             Sanitation                                                Coverage gap by wealth quintile




and nongovernmental organizations to work together                    CHILD HEALTH
                                                                       Immunization                                               Malaria prevention                                    Prevention of mother to child
                                                                                                                                                                                        transmission of HIV
                                                                                                                                                                                                                                                 100

                                                                                                                                                                                                                                                  80

                                                                                                                                                                                                                                                  60
                                                                                                                                                                                                                                                                                                                  100

                                                                                                                                                                                                                                                                                                                   80

                                                                                                                                                                                                                                                                                                                   60
                                                                                                                                                                                                                                                                                                                                                                            100

                                                                                                                                                                                                                                                                                                                                                                             80

                                                                                                                                                                                                                                                                                                                                                                             60




towards achieving Millennium Development Goals
                                                                                                                                                                                                                                                  40                                                               40                                                        40

                                                                                                                                                                                                                                                  20                                                               20                                                        20
                                                                        100                                                                                                               25
                                                                                                                                                                                                                                                    0                                                                0                                                        0
                                                                         80                                                                                                               20                                                                      1990                        2008                                1990                        2008                Poorest        2nd        3rd      4th     Wealthiest

                                                                         60                                                                                                               15




(MDGs) 4 and 5.
                                                                         40                                                                                                               10                                                   POLICIES                                                          SYSTEMS
                                                                         20                                                                                                                5
                                                                                                                                                                                                                                               International Code of Marketing of Breastmilk                     Financial Flows and Human Resources
                                                                          0                                                                                                                0                                                   Substitutes                                             Partial
                                                                           1990          1994     1998     2002      2006 2008                                                                      2006          2007          2008                                                                             Per capita total expenditure on health              42
                                                                                                                                                                                                                                               New ORS formula and zinc for management of
                                                                                                                                                                                                                                                                                                                 General government expenditure on health as
                                                                                                                                                                                                                                               diarrhoea                                                   Yes
                                                                                                                                                                                                                                                                                                                 % of total government expenditure                    8
                                                                       Diarrhoeal disease treatment                               Malaria treatment                                     Pneumonia treatment
                                                                                                                                                                                                                                               Community treatment of pneumonia with antibiotics           Yes   Out-of-pocket expenditure as % of total
                                                                                                                                                                                                                                                                                                                 expenditure on health                               65
                                                                                                                                                                                                                                               IMCI adapted to cover newborns 0-1 week of age              Yes
                                                                                                                                                                                                                                                                                                                 Density of health workers                           5.8
                                                                        100                                                                                                              100                                                   Costed implementation plan(s) for maternal,
                                                                                                                                                                                                                                               newborn and child health available                      Partial   Official Development Assistance to child health
                                                                         80                                                                                                               80                                                                                                                     per child                                            3




Countdown adds value by forging a clear, evidence-
                                                                                                                                                                                                                                               Midwives be authorised to administer a core set of
                                                                         60                                                                                                               60                                                   life saving interventions                               Partial   Official Development Assistance to maternal and
                                                                                                                                                                                                                                                                                                                 neonatal health per live birth                       8                           Bangladesh
                                                                         40                                                                                                               40                                                   Maternity protection in accordance with ILO
                                                                                                                                                                                                                                               Convention 183                                              No    National availability of Emergency Obstetric Care
                                                                         20                                                                                                               20                                                                                                                     services                                            ---
                                                                                                                                                                                                                                               Specific notification of maternal deaths                Partial
                                                                          0                                                                                                                0
                                                                                                                                                                                                                                                                                                                                                                                                       Countdown to 2015



based consensus on priority interventions and coverage
                                                                                    2004            2006             2007
                                                                                                                                                                                                                                                                                                                                                                                                                      2010 Report




indicators for maternal, newborn and child health and
by providing a mechanism for holding countries and
their partners accountable for results. Countdown also
addresses MDG 1 (eradicate poverty and hunger), MDG 6
(combat HIV/AIDS, malaria and other diseases) and
MDG 7 (ensure environmental sustainability).
                                Countdown headlines for 2010
Survival status                                                                                                                                                                               within countries represent a missed                                                                                                                                                                          Action now
                                                                                                                                                                                              opportunity to improve the health
Millennium Development Goal 4—                                                                                                                                                                of women and young children.                                                                                                                                                                                 Partners must work together now to
reduce child mortality                                                                                                                                                                                                                                                                                                                                                                                     increase their efforts and resources,
•	 19 of the 68 Countdown countries                                                                                                                                              Health systems and policies                                                                                                                                                                                               focusing not just on one intervention
   are on track to achieve MDG 4.                                                                                                                                                •	 53 of the 68 Countdown countries                                                                                                                                                                                       or cause but on developing a
•	 Globally 8.8 million children each                                                                                                                                               are experiencing acute shortages of                                                                                                                                                                                    functional continuum of basic services
   year die before their fifth birthday,                                                                                                                                            doctors, nurses and midwives.                                                                                                                                                                                          that save lives and improve health
   more than 40% of them during their                                                                                                                                            •	 Poorly functioning health                                                                                                                                                                                              for millions of women, newborns and
   first four weeks of life.                                                                                                                                                        infrastructure, inadequate numbers                                                                                                                                                                                     children. There is still time. This report
•	 At least two-thirds of all child deaths                                                                                                                                          of health workers, slow adoption of                                                                                                                                                                                    shows that, by investing our attention
   are preventable, with pneumonia                                                                                                                                                  evidence-based health policies and                                                                                                                                                                                     and our financial resources, so much
   and diarrhoea as the largest killers                                                                                                                                             insufficient focus on quality of care                                                                                                                                                                                  more is possible.
   of children after the newborn                                                                                                                                                    are holding back progress in many
   period; undernutrition contributes to                                                                                                                                            countries.                                                                                                                                                                                                             All countries should:
   more than 1 in 3 child deaths.                                                                                                                                                •	 Countries should aggressively                                                                                                                                                                                          •	 Identify gaps in coverage and
                                                                                                                                                                                    pursue policies to make health                                                                                                                                                                                            quality of care along the continuum
Millennium Development Goal 5—                                                                                                                                                      services available and affordable                                                                                                                                                                                         of care for maternal, newborn and
improve maternal health                                                                                                                                                             for all by making services free at                                                                                                                                                                                        child health.
•	 New studies suggest that some                                                                                                                                                    point of delivery and exploring                                                                                                                                                                                        •	 Improve the delivery of essential
   progress is being made on reducing                                                                                                                                               innovative financing strategies.                                                                                                                                                                                          interventions and packages.
   maternal mortality, but globally                                                                                                                                                                                                                                                                                                                                                                        •	 Identify inequities in coverage.
   and in most Countdown countries,                                                                                                                                              Closing the equity gap                                                                                                                                                                                                    •	 Increase resource allocations for
   progress is not sufficient to achieve                                                                                                                                         •	 Some Countdown countries                                                                                                                                                                                                  reproductive, maternal, newborn
   MDG 5.                                                                                                                                                                           are doing better at reaching the                                                                                                                                                                                          and child health services, ensuring
•	 An unacceptable number of women                                                                                                                                                  most disadvantaged women and                                                                                                                                                                                              that interventions and programmes
   die in pregnancy and childbirth                                                                                                                                                  children, but profound inequities in                                                                                                                                                                                      are sufficiently funded.
   each year. For every woman who                                                                                                                                                   coverage and health outcomes—
   dies, at least 20 others suffer                                                                                                                                                  both between and within                                                                                                                                                                                                Other Countdown partners should
   injuries, infection and disability.                                                                                                                                              countries—must be confronted and                                                                                                                                                                                       work together with countries to:
•	 Almost all maternal deaths are                                                                                                                                                   overcome.                                                                                                                                                                                                              •	 Advocate for increased funding
   preventable.                                                                                                                                                                  •	 The poor and excluded: high                                                                                                                                                                                               for reproductive and maternal,
                                                                                                                                                                                    national coverage levels do                                                                                                                                                                                               newborn and child health.
Coverage gains and gaps                                                                                                                                                             not always indicate progress in                                                                                                                                                                                        •	 Support country efforts to improve
•	 Progress on coverage of lifesaving                                                                                                                                               reaching the poorest and most                                                                                                                                                                                             data collection and analysis.
   interventions across the continuum                                                                                                                                               vulnerable women and children.                                                                                                                                                                                         •	 Invest in implementation research.
   of care is uneven.                                                                                                                                                                                                                                                                                                                                                                                      •	 Maximize financial and
•	 Skilled care during childbirth,                                                                                                                                               Closing the funding gap                                                                                                                                                                                                      technical support for large-
   including emergency care for                                                                                                                                                  •	 Funding is increasing for maternal                                                                                                                                                                                        scale implementation of priority
   mothers and newborns, is critical:                                                                                                                                               and child health, but at too slow                                                                                                                                                                                         strategies and interventions.
   about 2 million lives a year are lost                                                                                                                                            a pace, and funding for family                                                                                                                                                                                         •	 Encourage accountability of key
   to complications occurring during                                                                                                                                                planning has declined.                                                                                                                                                                                                    actors to keep their promises.
   labour and delivery.                                                                                                                                                          •	 Official development assistance is
•	 Wide disparities in coverage of                                                                                                                                                  not always targeted to countries                                                                                                                                                                                       New Countdown results
   family planning services across and                                                                                                                                              with the greatest need.                                                                                                                                                                                                are expected in 2011.

        Median national coverage of interventions across the continuum of care for 20 Countdown interventions and approaches in Countdown countries,
        most recent year since 2000 (%)

        100
             Pre-                                              Pregnancy                                                                           Birth                                     Postnatal                                                                                                Infancy                                                                                                                                                       Childhood
          pregnancy

         75



         50



         25



          0
                Contraceptive
              prevalence rate


                                       At least four
                                antenatal care visits


                                                        Prevention of mother-
                                                         to-child transmission


                                                                                 Intermittent preventive treatment
                                                                                    of malaria for pregnant women


                                                                                                                     Neonatal tetanus protection



                                                                                                                                                    Skilled attendant at birth



                                                                                                                                                                                  Postnatal visit for mother



                                                                                                                                                                                                               Early initiation of breastfeeding


                                                                                                                                                                                                                                                    Exclusive breastfeeding
                                                                                                                                                                                                                                                   (less than age 6 months)


                                                                                                                                                                                                                                                                              Complementary feeding
                                                                                                                                                                                                                                                                                   (age 6–9 months)


                                                                                                                                                                                                                                                                                                        Measles immunization



                                                                                                                                                                                                                                                                                                                               DPT3 immunization


                                                                                                                                                                                                                                                                                                                                                   Vitamin A supplementation
                                                                                                                                                                                                                                                                                                                                                                  (two doses)


                                                                                                                                                                                                                                                                                                                                                                                Children sleeping under
                                                                                                                                                                                                                                                                                                                                                                                insecticide-treated nets


                                                                                                                                                                                                                                                                                                                                                                                                            Careseeking for pneumonia



                                                                                                                                                                                                                                                                                                                                                                                                                                        Antibiotics for pneumonia



                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Malaria treatment



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Diarrhoea treatment



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Improved sanitation facilities



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improved drinking water

								
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