“Success factors” for reducing maternal and child mortality: why some LMIC countries did better than others?

Despite spectacular progress in reducing child (MDG 4) and maternal deaths (MDG 5) the world over in recent times (both reduced by 47% from 1990 to 2012), every year, approximately 6.6 million children under the age of five die (44% as newborns) and there are more than 287 000 maternal deaths, all from mainly preventable causes. It is therefore, imperative to accelerate the process to achieve MDG 4 and 5 goals.

The reduction in mortality hasn’t been consistent in the 75 ‘high burden’ LMICs, even where levels of income and initial mortality burden were similar. Some of the countries did better than others. To understand what works and what doesn’t including strategies adopted countries would help other countries to accelerate their progress towards achieving MDG 4 and 5 goals.

The Partnership for Maternal, Neonatal and Child Health (PMNCH) initiated “The Success Factors Study for Women’s and Children’s Health” to examine why some countries achieved faster rates of progress. This was a three year multi-country, multi-disciplinary study conducted in partnership with the World Health Organization, the World Bank and the Alliance for Health Policy and Systems Research, in collaboration with Johns Hopkins University, University of St Gallen, BRAC Institute of Global Health, and the London School of Hygiene and Tropical Medicine.

The study  included 144 LMICs as per World Bank definition in 1990 (the baseline year for the MDGs) and which had complete GDP data till 2010. For country-specific reviews, 10 “fast-track” (because they were on track in 2012 to achieve MDGs 4 and 5 ahead of comparable countries) countries were selected: Bangladesh; Cambodia; China; Egypt; Ethiopia; Lao PDR; Nepal; Peru; Rwanda; and Vietnam.

The study finds that the fast-track countries outperformed other low- and middle-income countries in three areas: i) progress not only in the health sector, but also in related health-enhancing areas such as education, nutrition, water and sanitation; ii) optimising health strategies to maximising outcomes; iii) and use principles to guide policies, align action and achieve results. Thus, “there is no exact formula for success as fast-track countries deploy strategies tailored to their unique context, challenges and strengths”.

The study identified some ‘necessary and sufficient’ conditions which made the fast-track countries to move forward faster than others: a well functioning health system, enabling population dynamics, environmental management, economic development, ensuring education, women’s empowerment, equity. This study contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond.

Source: Success factors for Women’s and Children’s health: Multisector action accelerates country progress (forthcoming in Bulletin of WHO)