At least two-thirds of all annual maternal and child deaths worldwide occur in sub-Saharan Africa. Despite recent improvements, significant inequities persist across countries and regions and within countries. An initiative by the African Population and Health Research Centre, Countdown to 2030, seeks to accelerate coverage and access to reproductive, maternal, newborn, child, and adolescents’ health and nutrition services by providing evidence that informs decision making for policy, programming and financing. Cheikh Mbacke Faye explains.
Why the focus on maternal and child health?
There has been substantial progress in reducing maternal and child deaths globally. This is due to increased investment in good infrastructure, the use of vaccines and other factors. Between 1990 and 2015, maternal and under-five mortality declined by 44% and 58% respectively globally. But maternal mortality remains unacceptably high, especially in developing countries. At least two-thirds of all annual maternal and child deaths worldwide occur in sub-Saharan Africa.
How does the Countdown 2030 initiative hope to change this?
This initiative aims to equip country health data experts to provide deep analyses of inequalities from existing data sources such as the District Health Information System and the Demographic Health Surveys. Evidence like this should help improve equity in maternal and child health as stipulated in the Sustainable Development Goals. The overall aim is to reach all populations with essential health services of good quality.
The analysis aims to show the inequities by sub-national level, socioeconomic status and the rural-urban divide. When governments have evidence, they are better placed to develop policies and programmes that provide equitable coverage of effective health interventions for women, children and adolescents. The project is anchored on the use of evidence to promote increased coverage and access to reproductive, maternal, newborn, child, and adolescents’ health and nutrition services to all people.
For example, in Uganda, working with Makerere University School of Public Health, we did an analysis to understand the rate of under-five mortality in different regions of Uganda. The analysis identified the six regions in Uganda with the highest child mortality rates. This evidence was shared at a meeting in Kampala with stakeholders in government and civil society organisations to facilitate a discussion of health system challenges in these regions.
In addition, the initiative seeks to ensure that disadvantaged groups are not left behind. This is because inequities in access and coverage of reproductive health and nutrition services for these target groups persist. Knowing the inequities is the first step to identifying the challenges and how to address them.
How do you plan to bring change in just over a decade?
Strengthening the evidence base and country analytical capacity is key. Countries need to have the capacity to interrogate properly the health data that is collected. Investigating what the data means will lead to its use in informing targeted action to address maternal and child health challenges.
The initiative is, therefore, training health data specialists at country level. They are trained on which analyses to do, how to do them and how to share the evidence. As a result, it is expected that there will be more demand for evidence. On top of this, the institutions with data analysis capacity will be considered as technical partners of government. Other actors can provide evidence on a needs basis.
This evidence can inform decision making for policy, programming and financing. Already country analyses have revealed the disparities in the coverage between the poor and wealthy, those living in urban and rural areas, and other strata.
The initiative is also highlighting the data collected in interesting ways that are easy to read, understand and use. These include equity profiles, country profiles and dashboards that are accessible for free.
Related to this are technical analyses and support for countries to define priority areas and activities for their participation and funding through the Global Financing Facility. This brings together partners focusing on women, children and adolescents to agree on priorities and country-led plans to implement. It is a catalyst for domestic financing as country funding commitments are matched through Trust Fund grants by the World Bank.
The initiative collaborates with the facility at country level to ensure priorities are informed by evidence.
The other element is building national capacity for the collection, quality assessment, analysis and use of data related to their policies and programmes. For example, the initiative trains people in each country to collect, analyse and share the data in consistent and useful ways to inform decision making for women’s children and adolescents’ health.
Finally, the initiative will support decision makers, civil society representatives, governments and advocates with evidence for effective advocacy efforts.
What are the measures of success?
At the top level is the creation of global public tools like country profiles. They help the monitoring and measurement of coverage, quality and equity.
At the regional level, the initiative is enhancing cross-country learning and sharing of best practices. It is also enhancing regional networks and multi-country monitoring, learning and evaluation. This will make it easier for regions and countries to track their progress in enhancing equity in the health outcomes of women, children and adolescents.
At national level, strengthened country-led data analysis and generation of evidence can be used to inform decision making for policy and programming. This will mean that countries will have more relevant information to plan and make effective decisions to address health system challenges.
Finally, improved communication and use of evidence on progress and performance will make it easier for anyone to see what progress is being made in preventing maternal, child and adolescent deaths.