What do ‘high-performing’ countries have in common in making progress

on women’s and children’s health?

Dr. Shyama Kuruvilla, Senior Technical Officer Partnership for Maternal, Newborn & Child Health

Accountability session, 22nd September 2013, New York

STUDY OVERVIEW

What ‘works’ in reducing maternal and child mortality?

• We know about U5MR and MMR estimates, the leading causes

of deaths, and effective interventions

• We know less about why some countries are better than others

at preventing maternal and child deaths

• We set out to identify key drivers of mortality reduction and

related strategies used by ‘high-performing’ countries

• We needed different methods: econometrics for 144 countries;

policy analysis for 10 countries; and evidence synthesis

• Study partners: PMNCH, WHO, WB, USAID, AHPSR, JHSPH,

LSHTM, UStG, GloHI, CEPA, Mamaye-E4A

1

Identifying policy packages that work

• Through a literature review and statistical modeling of data across 144 low and middle-income countries, we identified a set of policy packages that together could accelerate progress

• These policy packages did not come from the health sector alone

2

An integrated set of 11 policy packages used to estimate improved MDGs 4 & 5 progress

3

HEALTH SECTOR POLICY PACKAGES

MULTI-SECTOR POLICY PACKAGES

Health financing Education & gender equality

Human resources for health Environmental management

Service delivery/ technologies Urban planning

Functioning health systems Rural infrastructure

Population/ demographics Inclusive economic development

Good governance, including control of corruption

Source: Cohen et al. Forthcoming.

Key drivers of U5MR and MMR decline

• Within the 11 policy packages we assessed different drivers of maternal and child mortality reduction

• For example, the 5 key drivers of U5MR decline are:

Key Drivers of U5MR Decline Percent of U5MR Decline Attributable to Changes in Driver

Higher Odds of Having Clean Water

26%

Higher Vaccination Coverage 20%

Higher GDP per Capita 17%

Lower Total Fertility Rate 14%

Higher Girls’ School Enrollment 11%

4 Source: Bishai et al. Forthcoming.

What difference would better performance on this set of policy packages have made?

• We first set Minimum Performance targets for each country based on current trajectories for mortality reduction and GDP

• We then set High Performance targets, based on best-performing regional neighbors for the set of policy packages

• Between 2000 and 2010, in 144 countries, we estimate that High performance on the set of policy packages, compared to Minimum performance, could have been averted:

5 Source: Cohen et al. Forthcoming.

656,000 maternal deaths 6.8 million under-5 deaths

10 countries that have accelerated progress

6 Source: Success Factors booklet.

PMNCH, Mamaye. September 2013.

4 lessons from ‘high-performing’ countries

These countries have much to admire in each other:

1. Political commitment overcomes challenges

2. Evidence guides policy and investment

3. Sustainable development accelerates progress

4. Effective partnerships achieve goals

7

Lesson 1: Political commitment overcomes challenges

8

Lesson 2: Evidence guides policy and investment

9

Lesson 3: Sustainable development accelerates progress

Countries that are improving the health of women and children are also making

progress in achieving other MDGs:

10

Lesson 4: Effective partnerships achieve goals

11

In Nepal, pooled donor funding and community

ownership of health services helped ensure a continuum of care for

women and children even during the war.

In Rwanda’s decentralized health system, domestic

and external partners are required to align to the

government’s legislation, policies and strategies to

help deliver equitable, efficient health services.

For more information: www.who.int/pmnch/knowledge/publications/successfactors/en/

Understanding what works is critical as we embark on the approach to 2015