Academic journal article Bulletin of the World Health Organization

Cross-Country Analysis of Strategies for Achieving Progress towards Global Goals for Women's and Children's health/Analyse Transnationale Des Strategies Pour Accomplir Des Progres En Vue Des Objectifs Mondiaux Pour la Sante De la Femme et De l'enfant/Analisis Transnacionales De Las Estrategias De Progreso Hacia Objetivos Mundiales Para la Salud De Las Mujeres Y Los Ninos

Academic journal article Bulletin of the World Health Organization

Cross-Country Analysis of Strategies for Achieving Progress towards Global Goals for Women's and Children's health/Analyse Transnationale Des Strategies Pour Accomplir Des Progres En Vue Des Objectifs Mondiaux Pour la Sante De la Femme et De l'enfant/Analisis Transnacionales De Las Estrategias De Progreso Hacia Objetivos Mundiales Para la Salud De Las Mujeres Y Los Ninos

Article excerpt

Introduction

Between 1990 and 2015, during the era of the millennium development goals (MDGs), there was unprecedented global progress towards reducing both child and maternal mortality by around 50%. (1,2) Progress was uneven, however, between and within countries. Of the 95 countries with maternal mortality ratios above 100 deaths per 100000 live births in 1990, nine countries achieved MDG 5A to reduce maternal mortality by three quarters. Only 24 out of 104 low- and middle-income countries met the MDG 4 target of a two-thirds reduction in the under-five mortality rate between 1990 and 2015. (3,4) To understand why some countries did better than other comparable countries in preventing maternal and child deaths, a three-year multidisciplinary, multi-country series of studies on success factors for women's and children's health, referred to as the Success Factors studies, was undertaken. (4)

Among the 75 highest-burden countries flagged up by the Countdown to 2015 initiative, (3) 10 low- and middle-income countries were on track to achieve both MDGs 4 and 5A when the Success Factors studies started in 2012: Bangladesh, Cambodia, China, Egypt, Ethiopia, the Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. (5) Focusing on what contributed to the higher reduction of maternal and child mortality rates in these countries, the studies identified an integrated set of high-impact factors in the health sector and sectors outside health, underpinned by strong country leadership, collaboration between different stakeholders and economic development. (5) Statistical, econometric and policy analyses showed that these countries were not only progressing faster on mortality reductions, but were also performing significantly better than comparable countries on the identified success factors. (5)

Based on the initial analyses of success factors, we conducted a series of multistakeholder dialogues in the 10 fast-track countries to identify how these countries designed and implemented policies and programmes in the areas identified as success factors. This paper presents a synthesis of the multistakeholder dialogue findings across the countries. These findings informed the development of the Global strategy for womens, childrens and adolescents' health (2016-2030) (6) and could inform country policies and programmes to help accelerate progress towards meeting the sustainable development goals (SDGs).

Methods

The first part of the success factors studies comprised comparative analyses of data from 144 low- and middle-income countries over 20 years and a literature review of countries' progress in reducing maternal and child mortality during the MDG period, as described before. (4,5) Subsequently, between 2014 and 2015, country policy reports were developed through multistakeholder dialogues in the 10 fast-track countries identified in the Success Factors studies. (4) A multistakeholder dialogue is a structured, facilitated process that brings stakeholders together to develop a shared understanding of issues and evidence and to develop plans of action. In total, 407 stakeholders (representatives of government, academia, civil society, private sector, multilateral and other development partner organizations) across the 10 countries took part in the dialogues. Each dialogue was conducted in three phases: (i) preparation and review of literature and data; (ii) discussion meetings, usually over two days, supplemented in some cases by one-to-one interviews and additional meetings; and (iii) validation and preparation of country reports and dissemination of findings. The methods for the multistakeholder dialogues are described in more detail elsewhere. (7) Ethics approval for the Success Factors studies was obtained from the World Health Organization (WHO) Ethics Review Committee (reference RPC528), and participants in the dialogues gave consent to be interviewed for the analysis. …

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