1

Successes&in&

Improving&Health&

Outcomes:&

Countdown(Country(Case(Studies

Professor&Zulfiqar&A.&Bhu?a&

Co#chair,*Countdown(to(2015(26*September*2015*

Accountability(in(the(Post(2015(Era&

2

1.  Individuals: scientists/academics, policymakers, public health workers, communications experts, teachers…

2.  Governments: RMNCH policymakers, members of Parliament…

3.  Organizations: NGOs, UN agencies, HCPAs, donors, medical journals…

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Who&is&Countdown?&

3

75*countries*that*together*account*for*>*95%*of*maternal*and*child*deaths*worldwide*

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!  To*disseminate*the*best*and*most*recent*informaCon*on*country#level*progress**

!  To*take*stock*of*progress*and*propose*new*acCons*

!  To*hold*governments,*partners*and*donors*accountable*wherever*progress*is*lacking*

Countdown&aims&

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!  MulC#sectoral,*supra#insCtuConal,*consensus#building*

!  Use*of*recent,*replicable,*relevant*data*on*coverage*and*its*determinants*

!  DisaggregaCon*of*data*to*reveal*inequiCes*

!  Explaining*the*data*to*promote*uptake*and*acCon*

!  Strengthening*analyCcal*capacity*in*high#priority*countries*

Countdown’s&strengths&

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Countdown*Country*Case*Studies*

Use*evidence*to*explain*HOW*a*

country*progressed*in*MDG&4&&&5&

Translate&

research*to*policy*through*country*disseminaNon&

CapacityObuilding&

of*country*leaders*for*RMNCH&

monitoring*and*research*

Objec2ves:(

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PHASE&1&(n=2&)

PHASE&2&(n=6)&

PHASE&3&(n=2)

Bangladesh R M N C

75&Countdown&Countries

Niger R M N C

Ethiopia R M N C

Kenya R M N C

Malawi R M N C

Afghanistan R M N CChina R M N C

Tanzania R M N C

Peru R M N C

Pakistan R M N C

Countdown&&Country&Case&Studies

10*Case*Study*countries*

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!  Led*by*in#country*insCtuCon*independent*of*program*implementaCon**

!  Assessment*of*coverage*and*impact*measures*across*conCnuum*of*care;*equity*analyses,*including*subnaConal*analysis;*complementary*data*on*policy,*health*systems,*financing*

!  Strong*capacity#building*component,*with*technical*assistance*via*Countdown*Technical*Working*Groups*

!  Plans*and*results*presented*and*discussed*with*Government*and*relevant*stakeholders*in*country*

!  PublicaCon*and*in#country*disseminaCon*

How&it&works&

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2012& 2015&

Today*

Sep* 2013* May* Sep* 2014* May* Sep* 2015* May* Sep*

Niger&publicaNon&&

9/12*

SelecNon&of&first&6&full&county&case&studies&&

2/13*

First&country&case&study&meeNng&at&Women&

Deliver&Conference&in&Kuala&Lumpur&

5/13*

First&countryO

capacity&building&

workshop&in&

Pelotas&

6/13*

Health&systems&&&policy&and&financing&

workshop&in&Nairobi&

2/14*

Tanzania&disseminaNon&&

5/14*

Bangladesh&publicaNon&

6/14*

Country&case&study&meeNng&in&South&Africa&

at&Partner's&Forum&&&

7/14*

Peru&disseminaNon&&

11/14*

Capacity&bulding&workshop&in&London&

2/15*

Afghanistan&&&Pakistan&

disseminaNon&&

5/15*

Tanzania&publicaNon&&

6/15*

Ethiopia&disseminaNon&&

6/15*

Malawi&disseminaNon&&

7/15*

2/15/2013*#*11/15/2015*Phase&2&Country&Case&Studies&

4/1/2014*#*12/31/2015*Phase&3&Country&case&studies&&

Case*Study*Timeline*

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Case&study&milestones&

…*with*more*to*come*

5*capacity#building*workshops*and*

meeCngs*

6*disseminaCon*events*

5*scienCfic*publicaCons*

5&Case*Study*Briefs*

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0

10

20

30

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50

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70

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%

Interventions varies across the continuum of care in Afghanistan

Pregnancy Birth Postnatal Infancy Childhood Water and sanitation

Pre- Pregnancy

Median national coverage of selected interventions **MICS 2010,*NNS 2013 & ǂEPIC 2013

• Provincial Coverage (%)

12

Change in Skilled Birth Attendance (Afghanistan 2003-2011)

13

2682

10973

14330

18939 19648

21227

23363 25478

28837

2005 2006 2007 2008 2009 2010 2011 2012 2013 0

5000

10000

15000

20000

25000

30000

35000

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

CH

W (F

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Oth

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Community Health Workers MD Specialists MD Generalists Nurses Midwives

Investing in health workers makes sense (Afghanistan)

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Children (%) with ARI for whom advice or treatment was sought from a health facility or provider

15

Proportion of children never immunized (12-23 months children)

16

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Some&common&findings&

!  VerCcal*intervenCons*were*implemented*widely,*reached*high*coverage**

!  Persistently*lower*coverage*for*more*complex*intervenCons,*like*curaCve*and*maternal*care*services*

!  Childhood*malnutriCon,*requiring*mulC#sectoral*approach,*has*been*slow*to*improve*

!  Significant*equity*gaps,*along*socioeconomic*and*geographic*dimensions,*gender**persist*in*most*case*study*countries*

!  Importance*of*contextual*factors,*including*socioeconomic*development,*poliCcal*stability,*conflict*and*decentralizaCon*

But(many(mixed(findings(reinforce(the(need((for(more(countryAspecific(inAdepth(case(studies((

*

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Looking Forward

•  Countdown will continue to advance its technical inputs to monitoring & evaluating progress in delivering interventions for RMNCH & Nutrition of relevance to EWEC 2.0 and the Sustainable Development Goals.

•  Continue to develop its country-level work, strategic in-country partnerships & capacity development with regional networks

•  Build on the foundations of the last decade & strengthen

its contribution to the unified accountability process