Are the millennium development goals on target?

Multiple reports have been published throughout the year, but are the promises of the MDGs connecting to progress? At the heart of the MDGs are goals 4 for child survival and 5 for maternal survival. Are fewer mothers, newborns, and children dying? Is essential health care improving for the poorest? Or are the numbers themselves a battleground?

Despite superficial differences, common themes exist in the new data—a mixture of success and shortfalls. The good news is that progress for child mortality is accelerating. Although fewer children died this year than last year, it is unacceptable that each year 8.8 million children still die, including 3.6 million newborns.

However, progress for neonatal and maternal mortality seems to be lagging, with successes such as China being the exception rather than the rule. The proportion of deaths in under 5 year olds accounted for by newborn deaths has increased from 37% in 2000 to 41% in 2008. Yet few UN documents on MDG 4 even mention neonatal care. Each year upwards of 342 900 women die of maternal causes, depending on which report is subscribed to. Each year 60 million births occur at home and this is a critical determinant for maternal and newborn survival…

…Reducing these needless deaths is dependent on high and equitable coverage of basic interventions. Rapid increases in coverage have been achieved for some well funded and vertically delivered interventions such as immunisations, prevention of mother to child transmission of HIV/AIDS, and malaria interventions. For instance, almost 200 million bednets were distributed between 2007 and 2009, more than half of the 350 million required. 

However, progress remains too slow for some interventions, including the highest impact interventions, such as safe care at birth and treatment of neonatal and childhood illness. Family planning and contraception are at risk of falling off the agenda despite being rapid and cost effective ways to reduce maternal and child deaths and accelerate development. Many UN documents focus on the interventions that already receive the most attention rather than those with the greatest potential effect in the next five years…

…So what are the key priorities in the next crucial five years? The first is to use data at national or ideally subnational level, considering the main causes of death, coverage, and quality and equity gaps, and to focus on implementing the interventions with the greatest impact especially for care at birth and the first few days after birth. Rapid reductions in mortality are possible even with 20% increases in coverage of targeted interventions. National and subnational data are a key to designing programmes and tracking their progress.

The second priority is to innovate, especially for service delivery. Most of the countries with the highest mortality rates have fewer than 0.5 skilled health personnel per 1000 population, compared with over 10 per 1000 in the UK. This will require task shifting within the health system and bringing care closer to home—for example, using community health workers for appropriate care at home.

The third priority is to target the poor and remove financial barriers such as user fees for maternity and child health services, and not to leave lessening disparity to chance and “trickle down” philosophies.

The final priority is to strengthen accountability for donor governments, for low income country governments, and for all partners including the UN.

The year 2010 is a tipping point. We are the first generation to have the tools and the funding to transform lives for the world’s poorest families. Why should a mother in rural Nigeria die giving birth? Why should a baby in India die of birth complications? Why should a child in Ethiopia die of pneumonia? The underlying question is whether the world’s leaders, and all of us, will deliver on our promises.

Excerpt from BMJ, September 2010read the full Editorial

Read moreMeasuring impact in the Millennium Development Goal era and beyond: a new approach to large-scale effectiveness evaluations, The Lancet, early online publication, July 2010 (Lancet login required)

One comment
  1. Ms. Lawn makes a number of important points in her column. In particular, the ones relating to the slow progress on neonatal mortality struck me, since that is the field I work in. As she notes, while child deaths are falling, neonatal deaths are not — I just saw this in the Philippines where doctors reported an overall decrease in under-five child deaths, but virtually no change in neonatal mortality for ten years.

    In one hospital I visited, the death rate in the Neonatal Intensive Care Unit (NICU) was 50% at times, and overall between 35 and 45%.

    We faced this exact same situation in Vietnam, where we built a NICU at the National Hospital of Pediatrics. The mortality rate in that NICU is now less than 10%, thanks to the introduction of appropriate equipment plus intensive training and monitoring.

    Neonatal illnesses are a clinical problem that has to be treated in a medical facility. If the world wants to make progress on this issue, then funds need to be invested in improving those facilities.

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