TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL The 2008 Report TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT Tracking Progress in Maternal, Newborn & Child Survival The 2008 Report, V2. ISBN: 978-92-806-4284-1 © The United Nations Children’s Fund (UNICEF), 2008 Cover photo © UNICEF/HQ07-1153/Shehzad Noorani This is a working document. It has been prepared to facilitate the exchange of knowledge and to stimulate discussion. Participating agencies and institutions accept no responsibility for errors. The designations in this publication do not imply an opinion on legal status of any country or territory, or of its authorities, or the delimitation of frontiers. The views expressed in this document are solely the responsibility of the contributors. The document may be freely reviewed, abstracted, or translated in part or whole, but not for sale nor use in conjunction with commercial purposes. All reasonable precautions have been taken by UNICEF and the Countdown Partners to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or TRACKING PROGRESS IN MATERNAL, implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall UNICEF be liable for damages arising from its use. NEWBORN & CHILD SURVIVAL For more information contact UNICEF 3 United Nations Plaza The 2008 Report New York, NY 10017 USA www.countdown2015mnch.orgTRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT Abbreviations Contributors AARP Average annual rate of reduction Lead Authors Acknowledgements ARV Anti-retroviral treatment Jennifer Bryce (Johns Hopkins University, USA) and Jennifer Harris CHERG Child Health Epidemiology Reference Group Requejo (PMNCH, Switzerland) The Countdown Group would like to thank the following: DHS Demographic and Health Surveys GAVI Global Alliance for Vaccines Initiative Special Recognition UNICEF/Strategic Information Section for use of global databases, GFATM Global Fund for AIDS, TB and Malaria Tessa Wardlaw, Archana Dwivedi, Holly Newby of UNICEF, for technical preparation of country profiles, and review of report text. Particular Hib Haemophilus influenzae type B support and substantial contribution to all phases of report preparation recognition goes to Xiaodong Cai, Khin Wityee Oo, and Me Me ILO International Labour Organization and production Khine for their input and review of country profiles. Irene Deineko for IMCI Integrated management of childhood illness administrative support and convening of review meetings. ISCO International Standard Classification of Occupations 2008 Countdown Working Group ITNs Insecticide-treated nets Jasmina Acimovic, UNICEF, USA WHO regional offices and headquarters staff who contributed to data LSHTM London School of Hygiene and Tropical Medicine Priscilla Akwara, UNICEF, USA collection: Christopher Drasbek, Susan Farhoud, Olivier Fontaine, JMP WHO/UNICEF Joint Monitoring Programme on Water Supply and Sanitation Henrik Axelson, PMNCH, Switzerland Phanuel Habimana, Ardi Kaptinisingh, Aigul Kuttumaratova, Ramez MDGs Millennium Development Goals Stan Bernstein, UNFPA, USA Mahaini, Sudhansh Malhotra, Shameen Qazi and Mariana Trias. MERG Roll Back Malaria Monitoring and Evaluation Reference Group Zulfiqar Bhutta, Aga Khan University, Pakistan MICS Multiple Indicator Cluster Surveys Robert Black, Johns Hopkins University, USA The Countdown communications team for their inputs in shaping the NMR Neonatal Mortality Rate Ties Boerma, WHO, Switzerland key messages, media strategy and Countdown Executive Summary: OECD Organisation for Economic Co-operation and Development Josephine Borghi, LSHTM, UK Genine Babakian, Flavia Bustreo, Marie Agnes Heine, Olivia Lawe- PMNCH Partnership for Maternal, Newborn and Child Health Jennifer Bryce, Johns Hopkins University, USA Davies, Kate Kerber, Ruth Landy, Jessica Malter, Tunga Namjilsuren, SWAps Sector-Wide Approaches Flavia Bustreo, PMNCH, Switzerland George Ngwa, Jennifer Requejo, Jacqueline Toupin, Michelle Zelsman. U5MR Under-five mortality rate Dennis Caillaux, Global Movement for Children, Switzerland UNFPA United Nations Population Fund Naomi Cassirer, ILO, Switzerland Christa Fischer-Walker and Jeremy Schiefen of Johns Hopkins UNGASS United Nations General Assembly Special Session Eleanora Cavagnero, WHO, Switzerland University, USA for preparing maps. UNICEF United Nations Children’s Fund David Clark, UNICEF, USA WFFC World Fit for Children Giorgio Cometto, Save the Children, UK The DevInfo initiative for the development of the database and the WHO World Health Organization Bernadette Daelmans, WHO, Switzerland production of the Country Profiles. Nita Dalmiya, UNICEF, USA Maria Dal Poz, WHO, Switzerland UN Country Team in South Africa, particularly the UNICEF Sub-Office in Archana Dwivedi, UNICEF, USA Cape Town for administrative and logistics support. Leslie Elder, Saving Newborn Lives / Save the Children, USA David Evans, WHO, Switzerland The PMNCH Secretariat for convening meetings for Countdown Vincent Fauveau, UNFPA, Switzerland Core Groups and PMNCH colleague Tigest Yilma Desta for providing Helga Fogstad, NORAD, Norway administrative support. Anastasia J. Gage Tulane University, USA Youssouph Gaye, Ministry of Health, Senegal Working Groups Wendy Graham, University of Aberdeen, UK Giulia Greco, LSHTM, UK Coverage Indicators: Fred Arnold, Linda Bartlett, Stan Bernstein, Neeru Gupta, WHO, Switzerland Zilfiqar Bhutta, Robert Black, Ties Boerma, Jennifer Bryce, Flavia Richard Horton, The Lancet, UK Bustreo, Simon Cousens, Trevor Croft, Bernadette Daelmans, Leslie Julia Hussein, University of Aberdeen, UK Elder, Anastasia Gage, Wendy Graham, Kate Kerber, Stein-Erik Kruse, Monir Islam, WHO, Switzerland Joy Lawn, Elizabeth Mason, Jeffrey Mecaskey, Carine Ronsmans, Peter Kareen Jabre, Inter-Parliamentary Union, Switzerland Salama, Harshad Sanghvi, Lale Say, Werner Schultink, Anuraj Shankar, Kate Kerber, Saving Newborn Lives / Save the Children, USA Nancy Terreri, Anne Tinker, Vincent Fauveau, Cesar Victora, Tessa Betty Kirkwood, LSHTM, UK Wardlaw Joy Lawn, Saving Newborn Lives / Save the Children, USA Samantha Lobis, Columbia University, USA Equity: Henrik Axelson, Stan Bernstein, Ties Boerma, Wendy Graham, Viviana Mangiaterra, WHO, Switzerland Kate Kerber, Betty Kirkwood, Jeffrey Mecaskey, Carine Ronsmans, Elizabeth Mason, WHO, Switzerland Cesar Victora Jeffrey Mecaskey, Save the Children, UK Anne Mills, LSHTM, UK Financial Flows: Henrik Axelson, Zulfiqar Bhutta, Josephine Borghi, Holly Newby, UNICEF, USA Flavia Bustreo, Guilia Greco, Anne Mills, Tim Powell-Jackson Maryanne Neill, UNICEF, USA Arletty Pinel, UNFPA, USA Policy Review: Bernadette Daelmans, Vincent Fauveau, Andy Haines, Tim Powell-Jackson, LSHTM, UK Monir Islam, Stein-Erik Kruse, Viviana Mangiaterra, Jeffrey Mecaskey, Sonya Rabeneck, PMNCH, Switzerland Ann Starrs, Nancy Terreri, Stewart Tyson, Patrick Unterlerchner Jennifer Harris Requejo, PMNCH, Switzerland Carine Ronsmans, LSHTM, UK Peter Salama, UNICEF, USA David Sanders, University of Western Cape, South Africa Harshad Sanghvi, JHPIEGO, USA Lale Say, WHO, Switzerland Werner Schultink, UNICEF, USA Anuraj Shankar, WHO, Switzerland Meera Shekar, World Bank, USA Robert Scherpbier, WHO, Switzerland © UNICEF/HQ05-2159/Giacomo Pirozzi Francisco Songane, PMNCH, Switzerland Marcus Stahlhofer, WHO, Switzerland Ann Starrs, Family Care International, USA Sissel Hodne Steen, NORAD, Norway Nancy Terreri, UNICEF, USA Anne Tinker, Save the Children, USA Jim Tulloch, AusAid, Australia Stewart Tyson, DFID, UK Patrick Unterlerchner, PMNCH, Switzerland Costanza Vallenas, WHO, Switzerland Cesar Victora, Universidade Federal de Pelotas, Brazil Tessa Wardlaw, UNICEF, USA TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT v v Contents Chapter 1: Tracking intervention coverage for maternal, newborn and child survival 1 Countdown principles 2 Links to other monitoring efforts 4 Overview of this report 4 Notes 5 Chapter 2: Tracking indicators and methods 7 Selecting the Countdown priority countries 7 Priority interventions and coverage indicators 9 Indicators for factors that contribute to coverage 10 Tracking improvements in equity 11 Data sources and methods 11 Coverage 12 Policies, health systems and financial flows 13 Equity 14 Notes 15 Chapter 3: The 2008 Countdown findings - and a call to action 17 The bottom line: mortality 17 Nutritional status 21 Coverage in 2008 22 Recent coverage trends 23 Coverage levels and trends for selected programmatic areas 24 Equity in coverage levels 40 Health policies and health systems 41 Human resources and financing 44 Financial flows to maternal, newborn and child health 44 Conclusions and recommendations 46 The Countdown call to action 48 Notes 49 Chapter 4: The country profiles 51 References 188 Annexes Annex A: Initiatives, resources and databases for monitoring progress towards the health-related Millennium Development Goals, with a special focus on maternal, newborn and child survival Annex B: Indicators and data sources Annex C: Defining current Countdown indicators Annex D: Definitions of policy and health systems indicators Annex E: Countdown to 2015 measuring equity in maternal, newborn and child health through the coverage gap index: technical notes Annex F: Countdown priority countries considered to be malaria endemic TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT © UNICEF/HQ05-2131/Giacomo Pirozzi FAMILY CARE INTERNA TIONAL pantone pantone 382 C 322 C 381 U 321 U CMYK (process) CMYK (process) DS 302-3 C DS 249-3 C C 25, Y 95 C 95, Y 25, K 35 DS 302-5 U DS 248-2 U C 20, Y 65 C 100, Y 30, K 30 www.countdown2015mnch.org TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 0.