A Focus on Data
Countdown to 2015 aims to provide the best and most recent scientific evidence on country-level progress towards the achievement of MDGs 4 and 5, and to improve the use of national data to accelerate attention, accountability, and action for scaling up coverage of priority reproductive, maternal, newborn, and child health (RMNCH) interventions. Countdown adds value by forging a clear, evidence-based consensus on priority interventions and coverage indicators for RMNCH; producing country profiles and generating increased visibility and use of national level data; analyzing coverage trends, with increased awareness of gaps and contextual factors; developing and validating new and innovative methods to track progress towards MDGs 4 and 5; serving as an accountability mechanism through engaging parliamentarians and scientists; and linking science and action along the continuum of care.
Countdown priority countries
As of 2012, Countdown tracks coverage for 75 countries which, together, account for more than 95% of all maternal, newborn, and child deaths.
Country selection has taken place in three phases. In 2004, Countdown defined a list that included all countries with at least 50,000 child deaths and all countries with an under-five mortality rate of at least 90 deaths per 100,000 live births. The resulting list of 60 priority countries, which were profiled in the 2005 Countdown Report, represented almost 500 million children under age five — more than 75% of all such children then living — and represented 94% of all child deaths.
For the 2008 Countdown Report, the list was expanded to include those countries with the highest maternal mortality ratios (all countries with an MMR of more than 550 deaths per 100,000 live births) or highest numbers of maternal deaths (all countries with at least 750 maternal deaths, and an MMR of more than 200). Because countries with high child mortality overlapped significantly with those that had high maternal mortality, this exercise led to the inclusion of only eight additional Countdown priority countries. This list of 68 countries was also used in the 2010 Countdown Decade Report.
In 2011, with Countdown’s agreement to take responsibility for major parts of the follow-up agenda of the Commission for Information and Accountability for Women’s and Children’s Health, Countdown’s list of priority countries was again expanded to 75 countries (including the recently-established nation of South Sudan), including all high-burden countries as well as the 49 low-income countries discussed in the Global Strategy for Women’s and Children’s Health. Beginning in 2012, Countdown will produce annual reporting and analysis of country-specific information on key indicators for each of these 75 countries; all 75 are also included in the 2012 Countdown Report.
Interventions and indicators
Countdown’s selection of priority interventions and indicators is guided by the Countdown Principles, which include a focus on coverage — the proportion of individuals needing a service or intervention who actually receive it. All interventions tracked through the Countdown are scientifically proven to reduce mortality among mothers, newborns, or children. Coverage of service delivery platforms, such as antenatal and postnatal care, childbirth, and family planning services also need to be tracked, as they provide the basic platform for delivery of multiple effective interventions to reduce maternal, newborn and child mortality. Countdown tracks only interventions and approaches that are feasible for universal implementation in poor countries. In addition, to be tracked, an intervention or approach must be associated with a valid coverage indicator that is reliable, comparable across countries and time, nationally representative, clear and comprehensible by policy makers and program managers, and available regularly in most Countdown priority countries. As part of each Countdown reporting cycle, a broad consultative technical review process is carried out to review and update the Countdown indicator list so that it reflects the latest evidence on effective interventions for MNCH.
Each Countdown Report includes annexes that define all indicators and identify their data sources. Countdown does not collect new data for its coverage measures, but uses available data accessible to the public (www.childinfo.org). The 2008 Countdown Report also includes a detailed discussion of the process by which Countdown identifies priority interventions and coverage indicators, tracks contributory factors, analyzes improvement in equity, and tracks policies, health systems, and financial flows.
Data quality control
Quality control of Countdown’s coverage estimates is the responsibility of many different groups. Countdown supplements these efforts by working closely with UNICEF and others responsible for maintaining global databases, and conducts additional quality checks to ensure consistency and reliability. Country profiles are shared with ministries of health and UN colleagues prior to publication. Work is under way to address continuing challenges in estimating coverage and associated uncertainty.
In 2011, Countdown partnered with the Health Metrics Network, UNICEF, and the World Health Organization to launch a report, Monitoring maternal, newborn and child health: understanding key progress indicators, which summarizes the main opportunities and challenges to effective monitoring of core indicators identified by the Commission for Information and Accountability for Women’s and Children’s Health that, taken together, enable stakeholders to track progress in improving coverage of interventions needed to ensure the health of women and children across the continuum of care. The publication describes each indicator, its data sources, and potential areas of improvement, and explores the extent to which health information systems in priority countries are currently able to report on the indicators with the necessary accuracy, frequency, timeliness, and quality.
The coverage, equity, financing, and health systems and policies data and results used to construct the 2012 profiles are publicly available. For more information and to receive a copy of Countdown’s 2012 datasets, please contact the Countdown Secretariat at