The Lancet  
Sep 29, 2012  Volume 380  Number 9848  p1121 – 1202
http://www.thelancet.com/journals/lancet/issue/current

Comment
The Countdown for 2015: what lies ahead?
Zulfiqar A Bhutta, Mickey Chopra

Preview
As the 2015 deadline for achieving the Millennium Development Goals (MDGs) approaches, there is a growing sense of urgency to accelerate progress, especially for reducing child and maternal deaths. The most recent Countdown Report1 suggests that at the present rate of progress 23 (31%) of 75 countries are on track to achieve the MDG 4 target for child survival, whereas only nine (12%) are projected to reach the MDG 5 target for maternal mortality. Other estimates from the Institute of Health Metrics and Evaluation2 suggest that only nine and four of the 75 countries are expected to reach the MDG 4 and MDG 5 targets, respectively, by 2015.

Articles
How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys
Cesar G Victora, Aluisio JD Barros, Henrik Axelson, Zulfiqar A Bhutta, Mickey Chopra, Giovanny VA França, Kate Kerber, Betty R Kirkwood, Holly Newby, Carine Ronsmans, J Ties Boerma

Summary
Background
Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children.

Methods
We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels.

Findings
We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles.

Interpretation
Equity should be accounted for when planning the scaling up of interventions and assessing national progress.

Funding
Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.

Countdown to 2015: changes in official development assistance to maternal, newborn, and child health in 2009–10, and assessment of progress since 2003
Justine Hsu, Catherine Pitt, Giulia Greco, Peter Berman, Anne Mills

Summary
Background
Tracking of financial resources to maternal, newborn, and child health provides crucial information to assess accountability of donors. We analysed official development assistance (ODA) flows to maternal, newborn, and child health for 2009 and 2010, and assessed progress since our monitoring began in 2003.

Methods
We coded and analysed all 2009 and 2010 aid activities from the database of the Organisation for Economic Co-operation and Development, according to a functional classification of activities and whether all or a proportion of the value of the disbursement contributed towards maternal, newborn, and child health. We analysed trends since 2003, and reported two indicators for monitoring donor disbursements: ODA to child health per child and ODA to maternal and newborn health per livebirth. We analysed the degree to which donors allocated ODA to 74 countries with the highest maternal and child mortality rates (Countdown priority countries) with time and by type of donor.

Findings
Donor disbursements to maternal, newborn, and child health activities in all countries continued to increase, to $6511 million in 2009, but slightly decreased for the first time since our monitoring started, to $6480 million in 2010. ODA for such activities to the 74 Countdown priority countries continued to increase in real terms, but its rate of increase has been slowing since 2008. We identified strong evidence that targeting of ODA to countries with high rates of maternal mortality improved from 2005 to 2010. Targeting of ODA to child health also improved but to a lesser degree. The share of multilateral funding continued to decrease but, relative to bilaterals and global health initiatives, was better targeted.

Interpretation
The recent slowdown in the rate of funding increases is worrying and likely to partly result from the present financial crisis. Tracking of donor aid should continue, to encourage donor accountability and to monitor performance in targeting aid flows to those in most need.

Funding
Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Canada, Norway, Sweden, and the UK.