With less than 850 days to go until we reach the 2015 deadline for the eight Millennium Development Goals (MDGs), the question on the minds of many is: what can be done now to boost progress as we edge closer to that final date? At the Gates Foundation, we are posing this exact question as it relates specifically to MDGs 4 and 5 (improving maternal health and reducing child mortality). What can we change or improve that will ensure the greatest impact on maternal, newborn and child survival not only in the next 850 days but as we lay the foundation for sustained acceleration beyond 2015? The answer points to a series of improvements that we must undertake to improve the health and lives of women and children in the poorest countries in the world.
What can we change or improve that will ensure the greatest impact on maternal, newborn and child survival not only in the next 850 days but as we lay the foundation for sustained acceleration beyond 2015?
If we had to select only one solution for maternal and newborn survival it could be to rapidly increase the coverage of the effective use of contraception and family planning. Boosting family planning coverage is a given opportunity, as it contributes so significantly to women’s health, maternal survival and the survival and health of their newborns. The reduction in unintended pregnancies would avert a significant proportion of maternal and child deaths. And, if we have to zoom in one population group, investments in the health of adolescent girls would yield the highest economic and social benefits.If we had to select only one solution for closing the gap in child survival it could be to scale up integrated community case management of childhood illness in rural areas where under-five mortality remains the highest. And, if we had to focus on one target group for the delivery of these services, it would be community health workers to reach those most in need. Fortunately, there is not just one singular pathway to achieving MDGs 4 and 5.
But because we do not need to choose one solution above another to accelerate progress on selected MDGs, we can focus on critical methods that will help us achieve our goals across the continuum of reproductive, maternal, neonatal and child health and nutrition. In fact, we think there is not one intervention, solution or approach, but a few factors in particular that would reduce maternal and child mortality.We are learning that we can achieve greater impact if we get better at identifying opportunities to work together in more integrated and cross-cutting ways across programs, disciplines, sectors and across the life-cycle, most importantly in the critical stages of adolescence and the 1000 day window around pregnancy and birth.How?Through strategic & catalytic partnerships, a focus on quality services in response to demand generation for maternal, newborn and child health services, the consideration of both equity and scale in the design of programs, and by supporting efforts to develop a stronger performance management culture that would allow the scaling up of innovations with a focus on results. Some of this is highlighted in Stephen Hodgins’ Global Health and Practice Journal article: Achieving better maternal and newborn outcomes: coherent strategy and pragmatic, tailored implementation. Fortunately, there is not just one singular pathway to achieving MDGs 4 and 5. Unfortunately, there is no shortcut to development, and progress is not going to happen without behavior change among policymakers and the global community of partners working together to meet these critical goals. The question is not "what can we do," but "how willing are we to do what it takes, to change the way we work together." As we enter the last 850 days before the MDGs deadline we should act on the evidence we already have to save the lives of women and children.