The Countdown to 2015 initiative (Countdown) represents a remarkable consortium of academicians, UN agencies, and development partners, which over the past decade, has focused its attention on tracking and analysing coverage of key interventions for reproductive, maternal, newborn, and child health (RMNCH) across 75 high burden countries that account for more than 95% of global maternal and child deaths. Initially started to ensure follow-up on the landmark Lancet Child Survival series, with innovative consolidation and presentation of coverage data on key interventions by country and regions, Countdown rapidly evolved with an expansion of its mandate to include reproductive and maternal health indicators across the continuum of care and more recently, analysis of nutrition trends and health policies. Countdown is also an example of the collective power of champions, innovative scientifi c and collaborative work across academic groups, civic society organisations, and UN agencies and partnerships across various sectors. Elements that have worked include strong buy-in from the UN and development agencies and the legitimacy of Countdown analysis by countries. Important strengths of Countdown have included multidonor support, relatively fl exible governance and technical structures, strong links to the Partnership for Maternal and Child Health, and more recently to the independent expert review group (iERG) of the UN Secretary General for monitoring MDGs 4 and 5. Countdown’s core work on monitoring and measuring coverage of key interventions to aff ect MNCH interventions across the continuum of care represents one the major sources of consolidated information that governments, development agencies, civic society organisations, and the iERG have used in their work. Some aspects of Countdown’s work have also been challenging especially fi nancial dependence on a limited set of donors, perceptions of independence in view that much of its core funding fl owed through UN agencies, slow devolution of technical work to the regions, and relatively low-key advocacy. The latter is also evidenced by a gradual transition from standalone Countdown meetings as was the case in 2005 and 2008 to more limited sessions and visibility in other global MNCH meetings since. The release of its fi nal report and the adoption of a new set of global Sustainable Development Goals (SDGs) invoke the question of what next for the Countdown? There are several core features of Countdown that should be preserved as we move into the SDG era. The collation, presentation, and analysis of a core set of metrics centred on the coverage of crucial lifesaving interventions remains pertinent and critical to continued monitoring of SDG 3 (ensuring healthy lives and promotion of well being for all at all ages). Countdown further developed a range of equity measures across wealth quintiles and other markers such as geography, sex, and ethnicity that will be important to retain and link to assessments of equitable impacts of universal health care on MNCH. Of late, the group’s foray into geospatial analysis of inequities represents a powerful set of instruments to aff ect policies and investments. These must underpin any future monitoring of progress and accountability. A core working group on health fi nancing has monitored global resource fl ows with a specifi c focus on overseas development assistance for RMNCH and sequential assessments of fi nancing. Additional analyses of health systems and policies have allowed insight into awareness within countries of evidence-based key interventions for RMNCH and subsequent policy development and implementation at scale. A major development in recent years has also been the conscious move to analyse factors determining RMNCH progress at national or subnational level. Examples of these Countdown country case studies include insightful analyses of progress in child survival in Niger, maternal health in Bangladesh, and progress across RMNCH in Tanzania. At least six further case studies are underway in a range of countries including Peru, Pakistan, Afghanistan, Kenya, and Malawi and have engaged local experts and institutions as well as regional collaborations. Despite other similar exercises more recently, Countdown remains the dominant global group making available to countries a wide range of technical, fi nancial, and political support for multistakeholder capacity development for monitoring and evaluation. In view of Countdown’s regular inputs to the iERG in monitoring global progress in relation to Milennium Development Goals (MDGs) 4 and 5, it should continue with support to the newly proposed independent accountability panel for RMNCH. Multistakeholder partnerships, RMNCH focus, shift to regional and national support, and continued development of improved scientifi c methods will, we believe, keep the Countdown process relevant for the forthcoming SDG era. There is clear recognition of the need to address issues that go beyond mortality. The challenge would be to link the Countdown process to emerging issues, such as adolescent health and noncommunicable diseases without sacrifi cing the core mission of addressing RMNCH. The new global strategy Lancet 2016; 387: 2060–62
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