Countdown to 2015 Country Case Studies: Analysing progress towards maternal and child survival in the Millennium Development Goal era


Countdown to 2015 for Maternal, Newborn and Child Survival (Countdown) began in 2003, monitoring and analysing country progress towards achieving Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health). For 12 years Countdown synthesised data on coverage and its key determinants across the continuum of care for women’s and children’s health. Understanding global level progress to the MDGs was more recently complemented by a series of country case studies (Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania). The country case studies enabled an assessment of why and how countries progressed towards improving women’s and children’s health during the MDG-era, and what factors might explain the specific patterns of progress in individual countries. This supplement collates learning from these country case study analyses.

The full portfolio includes 10 countries at varying stages of progress towards MDGs 4 and 5. These studies involved a partnership between academic institutions well versed in Countdown’s global work and country-based teams consisting of members not directly involved in programme implementation or evaluation to safeguard the independence of the analysis. Each case study collaborative took advantage of country-specific opportunities for learning and faced unique challenges related to the different circumstances in the country (e.g. data availability, team capacity/attrition, and communication between agencies).

This journal supplement describes key lessons from the Countdown case study portfolio. It includes a combination of a summary paper and two methodological papers synthesising findings across the case studies and showcasing novel methods developed for the case studies and three country-specific papers (Tanzania, Peru and Afghanistan) that use subnational data to explore specific themes across the continuum of care.

The full journal supplement is available to read here:


Key learnings from the Countdown case studies evidence and experience are outlined in Box 1.


Box 1. Countdown’s portfolio of 10 country case studies led to the following recommendations:

1) Global monitoring efforts must be complemented by in-depth research at country level, building local capacity to carry out analyses and to use data for decision making.

2) The use of a common analytical framework enables a rich and standardized assessment of why and how countries succeed or fail in improving the health and survival of women and children. More work is needed on developing tools for comparative assessments of inputs and processes such as financial flows, health policy and systems factors.

3) Progress in intervention coverage was most evident for relatively simpler interventions delivered at the community or primary care level such as immunizations, and lagged behind for interventions requiring 24/7 availability of care such as skilled attendant at birth.

4) Many factors including health systems related and non-health sector factors (e.g., governance, women’s social status, and other social and economic issues) contribute to progress or lack of progress in individual countries. No one country or group of countries should be viewed as a ‘success’ or ‘failure’. The value of case studies is in understanding and learning from variations, successes and setbacks.

5)     Engagement in national data analysis and accountability requires significant time commitment and resources and should be prioritized, and

6) Systematic efforts are needed to integrate case study findings into country planning and review cycles. These efforts should include the development of concrete plans and local leadership – including the voice of civil society – for successful dissemination and uptake of case study findings. Countdown case-studies included a series of meetings with national stakeholders to ensure the dissemination and promote the uptake of their results and recommendations.