Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

Abstract

Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries-Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.

Transforming medical education in Liberia through an international community of inquiry

“…President Ellen Johnson Sirleaf's leadership, along with collaborative international partnerships, generated national improvements in several key health indicators from 2004-2014. Liberia met Millennium Development Goal #4 to reduce childhood mortality by two-thirds ahead of the global target dates [1,2]. However, the emergence of Ebola in Liberia in 2014 stymied progress in the health sector and revealed ongoing fragilities in the health system [3,4].…”

Aplicação e impactos dos objetivos de desenvolvimento sustentável nas grandes indústrias brasileiras

“…The deadline for achieving the objectives extended until 2015. While challenges such as poverty, inequalities and infant mortality (Brault et al, 2020) persisted. In view of this, following a mandate emanating from the Rio+20 Conference in 2012, a series of negotiations began in 2013 to discuss a new way of promoting sustainable development involving governments, companies and civil society.…”

Water and sanitation influence on child health in Namibia: using demographic and health surveys

“…The global under-five mortality (U5M) has reduced by 60% from 1990 to 2020, currently at 5.2 million, equating to a daily death rate of 14,000 children (UNICEF 2020). Reaching the targets set by the Millennium Development Goals (MDGs), which expired in 2015, remains a far-fetched dream (Brault et al 2020). Goal 3 of the Sustainable Development Goals (SDGs), which replaced the MDGs, is to 'reduce new-born mortality to at least 12 deaths per 1,000 live births and under-5 mortality to at least 25 per 1,000 live births' (United Nations 2017).…”