Factores de éxito para reducir la mortalidad materna e infantil

Introduction Worldwide, accelerated progress is required to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) as highlighted in the United Nations Secretary-General's Global Strategy for Women's and Children's Health. (1) There have been substantial achievements from 1990 (the baseline for the MDGs) to date. Child and maternal deaths decreased globally by around 50%, and contraceptive prevalence increased from 55% to 63%. (2-4) There is consensus on evidence-based, cost-effective investments and interventions (5,6) and on enabling health and multisectoral policies. (7) Despite these advances, every year 6.6 million children die before five years of age (44% as newborns) and 289 000 maternal deaths occur, most from preventable causes. (2-4) Progress varies widely across countries, even where levels of income are similar. (8) There is a need for evidence on why some low- and middle-income countries (LMICs) do better than others in preventing maternal and child deaths and on the strategies they use to accelerate progress. (8,9) This knowledge gap prompted discussions at the Partnership for Maternal, Newborn & Child Health Partners' Forum in 2010, leading to a three-year multidisciplinary, multicountry series of studies on Success Factors for Women's and Children's Health (hereafter referred to as the Success Factors studies). (10) The Success Factors studies were supported by the Partnership for Maternal, Newborn & Child Health, the World Health Organization (WHO), the World Bank and the Alliance for Health Policy and Systems Research, working closely with ministries of health, academic institutions and other partners. (10) The studies sought to understand what works to support countries' progress towards the MDGs and to inform the post-2015 goals and strategies under preparation. Methods Analytical framework The analytical framework for the Success Factors studies (Box 1) builds on the UN Millennium Project's "clusters of public investments and policies" (11) and WHO's "health systems building blocks". (12) We used literature reviews and expert consultations to identify over 250 related variables to develop the database for these studies. (13) Countries included The statistical and econometric analyses included all 144 countries that the World Bank designated as LMICs in 1990. For the in-depth country reviews, we selected 10 of the 75 "Countdown to 2015" high-mortality burden countries: (8) Bangladesh, Cambodia, China, Egypt, Ethiopia, Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. We refer to these countries as "fast-track" because they were on track in 2012 to achieve both MDGs 4 and 5 ahead of comparable countries. (Other Countdown countries such as Liberia and the Niger are achieving fast-track progress to reduce child mortality. If we consider all 144 LMICs, rather than only the 75 Countdown countries, additional fast-track countries for reducing both maternal and child mortality include the Maldives and Turkey). Research methods The Success Factors studies teams developed five primary technical papers based on: (i) quantitative mapping of trends; (14) (ii) econometric modelling; (15) (iii) Boolean, Qualitative Comparative Analysis; (16) (iv) literature review with narrative evidence synthesis; (17) and (v) country-specific literature and data reviews in 10 fast-track countries. (18) As a following step, ministries of health will convene multistakeholder policy review meetings in the 10 selected fast-track countries to document milestones on each country's pathway to improving women's and children's health. Each country will subsequently publish a policy report. (19) Box 1. Analytical framework for the Success Factors for Women's and Children's Health study series Independent variables Health sector: investments in health systems with universal access to services * Service delivery (e. …