Women, newborns, children, and adolescents: life-saving momentum after a slow start
Improving information systems
Improving information systems became the next objective, spearheaded by the government of Canada with its G8 Muskoka Initiative in 2010. That initiative, which secured commitments of more than $7.3 billion in funding over the next five years, put information and accountability firmly on the agenda of plans for improving maternal and child health. As health officials increasingly recognized, the information collected in a well-performing system for civil registration and vital statistics saved lives but also provided proof of legal identity. Having that legal identity facilitated access to essential social services, including health and education.
The international community had much to build on. Country-specific estimates of maternal and child mortality had been steadily improving since 2004, when WHO, UNICEF and the World Bank launched two interagency groups to produce yearly estimates of maternal and child mortality. The interagency groups used a standardized methodology that brought consistency and greater precision to what had been widely varying estimates separately issued by the three agencies. Membership of the interagency group was later expanded to include the UN Population Division and several national and academic institutes devoted to the improvement of statistical data. Over the years, the modelling approach was refined to optimize the use of diverse country-specific data sources and provide more precise estimates of uncertainty. The two annual estimates of maternal and child mortality became the foundation for other annual reports, including UNICEF’s The State of the World’s Children, the World Bank’s World Development Indicators, and WHO’s World Health Statistics.
The estimates from the interagency groups also informed the annual reports, starting in 2005, of the Countdown to 2015 for Maternal, Newborn and Child Survival initiative, which became the principal instrument for monitoring and accountability in the 75 countries that bear 99% of the burden of maternal and child mortality. Drawing on the expertise of more than 40 participating institutions and agencies, including WHO, Countdown gave measurement a strong technical component, with a standardized methodology that brought confidence in the data and facilitated reliable country comparisons and charting of trends.
Countdown’s annual reports assessed coverage with specific life-saving interventions and gave particular attention to health systems and financing as the two main drivers of coverage. With their focus on the situation in individual countries, the reports showed how building on existing systems for monitoring and reporting was the best way to achieve realistic and sustainable improvements.
"Each maternal death has a story to tell and, if properly investigated, can yield data on ways to prevent future deaths among women in similar circumstances."
Dr Chan, WHO Director-General
In 2010, the heads of WHO and seven other agencies working in global health issued a call to improve health data in response to demands for evidence of results and accountability. The agency heads called for a shift away from the current focus on defining indicators and reporting requirements towards building the capacity of information systems within countries. They also noted that systems for civil registration and vital statistics had shown virtually no improvements over the past several decades.
At the time, maternal mortality estimates were based on statistical models, which increase global awareness of the problem, but do not provide information needed for a targeted and timely response. To improve the situation, WHO built on the established methodology for conducting maternal death reviews to put forward a comparatively new approach, Maternal Death Surveillance and Response, based on the premise that each maternal death has a story to tell and, if properly investigated, can yield data on ways to prevent future deaths among women in similar circumstances.
The emphasis was firmly placed on taking action in a continuous cycle of investigation, learning, and introducing improvements. Using the approach, investigation leads to identification of the barriers women faced, the resources available, and the care they received, benchmarked against standards of best practice where available. Apart from supporting progressive improvements in the prevention of maternal deaths, the approach made health professionals accountable for ongoing self-assessment.
WHO also issued guides showing how ICD-10, the standard coding tool, could be used to accurately capture and classify the causes of perinatal and maternal deaths.