Countdown to 2015 and Countdown to 2030

The Countdown to 2015 started in 2005 as an initiative from the team that published the Lancet Series on Child Survival 1 in 2003. Cesar Victora, one of the authors, was also a co- founder of the Countdown to 2015: Maternal, Newborn and Child Survival initiative, aimed at monitoring population coverage with effective interventions against the leading causes of death among women and children in low- and middle-income countries.

Countdown to 2015 was a multi-stakeholder initiative aimed at monitoring progress toward the Millennium Development Goals numbers 4 (Child Survival) and 5 (Maternal Health). Different from other initiatives, health equity was paramount to their monitoring effort. Standardized health indicators stratified by all relevant equity dimensions were needed for that.

In 2009, Cesar Victora presented Aluisio Barros with a big challenge: reanalyzing all available MICS and DHS surveys to produce stratified estimates of the MDG indicators. The challenge was accepted, and the International Center for Equity in Health (ICEH) was born as a key Countdown partner.

In a few months, the analysis platform designed to deal with all survey specificities was working, and estimates were being produced. Those estimates were the base for the Countdown Decade Report (2000-2010) published in 2010.

Since then, the ICEH has grown in size and remit, taking a central role in Countdown, supporting its research, training, and dissemination activities. In 2015, Countdown wasrebranded to Countdown to 2030 for Women’s, Children’s & Adolescents’ Health when the Sustainable Development Goals were launched. Currently, Countdown’s focus is on groundwork, developing monitoring activities with 25 African countries, along with capacity strengthening through a fellows program for young researchers, and multicountry studies on regional health priorities. Visit the Countdown website for more information, reports, publications and health equity analysis tools.

Collection of CD2015 reports in the MDG period

Lives Saved Tool

Lives Saved Tool is a mathematical modeling tool developed to estimate the impact of scaling up specific maternal, newborn, child, and nutritional (MNCH&N) interventions in child and maternal mortality. By estimating the number of lives saved in various scenarios, it helps policy makers prioritize investments in health. LiST was created and is maintained by a team based at the Johns Hopkins Bloomberg School of Public Health led by Neff Walker.

Since 2013, the ICEH has been working with the LiST team to provide custom-tailored disaggregated health-related indicators that are essential to the tool. Currently, the ICEH provides over 15,000 estimates per survey analysed, covering antenatal care, breastfeeding, child development, child health, delivery care, feeding practices, fertility, gender, malaria, mortality, nutritional status, sexual and reproductive health, among others.

GAVI, the Vaccine Alliance

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Gavi, the Vaccine Alliance is an initiative born out of the necessity for progress in international immunization and for making vaccines more accessible to low-income countries. Currently, Gavi vaccinates more than half of the world’s children, as a result of its efforts in negotiating vaccine prices for the poorest nations and funding part of their costs in vaccine implementation.

In order to help Gavi in its mission to save lives by increasing equitable and sustainable use of vaccines, Gavi and ICEH started to work together in 2018. Throughout the years, a team from both institutions has worked in multiple analyses trying to identify drivers of vaccination uptake and inequalities in low- and middle-income countries. Using a global health perspective, the team has worked with a wide range of topics – always connected to vaccination – including religious affiliation, ethnicity, women's empowerment, multiple deprivation, and vaccine cards.

This partnership has already resulted in 25 equity-focused analyses, also producing 8 peer-reviewed publications. The main findings of the articles published demonstrated:

• Focusing on the same four basic vaccines delivered in infancy, 70.9% of the children in 92 countries received all four vaccine types and 59.9% were fully immunised with all necessary doses of the four vaccines. Additionally, zero-dose prevalence ranged from 12.5% in the poorest households to 3.4% in the wealthiest.
• Zero-dose children (those who didn’t receive any doses of the BCG, DPT, Polio, and Measles vaccines) and their mothers were less likely to receive other health interventions, such as antenatal care visits during pregnancy.
• Children with highly empowered mothers had a lower zero-dose prevalence than children from less-empowered mothers
• Children from the majority religious group in each country tended to have lower no-DPT prevalence than the rest of the population, except in Muslim-majority countries.
• No-DPT children were significantly more likely to be exposed to other markers for deprivation, such as lack of improved water and sanitation and less-educated mothers.
• Zero-dose children (those who didn’t receive any doses of the BCG, DPT, Polio, and Measles vaccines) and their mothers were less likely to receive other health interventions, such as antenatal care visits during pregnancy.
• Home-based records of immunization coverage were remarkably low in many low- and middle-income countries, particularly among children from the poorest families and those whose mothers had lower education.
• The number of siblings is a strong risk factor for zero-dose. Zero-dose prevalence increased monotonically with the number of children in the household, as well as with birth order. When the younger sibling was unvaccinated, 69.8% of the older siblings were also unvaccinated.

Combined, ICEH and Gavi help to identify determinants that can be used to target unvaccinated children and tailor interventions that are more likely to reach children, families, and communities that are currently being left behind. More information about GAVI is available here, and about ICEH publications here

Countries supported by GAVI