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How Ethiopia achieved Millennium Development Goal 4 through multisectoral interventions: a Countdown to 2015 case
Jenny Ruducha1, Carlyn Mann2, Neha S Singh3
1Braintree Global Health, Cambridge, MA, USA.
The Lancet. Global Health
|October 14, 2017
Summary
Ethiopia significantly reduced under-5 mortality, achieving Millennium Development Goal 4 by 2013 through integrated health, nutrition, and non-health sector strategies. Increased funding and community-based delivery systems accelerated progress, though challenges in equity and coverage remain.
Area of Science:
- Public Health
- Global Health
- Health Policy and Systems Research
Background:
- Ethiopia achieved Millennium Development Goal 4 (MDG4) for child survival 3 years ahead of the 2015 deadline.
- Under-5 mortality rate (U5MR) decreased by 69%, from 205 to 64 deaths per 1000 livebirths between 1990 and 2013.
- Ethiopia was chosen as a case study by the Countdown to 2015 initiative to analyze factors contributing to this success.
Purpose of the Study:
- To analyze the progress in child health in Ethiopia from 1990 to 2014.
- To identify the underlying factors, including policies and interventions, that contributed to the reduction in under-5 mortality.
- To assess the role of health system investments and multisectoral approaches in achieving child survival goals.
Main Methods:
- Utilized Demographic Health Surveys (DHS) to track trends in reproductive, maternal, and child health (RMCH) indicators and equity.
- Employed standardized tools to analyze the timing and content of health and non-health policies.
- Conducted financial analysis of National Health Accounts for health system investment trends and used the Lives Saved Tool (LiST) to quantify intervention impact.
Main Results:
- The annual rate of reduction in U5MR accelerated significantly from 3.3% (1990-2005) to 7.8% (2005-2013).
- Stunting prevalence decreased from 60% (2000) to 40% (2014); child immunization coverage rose from 21% to 80%.
- A post-2005 upturn was driven by increased health funding, expansion of health infrastructure/workforce via community-based systems, and multisectoral policies integrating child survival with poverty reduction and food security.
Conclusions:
- Ethiopia's success in reducing under-5 mortality resulted from integrated efforts across health, nutrition, and non-health sectors.
- Significant improvements were observed in child immunization and family planning coverage, alongside a reduction in stunting.
- Despite progress, challenges persist in addressing neonatal/maternal mortality, reducing inequalities, and strengthening multisectoral partnerships.