Today we publish our special Countdown to MDG 4 & 5 issue of The Lancet to coincide with the Countdown to 2015 Conference taking place in Capetown next week. You can access the PDFs of the whole issue on The Lancet Global Health Network (here) and also listen to the whole press conference of yesterday’s launch (here).

I was at the press conference yesterday and I think it is fair to say that there was a mixture of optimism and pessimism in the room. There are many things to be gloomy about as some of the key challenges I have listed below highlight. But let’s be positive. Tanzania shows that with strong leadership and increased funding, reaching the MDG 4 target can be achievable. And this increased funding is not much. Tanzania now spends US$11 per child per year, $4 more than the average in the target 68 countries. But it is not just the amount of funding that is important but what donors are funding. Pneumonia is still the biggest killer in children under 5 and treatment for this condition relies on functioning health systems. To date, donors have mostly favoured funding programmes that target the “easy wins,” such as immunisations, rather than trying to help strengthen health systems, with many shying away from giving budget support. So although the international community now has a much better idea about what needs to be done to achieve MDG 4 and 5, we actually need to make it happen.

We MUST encourage stronger leadership, encourage donors to give more- and to be more flexible about what they give to, ramp up our campaigning and advocacy work, and encourage everyone to get involved and play their part. As Jennifer Bryce said at the press conference yesterday, we are at a tipping point. If we wait another 2 years before taking these measures, it is almost certain that the MDG targets will be missed. But we should also get ready for the long haul. The MDG targets only cover half ie HALF the number of deaths in women and children, HALF the number of people living in poverty, HALF the number of people without access to clean water and improved sanitation… What about the other half? Reaching the MDG targets alone is not enough and the international community must begin to prepare and plan now to go beyond this “health for half”, and aim once again for health for all. Rhona MacDonald

Key Challenges

• The great majority of the priority countries (50 of 68) are making inadequate progress towards both MDGs–a call for massive global efforts.
• Twenty-six of the 68 priority countries (38%) are making insufficient progress and another 26 (38%) are making no progress towards MDG 4. Twelve countries (Botswana, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Kenya, Lesotho, South Africa, Swaziland, Zambia and Zimbabwe) had increased child mortality rates since 1990.
• A large majority of the priority countries (82% or 56 countries) had either “high” or “very high” rates of maternal mortality.
• The lifetime risk of maternal death ranges from 1 in 7 in Niger to 1 in 1300 in China (a more than 160-fold difference) across the priority countries.
• Progress in reaching MDGs 4 and 5 will also depend on the global progress in tackling under-nutrition–an underlying cause of 3.5 million child deaths annually, and at least 35% of disease burden in under fives and 20% of maternal mortality. In 33 of the 68 priority countries, at least 20% of children are either moderately or severely underweight.
• Africa is where the biggest proportion of deaths occur, half of all maternal and child deaths, amongst only 11% of world population.

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