The Countdown report for 2010 contains good news—many countries are making progress, reducing mortality and increasing coverage of effective health interventions at an accelerating
pace. But the news is not all good. Many countdown countries are still off track for achieving Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health),
and are not increasing coverage of key health interventions quickly enough. Countdown countries in Sub-Saharan Africa are especially far behind, although a few have shown improvements. The vast majority of maternal and child deaths are preventable, but unacceptably large numbers of women, newborns and children are still dying each year in Countdown countries, where at least 95% of all maternal and child deaths occur. A growing proportion of child deaths occur in the first four weeks of life. Poorly functioning health infrastructure, inadequate numbers of health workers, slow adoption of evidence-based health policies and insufficient focus on quality of care are holding back progress in many countries. Skilled care at birth, including emergency care for mothers and newborns, is critical to achieving Millennium Development Goals 4 and 5: about 2 million lives a year are lost to complications occurring during labour and childbirth. Pneumonia and diarrhoea remain the largest killers of children after the newborn period. Undernutrition contributes to more than onethird of child deaths. Some Countdown countries are doing better at reaching the most disadvantaged women and children, but profound inequities in coverage and health outcomes—both between and within countries—must be confronted and overcome. Countries should aggressively pursue policies to make health services available and affordable for all, by making services free at the point of delivery and exploring innovative financing strategies. Funding is increasing for maternal and child health, but at too slow a pace, and funding for family planning has declined. Millennium Development Goals 4 and 5 are still achievable by 2015—but only a dramatic acceleration of political commitment and financial investment can make it happen.