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World Health Organization, Geneva, Switzerland. Options Consultancy, London, England. University of Otago, Dunedin, New Zealand.
Correspondence to Shyama Kuruvilla email: Bulletin of the World Health Organization ; Gini; ratification of human rights treaties Economic development e. GDP per capita Good governance across sectors e. Other Countdown countries such as Liberia and the Niger are achieving fast-track progress to reduce child mortality.
If we consider all LMICs, rather than only the 75 Countdown countries, additional fast-track countries for reducing both maternal and child mortality include the Maldives and Turkey. Research methods The Success Factors studies teams developed five primary technical papers based on: Each country will subsequently publish a policy report.
We then refined the thematic categories, inductively and iteratively, using a triangulate to validate approach across the qualitative and quantitative methods.
Using a narrative synthesis approach 21 we anchored each thematic category to data from the Success Factors studies; for example, with statistical trends, econometric models or country examples.
Through regular discussions with the different study teams, we reached a shared understanding and agreement on the emerging narrative synthesis. The narrative synthesis continued until there was thematic saturation; 22 that is, when existing thematic categories could accommodate new findings but no new themes were required to categorize the data.
While there is no standard formula, fast-track countries are moving ahead in three main areas to reduce maternal and child mortality: Multisector progress The Success Factors studies find that the key to progress in fast-track countries is improvement across a range of health determinants within and beyond the health sector Fig.
For example, countries that are making accelerated progress towards MDGs 4 and 5a are also making progress on most of the other MDGs, e. Factors involved in declining child mortality in low- and middle-income countries,— GDP: Adapted from Bishai et al.
P-values estimated using N-way ANOVA comparing fast-track countries with the 65 other countries, excluding the 10 countries with slower rates of progressfor stronger statistical power.
Some values are scaled by factor of 10 to be comparable on a single chart. Inacross the countries, levels for most factors were not significantly different, except that fast-track countries had significantly lower prenatal care, power consumption per capita and Gini coefficient.
For each Success Factor fast-track country, one matched control country was identified to form a comparison group.
Adapted from World Health Organization http: The Success Factors econometric analysis by Bishai et al. India, Nigeria experienced fast economic growth, but did not make commensurate progress on maternal and child health.
Bangladesh, China and Rwanda made good progress while following diverse economic strategies. High-impact interventions and systems strengthening were important; e. Income inequalities within countries had a negative impact on child mortality Fig.
The proportions of factors varied by country, and with the statistical models used, but the core set of multisector factors contributing to accelerated progress was the same.
The Boolean analysis further explored whether there were specific configurations of factors associated with countries making fast-track progress. No single configuration of factors proved necessary or sufficient. There were also no simple cut-off points, or levels of coverage, associated with fast-track progress, as these varied depending on country contexts, starting levels in and combined progress across a core set of multisector factors.
However, both the Boolean and econometric analyses were limited by the fact that the global maternal mortality estimates, e. GDP per capita, total fertility rate, and skilled birth attendance. Ensuring value for money is also a key feature of enabling governance, as most fast-track countries improved health outcomes despite relatively low levels of investment Fig.
The Success Factors literature review found decentralized governance to be an enabling factor for accelerated progress. Rwanda has a highly centralized policy-making approach supported by district-level planning and implementation.
Caution is therefore needed when interpreting decentralized governance as a success factor.It may seem hard to believe in this age of the Internet and virtual reality, but anything can't be anywhere. Despite the emergence of a global economy, regional and statewide economic initiatives based on industry clustering have taken hold, proving the importance of place as a trigger for bolstering economic development and business success.
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Critical-to-success factors (CSFs) have become essential elements to strategic planning and no business can achieve consistent success without effectively adopting them. Michael Stanleigh, CMC, CSP, CSM is the CEO of Business Improvement Architects.
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