Introduction
Aligned with the Sustainable Development Goals, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) represents an essential shift in prioritisation for actions designed to help families live healthy, secure lives and fulfil their economic potential.1 The reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N) agenda is now both broader and more complex than was the case during the Millennium Development Goal era, creating a need for new data. To contribute to this need, Countdown to 2030 for Women’s, Children’s and Adolescents’ Health (Countdown), a multi-institutional network of academics from institutions around the world and representatives from United Nations agencies and civil society, aims to enhance monitoring and measurement of women’s, children’s and adolescents’ health globally and in countries.2 In 2018, Countdown organised a measurement conference in Stellenbosch, South Africa, that brought together 100 experts in multiple areas of RMNCAH-N, which resulted in the six papers in this supplement and an overall research agenda.
The manuscripts in this collection represent the first developments of Countdown’s work to enhance measurement. They identify some of the persistent measurement and monitoring gaps in RMNCAH-N, for example, by reviewing the evidence on methods for generating effective coverage estimates and presenting actionable analytical methods to identify inequalities within and between countries. The collection also considers measurement advances for early childhood development and for nutrition. Further, it expands to analyse new priority issues, including using national surveys to analyse the impact of armed conflicts on RMNCAH-N;3 and describing the new data needed to better understand the social, political and contextual complexity of health system governance.
Countdown will continue to extend this measurement improvement agenda. In some aspects, however, the measurement and monitoring of RMNCAH-N is more advanced than other health areas, such as infectious diseases, non-communicable diseases, injuries and mental health. Many indicators of service contact and mortality are collected through surveys and can be disaggregated by multiple dimensions of inequality. Indeed, the inequality component of the Universal Health Coverage service coverage index is almost entirely based on RMNCAH-N indicators.4 Major gaps remain, however, in terms of service quality and effective coverage, maternal mortality, morbidity and causes of deaths, cognitive development and multiple other indicators of child well-being, and multisectoral service provision.
Beyond the technical detail of each field, the papers in the collection broadly share two common calls for measurement. First, the need for greater harmonisation of measurement standards, ideally underpinned by an authority such as WHO, as demonstrated by current endeavours in the field of maternal and newborn health, for example.5 Second, the need for investment in further development of measurement tools and methods. Both are plainly justified and align well with expert opinion.6 Consistent with Countdown’s commitment to situate more measurement work in countries and to help build domestic measurement expertise, harmonisation and investment have potential to advance agendas at both global and national levels. But, depending on perspective, there is the possibility of a tension between these two sets of needs.