Closing the Gap: Accelerating Maternal and Child Health Progress in South and Southeast Asia
Countries across South and Southeast Asia have made remarkable progress in maternal, newborn, and child health (MNCH) over the past two decades, but have followed markedly different paths to achieve these gains. Through a comparative analysis of Bangladesh, India, Indonesia, Malaysia, Nepal, Pakistan, and Sri Lanka, this report finds that sustained improvements have not been driven by individual interventions alone, but by long-term investments in primary healthcare, institutional capacity, community-based service delivery, and adaptive governance. While each country’s context is unique, their experiences demonstrate that durable progress depends on building resilient health systems capable of delivering continuous, equitable, and quality care. The report highlights cross-country lessons and emerging opportunities to help policymakers strengthen MNCH systems and accelerate progress across the region.
Key Insights
- MNCH progress is driven by systems, not standalone programs. The countries that achieved the most sustained gains built institutions capable of maintaining services through political transitions, fiscal constraints, and changes in government.
- Where countries spend matters as much as how much they spend. Malaysia, Sri Lanka, Bangladesh and India demonstrate that substantial MNCH gains are possible without exceptionally high health spending when resources are consistently directed toward primary care, prevention, skilled birth attendance and community-based delivery. At the same time, Pakistan shows that chronically low financing eventually constrains system capacity.
- Community health workers are most effective when they are embedded in the health system. There is no single optimal CHW model: volunteer cadres can be highly effective for mobilization and referral, while more clinical responsibilities require stronger remuneration, supervision, training and institutional integration.
- Demand-side interventions work best when supply is ready to respond. Cash transfers, fee removal and financial protection can increase utilization, but incentives alone cannot overcome poor-quality or unavailable services. The strongest approaches combine affordability with community trust, information and adequate service capacity.
- MNCH and demographic transition reinforce each other. Investments in health, family planning, girls’ education and women’s empowerment contributed to declining fertility; lower fertility, in turn, reduced pressure on health systems and created greater space to improve quality and equity. Pakistan remains the regional outlier on this trajectory.
Focus Areas
Acknowledgements
This report was developed by Globesight as part of the broader South-South Collaboration Initiative, which seeks to strengthen regional learning and knowledge exchange on maternal, newborn, and child health across South and Southeast Asia. We are grateful to the Gates Foundation for its continued support of this initiative and its commitment to advancing evidence-based dialogue and cross-country collaboration to improve health outcomes across the region. We are especially grateful to Dr. Irshad Danish, Dr. Umair Siddiqui, and Zoha Waqar (Pakistan); Dr. Ravi Rannan-Eliya (Sri Lanka); Dr. Dharma S. Manandhar (Nepal); Dr. Syed Abdul Hamid (Bangladesh); and Dr. Widyaretna Buenastuti (Indonesia) who generously shared their time and expertise through structured consultations that informed the country analyses presented in this report. Their insights provided invaluable context on national reform trajectories, implementation experiences, and emerging priorities in maternal, newborn, and child health. We also thank Global Health Strategies, particularly Anjali Nayyar, Akshay Ravi and Sita Shankar Wunnava; Inke Maris, particularly Amira Husna Natanegara; and Tabadlab, particularly Umar Nadeem and Shahab Siddiqi, for their thoughtful guidance and feedback during the development of this report. The findings, interpretations, and recommendations presented in this report are those of the authors and do not necessarily reflect the views of the Gates Foundation or the individuals acknowledged above.