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Cross Country Synthesis

Exemplars in Global Health has identified Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal as Exemplars in reducing under-five mortality.

This cross-country synthesis provides the highest-level insights from our under-five mortality research across all Exemplar countries. For policy makers, funders, and implementers seeking to understand what has worked to reduce under-five mortality quickly and at scale, this is a central repository of knowledge on our website.

Here, we have highlighted the most critical lessons and recommendations based on learnings across all of the Exemplars countries in under-five mortality. The hyperlinks on this page serve as a useful tool for locating corresponding background and illustrative examples that support our findings within each country narrative.

Tremendous progress has been made in reducing mortality among children under the age of five (under-five mortality or U5M), but over 5 million children still die every year, and most of these deaths are from preventable causes. Continued progress in reducing U5M remains a central global health priority.

Some countries have shown exceptional progress at reducing U5M, and some countries have done so against odds, reducing child mortality faster than their rate of economic development would suggest is likely. The ongoing burden of U5M underscores the need to look at key lessons from these countries.

We present the results of a cross-cutting analysis of six “Exemplar” countries that have made particularly impressive strides to reduce U5M relative to their economic growth: Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal.

While each of the Exemplar nations operated within their own distinctive political, economic, cultural, and geographic contexts, findings from the research revealed a number of strategies commonly adopted by Exemplar countries. Five of these strategies are detailed in this section, which hold value for other countries looking to reduce their under-five mortality.

  • Stakeholder engagement and coordination
  • Use of data and evidence for decision-making
  • Integration of new and existing initiatives into health systems
  • Building and using research capacity
  • A focus on equity

In addition, to the cross-cutting recommendations, it is also important to recognize the unique contextual factors in each country that influenced their strategies for reducing under-five mortality. These contextual factors include geography, culture, economics, political structure, and national history, among others. Further detail on how the Exemplar countries accounted for key contextual factors can be found in this section.


Between 2000 and 2017, the Exemplar countries each achieved substantial declines in under-five mortality, as a result of key interventions and strategies. These either directly addressed amenable mortality or more broadly reduced the burden of disease and improved the resiliency of children and families.

This section contextualizes the relative impact of interventions in each Exemplar country, through describing the percentage reduction in under-five deaths in each country, along with what percentage of this decline can be attributed to interventions. 

Although the Exemplar nations achieved significant drops in under-five mortality during the study period, they face a number of challenges to sustaining progress. Some of these challenges are detailed further in this section.

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