Health extension workers in Ethiopia Photo Credit Dominic Chavez

A little known reality at well-publicized donor pledging conferences is that the pledges sometimes are just empty promises and nothing materializes.

But, a new United Nations spending report released Tuesday had two pieces of surprising news.

Here’s the story: Last year, as the U.N. general assembly was holding its annual meeting, member states pledged more than $40 billion for a maternal and child health initiative known as ‘Every Woman Every Child.’

Now as they are again convening, the U.N. checked to see what happened.  Donors have committed close to $45 billion – exceeding the pledges – and some of the biggest givers have been developing countries.  In fact, developing countries gave $11 billion.

Three countries leading the way in investments to save the lives of women and children are Bangladesh, Ethiopia, and Nepal. These countries delivered not only the committed money, but also increased the provision of services for maternal and child health.

On Tuesday, at a high-level event chaired by U.N. Secretary-General Ban Ki-moon to discuss the report, the two MLI countries – Ethiopia and Nepal –  as well as Bangladesh were lauded for their progress over the last year. In addition to meeting their U.N. pledge, these countries went above and beyond by setting aside more funds for maternal and child health for their populations. The report noted that this accomplishment signals a change in development aid as more countries are taking more responsibility over their spending priorities.

Dr. Julio Frenk, chairman of the World Health Organization’s Partnership for Maternal, Newborn and Child Health, noted that these countries are “moving away from the paternalistic to a framework for shared accountability.”

Part of Ethiopia and Nepal’s success has been due to the training of community health workers. A stronger health workforce to reach women and children to deliver antenatal and postnatal care is vital to decreasing maternal and child mortality. Nepal has begun training a legion of 10,000 more skilled birth attendants and Ethiopia has 30,000 health extension workers that function in pairs in villages all over the country to reach its population of 85 million people.

Minister of Ethiopia’s Federal Ministry of Health, Tedros Adhanom Ghebreyesus, told The Lancet earlier this year, “We really want to be helping communities help themselves by expanding public health services in villages.”

And it has paid off as Minister Tedros announced this week the preliminary results of the 2011 Ethiopia Demographic and Health Survey. The infant mortality rate has decreased 23% from 77 deaths per 1,000 births in 2005 to 59 deaths per 1,000 births and while under-five mortality has decreased by 28% from 123 to 88 per 1,000 births.

Expansion of services is working to save lives everywhere as Norwegian Prime Minister Jens Stoltenberg told the gathering on Tuesday that in the past year 600,000 more children survived and an additional 70,000 mothers survived childbirth.

U.N. Secretary-General Ban Ki-moon, who made the ‘Every Woman Every Child’ a special project after seeing high levels of maternal and child mortality growing up in South Korea, was pleased with the results.

 “In our time, it is wrong to allow women and children to die when we have the tools to save them,” Ban said. “I am happy to say that one year later we are delivering.”