Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care

This article reviews the evidence on the cost-effectiveness of strategies to improve maternal and newborn health in low resource settings.Methods

• A systematic literature review was conducted of all articles published since 1990. These included papers from peer-reviewed journals as well as informally published materials e.g. international reports
• 48 articles were identified and included in the review, reporting on 43 individual studies conducted across 21 countries. 16 of the articles were classified as ‘high quality’
• Cost-effectiveness was assessed by comparing GDP per capita with ‘cost per life-year saved’ and ‘cost per DALY averted’. To ensure comparability of cost-effectiveness across countries and years, results were converted to US Dollars at 2012 prices.

Key findings & facts

• A diverse range of cost-effective strategies for improving the use and supply of maternal and newborn health services were reported
• Common themes included the use of community-based initiatives, particularly women’s groups and home-based newborn care using community health workers and volunteers. The integration of additional services to routine antenatal care was also highlighted, in addition to breastfeeding promotion and facility compliance with quality of care standards
• Comparisons were made difficult by the variety of ways in which cost-effectiveness was framed, the reporting of context-specific measures, as well as the limited quality of the evidence

Conclusions & key recommendations

• Cost-effective strategies to improve maternal and newborn health can work by two mechanisms 1) increasing the provision and quality of services (supply-side strategies), and 2) encouraging the use of such services among the population (demand-side strategies)

• The paper emphasises the need for a comparable cost-effectiveness measure, such as cost per DALY averted. It also recommends the inclusion of household costs (e.g. travel costs) and volunteer time in a cost-effectiveness analysis
• The authors highlight a lack of high quality data in this area and call for further research, especially into cost-effective strategies for post-partum care

To read the article for free, click here. No subscription required.Mangham-Jefferies, L., Pitt, C., Cousens, S., Mills, A., & Schellenberg, J. (2014). Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review. BMC Pregnancy and Childbirth, 14, 243.