Next generation maternal health: external shocks and health-system innovations
2016
Paper five in the maternal health Lancet series discusses external factors that may affect pregnant women, their communities and health facilities over the next 15-20 years. These include social, political, environmental and demographic changes.
IntroductionPaper five in the maternal health Lancet series discusses external factors that may affect pregnant women, their communities and health facilities over the next 15-20 years. These include social, political, environmental and demographic changes.The authors identify four external shocks and three promising innovations that will affect maternal health. These present both challenges and opportunities.External shocksEconomic growth and domestic health financingOver time, countries will need to rely more on domestic financing as donor health funding declines.In the next 20 years, low- and middle-income countries (LMICs) are on course to experience a surge in economic growth generating more domestic revenues that could be allocated to health, such as taxation of tobacco, alcohol and tourism, and redirecting subsidies in fossil fuels.Shifts in health governanceThe shift from the Millennium Development Goals to the Sustainable Development Goals (SDGs) means that maternal health is now one of many indicators relating to health, rather than a standalone indicator.Governance decentralisation will shift decision making from federal to sub-national level, challenging the standardisation of policies. This could affect progress towards global commitments as local governments may feel less accountable to meeting the SDGs.UrbanisationRural to urban migration has increased the world’s urban population, with urban migration highest in LICs. The benefits for women and their newborns living in urban areas include reduced travel times to health facilities, greater availability of services, and increased number of trained workforce. Low-income women in urban settings, however, often give birth in facilities with poor regulations, weak personnel and low provision of emergency obstetric care. Further investigation is needed of poor, urban women and their access to maternal health-care.Health crisesOutbreaks of diseases, armed conflict, and natural events can breakdown health systems that are already weak. Health systems must build a resilience to simultaneously respond to health crises and provide routine maternal health care.Health system innovationsUniversal health coverageUniversal health coverage (UHC) aims to improve access to health services while reducing financial barriers.UHC improves maternal health through health insurance, expanding access to acute and chronic treatment, and promoting a life-course of care as part of an integrated approach to women’s health. In Ethiopia, for example, free caesarean section as a life-saving intervention prevented 98 cases of poverty for each $100,000 spent.Behavioural economics to improve choicesThe decisions of mothers and their partners can influence maternal and newborn health, yet these decisions aren’t always informed or rational. Behavioural economics can help assess why individuals make inconsistent decisions with their health and wellbeing, and how changes in decision making have the potential to positively affect maternal health outcomes.Mobile health (mHealth) and the data revolutionA surge in mobile phone use has led to a rise in mHealth that can improve individual and household engagement in maternal health care.Increases in data availability can improve the use of evidence in decision making and accountability.DiscussionWith rapid changes in maternal health over the next 15 to 20 years, five policy implications must be considered:
- The three delays model, “seeking, reaching and receiving care” (p.8), requires updating. The first and second delays are expected to reduce as rural women migrate to urban areas. The third delay has been relatively neglected and requires further investigation.
- Health-system financing to ensure UHC must include women from marginal groups to avoid widening health inequities.
- Community action is needed to advocate for greater domestic financing and accountability in health.
- Donors must ensure that external financing supplements domestic spending.
- More research is needed in urban health and the health of migrant women.
Kruk, M.E., Kujawski, S., Moyer, C.A., Adanu, R.M., Afsana, K., Cohen, J., Glassman, A., Labrique, A., Reddy, K.S., Yamey, G. (2016). Next generation maternal health: external shocks and health-system innovations. The lancet, Maternal Health Series Paper 5, (Early online publication).
