Investment case for improving maternal and child health: results from four countries

Abstract

BackgroundWithout addressing the constraints specific to disadvantaged populations, national health policies such as universal health coverage risk increasing equity gaps. Health system constraints often have the greatest impact on disadvantaged populations, resulting in poor access to quality health services among vulnerable groups.MethodsThe Investment Cases in Indonesia, Nepal, Philippines, and the state of Orissa in India were implemented to support evidence-based sub-national planning and budgeting for equitable scale-up of quality MNCH services. The Investment Case framework combines the basic setup of strategic problem solving with a decision-support model. The analysis and identification of strategies to scale-up priority MNCH interventions is conducted by in-country planners and policymakers with facilitation from local and international research partners.ResultsSignificant variation in scaling-up constraints, strategies, and associated costs were identified between countries and across urban and rural typologies. Community-based strategies have been considered for rural populations served predominantly by public providers, but this analysis suggests that the scaling-up of maternal, newborn, and child health services requires health system interventions focused on 'getting the basics right'. These include upgrading or building facilities, training and redistribution of staff, better supervision, and strengthening the procurement of essential commodities. Some of these strategies involve substantial early capital expenditure in remote and sparsely populated districts. These supply-side strategies are not only the 'best buys', but also the 'required buys' to ensure the quality of health services as coverage increases. By contrast, such public supply strategies may not be the 'best buys' in densely populated urbanised settings, served by a mix of public and private providers. Instead, robust regulatory and supervisory mechanisms are required to improve the accessibility and quality of services delivered by the private sector. They can lead to important maternal mortality reductions at relatively low costs.ConclusionsNational strategies that do not take into consideration the special circumstances of disadvantaged areas risk disempowering local managers and may lead to a “business-as-usual” acceptance of unreachable goals. To effectively guide health service delivery at a local level, national plans should adopt typologies that reflect the different problems and strategies to scale up key MNCH interventions.

Trends and inequities in use of maternal health care services in Indonesia, 1986−2012

“…Along with education and economic status, geographic location is of equal importance. 15 , 36 – 38 In this study, utilization was significantly lower in rural areas and outside of Java–Bali regions. Our results corroborate with finding from previous studies as similar disparities in terms of rural–urban and regional differential in health outcomes have been reported earlier.…”

“…Our results corroborate with finding from previous studies as similar disparities in terms of rural–urban and regional differential in health outcomes have been reported earlier. 33 , 38 , 39 Undeniably, health facilities, health workers, and other resources are more concentrated in urban areas and in Java–Bali, 11 , 28 making the services more readily available in these locations. From the annual trend, it was obvious that worse-off regions such as Maluku and Papua consistently lagged behind.…”

Investment case approach for equitable access to maternal neonatal and child health services: Stakeholders’ perspective in Nepal

“…Furthermore, in the primary health care system, which is the main health service provider, the existing critical knowledge and capacity gaps prevent contribution to health plans and budgets [ 13 ]. Health system constraints often impact most negatively on disadvantaged populations, resulting in poor access to quality health care among vulnerable groups [ 14 ].…”

“…In the DIC program the aim was to identify inequities in health service coverage and to design targeted interventions. Existing data suggest that the IC approach helps improving the situation of maternal and child health in Nepal and other countries [ 13 , 14 , 17 ]. This qualitative study aims to understand the perception of local stakeholders of health planning and budgeting of the health care expenses on local level.…”

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia

“…National programs and strategies often fail to consider the hardship imposed by distance and lack of infrastructure that is peculiar to people living within rural settings [18]. Poor social status among women in South Asian countries is a great contributor to lack of family planning and a rising population growth.…”