The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review

Abstract

IntroductionMaternal health services are effective in reducing the morbidity and mortality associated with pregnancy and childbirth. We conducted a systematic review on costs of maternal health services in low-income and middle-income countries from the provider’s perspective.MethodsWe searched multiple peer-reviewed databases (including African Journal Online, CINAHL Plus, EconLit, Popline, PubMed, Scopus and Web of Science) and grey literature for relevant articles published from year 2000. Articles meeting our inclusion criteria were selected with quality assessment done using relevant cost-focused criteria of the Consolidated Health Economic Evaluation Reporting Standards checklist. For comparability, disaggregated costs data were inflated to 2019 US$ equivalents. Costs and cost drivers were systematically compared. Where heterogeneity was observed, narrative synthesis was used to summarise findings.ResultsTwenty-two studies were included, with most studies costing vaginal and/or caesarean delivery (11 studies), antenatal care (ANC) (9) and postabortion care (PAC) (8). Postnatal care (PNC) has been least costed (2). Studies used different methods for data collection and analysis. Quality of peer-reviewed studies was assessed average to high while all grey literature studies were assessed as low quality. Following inflation, estimated provision cost per service varied (ANC (US$7.24–US$31.42); vaginal delivery (US$14.32–US$278.22); caesarean delivery (US$72.11–US$378.940; PAC (US$97.09–US$1299.21); family planning (FP) (US$0.82–US$5.27); PNC (US$5.04)). These ranges could be explained by intercountry variations, variations in provider type (public/private), facility type (primary/secondary) and care complexity (simple/complicated). Personnel cost was mostly reported as the major driver for provision of ANC, skilled birth attendance and FP. Economies of scale in service provision were reported.ConclusionThere is a cost savings case for task-shifting and encouraging women to use lower level facilities for uncomplicated services. Going forward, consensus regarding cost component definitions and methodologies for costing maternal health services will significantly help to improve the usefulness of cost analyses in supporting policymaking towards achieving Universal Health Coverage.

Maternal Mortality and Women’s Political Power

“…We nd no evidence that more resources became available -there is no impact of gender quotas on GDP or international development assistance for maternal health (DAH). We argue that large changes in outcomes are feasible without a large increase in resources, highlighting the low costs of relevant interventions (Banke-Thomas et al 2020;Dupas 2011), and the slack generated by inef ciency and corruption that a motivated leader can put to use (Folbre 2012;Brollo and Troiano 2016;Baskaran et al 2018). In Section 7, we cite evidence consistent with leaders being able to move the outcomes they prioritize by building consensus, provoking legislation and improving policy design and delivery, including better targeting and greater outreach.…”

“…First, policy action on the margins we identify in our analysis of mechanisms (namely, expanding the cadre of skilled prenatal and birth attendants and educating young women) is relatively low-cost because wages of the relevant personnel are low in developing countries. In particular, midwives, nurses and teachers can make a large difference to these outcomes-see Banke-Thomas et al (2020) on costs of extending prenatal care, and Andrabi et al (2020) on costs of extending schooling. Second, there is considerable scope to improve public services by limiting leakage of public funds on account of corruption.…”

Unlocking big data to understand health services usage and government funding during pregnancy and early childhood, evidence in Australia

“…4 In low and middle-income countries without well-established public healthcare systems, the costs and quality of maternal care are generally lower; many women lack access to adequate care and may face high out-of-pocket costs to receive necessary care. 7,8 Escalated costs of maternity care in high-income countries have not resulted in great improvements to the quality of care. 9 Thus, ensuring high-value health care to optimize health outcomes, including women-centredness, is a priority in all nations regardless of income designation.…”

“…In 2011, more than U$15.1 billion were paid to hospitals providing maternity care, which makes birth one of the most expensive conditions for hospital care in the United States 4 . In low and middle‐income countries without well‐established public healthcare systems, the costs and quality of maternal care are generally lower; many women lack access to adequate care and may face high out‐of‐pocket costs to receive necessary care 7,8 . Escalated costs of maternity care in high‐income countries have not resulted in great improvements to the quality of care 9 .…”

Utilization of Facility-based Delivery Services in the Wa Municipality, Ghana

“…Health system factors such as cost of services remains a signi cant barrier that continuously hamper most reproductive women from lower-and-middle income countries in seeking institution-based obstetric care [12]. In order to promote safe motherhood, various policies including no-fee-for-service, pay-for performance and voucher packages were implemented in most countries [13].…”