Academic journal article Bulletin of the World Health Organization

Estimated Global Resources Needed to Attain Universal Coverage of Maternal and Newborn Health services/Estimation Des Ressources Necessaires a L'echelle Mondiale Pour Atteindre Une Couverture Universelle Par Les Services De Sante Maternelle et neonatale/Estimacion De Los Recursos Mundiales Necesarios Para Lograr la Cobertura Universal De Servicios De Salud De la Madre Y del Recien Nacido

Academic journal article Bulletin of the World Health Organization

Estimated Global Resources Needed to Attain Universal Coverage of Maternal and Newborn Health services/Estimation Des Ressources Necessaires a L'echelle Mondiale Pour Atteindre Une Couverture Universelle Par Les Services De Sante Maternelle et neonatale/Estimacion De Los Recursos Mundiales Necesarios Para Lograr la Cobertura Universal De Servicios De Salud De la Madre Y del Recien Nacido

Article excerpt

Introduction

An estimated 15% of pregnant women in developing countries experience pregnancy-related complications, 7% require care at centres with surgical capacity (referral care) and 2% to 3% require surgical care. (1) Nearly 530 000 women die from pregnancy complications annually. (2) Furthermore, each year an estimated 4 million babies die within the first 4 weeks of life, around three-quarters during the first week of life. (1) Deaths among neonates account for almost 40% of deaths occurring among children aged < 5 years and for more than half of all deaths among infants. (3,4) An additional 3.3 million babies are stillborn, a quarter of them dying during birth.

In developing countries, interventions that are known to be effective in lowering maternal and perinatal mortality and morbidity are not universally provided. These interventions can be delivered by skilled health personnel providing care during pregnancy, childbirth and the postpartum and postnatal periods; health-care personnel may also provide early detection and management of complications that occur during pregnancy, birth and the postpartum period. However, in the countries included in this analysis, only about 43% of births take place in health facilities where there are skilled health personnel. (5,6) The skill levels of these personnel vary, and only a fraction of mothers and babies have access to a full range of maternal and neonatal health interventions. Thus, scale up of these interventions must occur on two fronts: the quality and range of health services for mothers and neonates must be improved, and access to skilled birth attendants must be increased.

Scaling-up the coverage of maternal and newborn health care provided by skilled personnel is expected to have a considerable impact on achieving the Millennium Development Goals, specifically goal 5 (which aims to improve the health of mothers), large parts of goal 4 (which focuses on reducing child mortality) and parts of goal 6 (which seeks to combat AIDS, malaria and other diseases). For these goals to be achieved, countries, donors and multilateral agencies must mobilize resources. To determine the resources needed, it is necessary to estimate the cost of scaling-up to universal coverage.

This paper presents the methods used to construct a model and the results of two scenarios used in the model to estimate the financial costs of expanding the coverage of skilled maternal and newborn health care at facilities. The two scenarios reflect uncertainty around the speed and scope of future scale-up rates. Both scenarios assume that resources supporting current maternal and newborn health-care programmes will remain available; thus, they include only costs additional to current resource use.

The cost projections are based on country-specific and year-specific estimates for 75 low- and middle-income countries. The costing includes clinical interventions critical to improving health outcomes during pregnancy for mothers and neonates, and it is not limited to interventions that save lives. It includes the provision of information, advice and counselling to help women and their families with home care, birth planning and emergency preparedness as well as community support for women with special needs. It assumes that existing primary- and secondary-level health-care services deliver maternal and newborn health services. The cost estimates include the investments needed to strengthen the health system infrastructure and human resources as well as the costs of the management and support needed to ensure that high-quality care is provided, that there is a demand for these health services and that they are accessible.

Methods

To estimate financial needs until 2015 of expanding the coverage of maternal and newborn care provided by skilled personnel, we selected countries for the analysis; derived country-specific estimates and projections of pregnancies, births and abortions; selected the activities to be scaled up; estimated scale-up scenarios; and calculated country-specific unit costs (for additional information, see http://www. …

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