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Maternal and Child Health

• Health Financing
• Maternal Child Health Services
• National Health Accounts
• Costing Tools

Health Financing

Community-Based Health Financing

There is evidence that mothers and children who are members of community-based health financing schemes (CBHF) have better access to and higher use of health interventions such as pre-natal care and insecticide treated nets (ITNs), compared to non-members.

Health Systems 20/20 is taking this CBHF advantage a step further by evaluating the effectiveness of CBHF schemes to promote the sustained use of products such as point-of-use water purification among women and children. It is hoped that CBHF schemes will facilitate the distribution and use of these products among target populations, and in turn will achieve reduced costs by preventing disease. Health Systems 20/20 is collaborating with the Point-of-Use Water Disinfection and Zinc Treatment (POUZN) project in Rwanda to initiate an evaluation there, given the high prevalence of malaria and diarrheal disease among children, the extensive coverage of CBHF, and the pre-existing supply of point-of-use water and ITN products.

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Elimination of Cost Barriers to Maternal and Child Health Care

Mali has a high maternal mortality ratio. At the same time, access to caesarians and other life saving obstetric care is extremely low. Health Systems 20/20 is working with the Ministry of Health to evaluate the impact of the free caesarian policy introduced by the government of Mali in 2005. The study will assess the policy’s impact on access to caesarians (especially among women from lower socio-economic strata) and identify remaining barriers. Findings from the study will be used to define future interventions or programmatic changes to reduce maternal mortality. The team is using a combination of research methods, including a comparison of pre- and post-policy data from health facilities’ HMIS, post-policy public sector facility data, and community-level qualitative data.

In addition to evaluating the impact of the free Caesarian policy on access to maternal health care, Health Systems 20/20 is investigating the financial impact of removing user fees for children under five in the public sector in Mali. There is a general consensus that eliminating fees will increase the utilization of public health services especially among the poorest populations. Health facilities, however, depend on user fees to cover a large proportion of their non-salary operational expenses. Eliminating user charges could have adverse consequences for the delivery of primary health services. Health Systems 20/20 will use the evaluation results to address these policy questions and identify the challenges in implementing a user fee waiver. Read more about work in Mali.

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Maternal Child Health Services

Misoprostol to Prevent Postpartum Hemorrahage

Many of the effective methods and treatments to prevent postpartum hemorrhage (PPH) are not feasible in resource-poor settings. PPH, therefore, is a major cause of maternal mortality in the developing world. In recent years, studies have been conducted in developing countries to measure the benefits of Misoprostol, a drug that reduces the risk of severe PPH. Misoprostol has been approved in many countries worldwide. Most African countries have yet to explore Misoprostol at a public policy level. In the meantime, high rates of maternal mortality due to PPH persist.

USAID’s Maternal Health team, Global Health Bureau, and Africa Bureau developed the Safe Birth Africa Initiative (SBA) in early 2006 to focus on active management of 3rd stage labor and essential newborn care. Health Systems 20/20 conducted a SBA activity in Senegal to evaluate community-based approaches to using Misoprostol to prevent PPH in home births and rural maternity locations.

Health Systems 20/20 worked in collaboration with the Ministry of Health of Senegal, Centre de Formation et de Recherche en Santé de la Reproduction (CEFOREP), IntraHealth and Christian Children’s Fund. Policy issues included adding this drug to the MOH drug list and allowing the introduction of this drug for prevention of PPH at the community level.

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Immunization Coverage

In recognition of the importance of strong health systems in achieving child health improvements such as immunization coverage, in 2006 the GAVI Alliance launched a new grant window expressly for health system strengthening (www.gavi.org). Health Systems 20/20 assists countries with grant applications and implementation. Read more about work in Madagascar.

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National Health Accounts

Advocates for child health services rely on data describing child health expenditures. As noted in The Lancet 2003 series on child survival, “Knowledge of how much is being invested is essential to measure progress and ensure accountability. Mechanisms are needed to track financial investments in child survival.” Read more from this report.

Health Systems 20/20 works with the Child Survival Partnership (CSP), WHO, and other partners to finalize the methodology for conducting a child health National Health Accounts subanalysis that captures public, private, and donor expenditures whose primary purpose is to improve, maintain, or restore the health of a child under five years of age. For example, the child health subanalysis in Malawi measured a slight decline in child health expenditures from 16% in 2002/03 to 15% in 2004/05. Read more from this analysis.

Health Systems 20/20 assists countries across the full range of activities from data collection approaches to the translation of the information into formats that legislators, policymakers, and civil society members can easily understand and use.

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Costing Tools

Interagency Working Group on Health Millennium Development Goals Costing Tools

A major barrier to achieving child health goals and to scaling up child health interventions is a lack of financial resources. Even in situations when there are sufficient financial resources available, they are not optimally used and cost-effective interventions are not implemented. Given limited funds, it is important for policymakers and program managers to strategically plan for and allocate resources that are in line with program goals and objectives.

It is critical to be able to calculate the costs of child health interventions to provide health decision-makers with valuable information for budgeting, carrying out efficiency assessments, and prioritizing health interventions. Conducting costing exercises can help policymakers and program managers estimate the costs needed to scale up certain services and reach program goals.

To help countries navigate the variety of costing tools and to help guide them in deciding which tools should be used for which circumstances, Health Systems 20/20 has partnered with the Interagency Working Group on Millennium Development Goals (MDG) Costing Tools, convened between the World Bank, WHO, UNICEF, and UNFPA.

Health Systems 20/20 provided support to the Interagency group to review methodologies of MDG costing tools, to facilitate a costing tools’ user meeting to get perspectives from users on the usefulness and utility of the tools, and to generate a toolkit/guidelines to help countries navigate the array of available costing tools. This work assisted countries to choose the most appropriate tool and determine what level of expertise is needed to undertake a costing exercise.

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Interactive Costing Tool Guide

In collaboration with Health Systems 20/20, the Partnership for Maternal, Newborn & Child Health (PMNCH) has launched an online costing tools guide that helps users determine which costing tools are most appropriate for their needs. The guide provides information on costing tools available in multiple languages and technical areas.

Click here to see the Costing Tool Guide.

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