Centre for Maternal, Adolescent, Reproductive, and Child Health

Ten years on: Content, Cadres and Costs for Community Based Maternal Newborn Care

By Ninha Silva, MARCH Centre Blog Editor (MSc Public Health Candidate)

On the 3rd of October, the MARCH centre celebrated the culmination of ten years of an intervention programme on Community Based Maternal and Newborn Care (CBMNC). The occasion was marked with the launch of a series of eight papers in the last supplement of the Health Policy and Planning journal.

The eight papers that constitute this supplement are the result of a multi-country analysis of costs and health systems conducted in Ethiopia, Tanzania, Uganda, South Africa, Malawi and Bolivia. Led by the London School of Hygiene and Tropical Medicine, the South African Medical Research Council (MRC), Save the Children, UNICEF and the Makarere Centre of Excellence for Maternal Newborn & Child Health, the papers are result of a collaborative work between 38 authors, from 17 institutions.

The event, held at John Snow Lecture Theatre (Keppel Street), was chaired by Professor Joy Lawn, Director of the MARCH Centre and one of the authors of the eight papers. Joining Professor Lawn on the podium and providing an overview of the study, were Dr Emmanuelle Daviaud, lead health economist within the Health Systems Research Unit at South African MRC, Diana Barger, researcher in systems and economics at the University of Bordeaux, and Dr Tedbabe Degefie, researcher at UNICEF New York.

Since 2005, the time of design of this multi-country study, to the present date, the world has observed a considerable shift away from home births towards more facility births. However, research shows that to achieve universal health coverage and a continuous reduction in maternal and newborn mortality, there is a need for health systems to focus community contact points during pregnancy and postnatally.

Implemented in different settings, these research studies included cluster Randomised Control Trials (cRCTs) and two before and after studies. The study team explored the impact, affordability and commodities variations of CBMNC, with the aim to inform policy makers and scale up.

The primary aim of the programme was to analyse costs of the Community Based Maternal and Newborn Care from a provider perspective. To ensure comparability between countries, the study team developed the excel based Cost of Integrated Newborn (COIN) Care tool.

Dr Emmanuelle Daviaud explains that results of the study show that routinely implementing this model of care would translate to an additional annualized financial cost of health expenditures as low as $1 per capita total population in Ethiopia, Uganda and Bolivia. She continues explaining that countries such as Malawi and Tanzania, where “health expenditure per capita is very low, that percentage [of additional health expenditures] looks much higher”.

With more than 5000 Community Health Workers (CHW) trained or assessed throughout the ten years of intervention, results suggest that fixed costs of the programme (such as training, supervision, incentive, and kits) represent “at least 97% of financial costs in four countries and 63% in South Africa”.

Additionally, the authors argue that for the programme to be highly cost-effective, all countries studied would need to avert less than one additional neonatal death per 1000 live births, with exception to Uganda where the requirement would be 1.5 additional averted deaths per 1000 live births.

The launch of the HPP supplement provided space for panellists Dr Josephine Borghi, Dr Claudia Hanson and Dr Donat Shamba to contribute to the discussion and results of the multi-country study.

The Editor in Chief of the journal, Sandra Mournier Black, also marked her presence in the event explaining that the supplement not only “fits with the ambition of the journal”, but also brings “important policy and health research practice and evidence to policy makers”.

If you have missed the launch of the Health Policy and Planning supplement, you can listen to the recording here and find infographic here.

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