Setting Priorities for Safe Motherhood Interventions in Resource Scarce Settings

This study aims to guide policy-makers in prioritizing the different components of safe motherhood programs. We compile existing data on safe motherhood interventions and cost these using the WHO's Mother Baby Package (MBP) Costing Spreadsheet as well as Crystal Ball 7.3 to run Monte Carlo simulations with 10,000 trials for each intervention. First, we compare the cost-effectiveness of the 18 interventions included in the MBP as well as safe abortion in low, medium, and high infrastructure settings in sub-Saharan Africa. Socio-demographic data and current maternal health indicators used in the analyses were gathered from the latest available Demographic and Health Surveys and the 2007-08 Human Development Index. Second, we perform a budgetary simulation of the three model settings assuming per capita maternal health expenditures of US $0.50, $1.00, and $1.50. Finally, we conduct a multivariate sensitivity analysis to assess the contribution to variance of different interventions. Preliminary results show that family planning/safe abortion, as well as postpartum hemorrhage (PPH) prevention are among the most cost-effective interventions. The introduction of misoprostol significantly increases the effect which PPH interventions can have on preventing maternal deaths. Safe motherhood interventions save a significant amount of newborn lives. A dollar spent on resource scarce settings saves more lives than in higher resource settings. To achieve the expected 75% reduction in maternal mortality by 2015 will require program planners to make informed and evidence-based choices when allocating scarce resources. The combinations of interventions that result in largest number of maternal deaths averted should be prioritized.