187022 Setting Priorities for Safe Motherhood Interventions in Resource Scarce Settings

Monday, October 27, 2008: 12:50 PM

Ndola Prata, MD, MSc , The Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA
Amita Sreenivas, MPH , University of Washington School of Nursing, Seattle, WA
Fiona E. Greig , Doctoral Candidatein Public Policy; Harvard University, Cambridge, MA
Julia Walsh, MD DrPH , UC Berkeley School of Public Health, Berkeley, CA
Malcolm Potts, MB, PhD, FRCOG , University of California, Berkeley, Berkeley, CA
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.

Learning Objectives:
(1) List what the WHO considers the 18 priority safe motherhood interventions for developing countries. (2) Describe the interventions on which governments with low-resources should focus if they are not able to implement all 18 of WHO's safe motherhood interventions. (3) Delineate various combinations of interventions that are similarily cost-effective and can be chosen by governments with different maternal health interests. (4) Articulate how misoprostol significantly increases the effect which postpartum hemorrhage prevention programs can have on reducing maternal mortality in low-resource settings.

Keywords: Cost Issues, Interventions

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: We include the discussion of misoprostol for post-partum hemorrhage, but our paper is solely a review of currently existing data and not our own research on misoprostol.

Qualified on the content I am responsible for because: MPH from UC Berkeley in the Maternal-Child Health program/Internatoinal Health specialty area; Currenlty employed as an Associate Specialist with the UC Berkeley, Bixby Program for Population, Family Planning, and Maternal Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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