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Effort Levels of National Maternal and Neonatal Health Programs: 2005 Measures and Six Year Trends

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Abstract

Objective To assess efforts by national programs in developing countries to improve maternal and neonatal health in 2005 in the context of the six-year trend. Methods A total of 14 components of effort based upon 81 questionnaire items were measured for 49–55 countries in 1999, 2002, and 2005, covering about 85% of the developing world’s population. A standard questionnaire was completed by 10–25 experts in each country, with all questionnaires analyzed centrally and results returned to each country. The 2005 round includes new items and analysis for malaria and newborn interventions. Findings An overall index of effort showed no significant improvement over the six-year period. The patterns of effort across the 14 components were quite similar in the three rounds, supporting the usefulness of the methodology while also confirming the consistency of non-improvement. Rural access to services, in essentially all countries, is very inferior to urban access. Effort scores for antenatal and neonatal care were among the highest while those for health center capacities were among the lowest. Conclusion Effort levels by maternal health programs in developing countries remain seriously deficient. Even by the standard set by the best scoring countries the ratings show only about 75% of maximum effort achieved. The overall average is just above half of maximum effort, at about 56% in all three years, whether countries are weighted equally or by their population sizes.

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Notes

  1. A listing of questionnaire items for each component is in Appendix 1 of reference 1.

  2. See reference 1.

  3. The maternal mortality ratio (MMR) is defined as the number of pregnancy-related deaths per 100,000 live births per year. The two principal relationships are to abortion-related deaths and birth-related deaths. Estimates for essentially all countries are found in references below for 1990, 1995, and 2000.

  4. The MMR estimates for 1990, 1995, and 2000 used somewhat different methods, and changes for individual countries vary considerably. However the overall MMR mean value for developing countries fell from 545 in 1990 to 514 in 1995 to 455 in 2000. Weighting each country’s MMR by its population gives the lower figures of 378, 327, and 321 respectively, since China and certain other large countries have achieved somewhat lower maternal mortality.

References

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  7. The components were conceptualized in stages, as described in Ross, Campbell, and Bulatao (2001). See reference no. 1.

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  12. The list of key neonatal interventions is taken from Darmstadt, G. L., Bhutta, Z. A., Cousens, S., Adam, T., Walker, N., & de Bernis, L. (2005). Evidence-based, cost-effective interventions: How many newborn babies can we save? Lancet, 365, 977–988.

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  19. A recent estimate of global costs during 2006–20015 to attain the MCH objectives in the Millennium Development Goals is available in Benjamin Johns et al., “Estimated Global Resources Needed to Attain Universal Coverage of Maternal and Newborn Health Services.” Bulletin of the World Health Organization,April 2007; 85:256–263. The aggregate outlays total $39.3 to $55.7 billion depending upon the pace of scaling up.

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Acknowledgments

This research under the POLICY II project was funded by the U.S. Agency for International Development under Contract No. HRN-C-00-00-00006-00. It was implemented by Futures Group in collaboration with Research Triangle Institute (RTI) and the Centre for Development and Population Activities (CEDPA). We thank John Stover of the Futures Institute for helpful suggestions concerning the analysis.

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Authors and Affiliations

  1. Constella-Futures Group, 80 Glastonbury Blvd., Glastonbury, CT, 06033, USA

    John A. Ross & Demi Adelaja

  2. Futures Institute, 41-A New London Turnpike, Glastonbury, CT, 06033, USA

    Lori Bollinger

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  1. John A. Ross
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  2. Demi Adelaja
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  3. Lori Bollinger
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Correspondence to John A. Ross.

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Ross, J.A., Adelaja, D. & Bollinger, L. Effort Levels of National Maternal and Neonatal Health Programs: 2005 Measures and Six Year Trends. Matern Child Health J 12, 586–598 (2008). https://doi.org/10.1007/s10995-007-0266-4

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  • DOI: https://doi.org/10.1007/s10995-007-0266-4

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