Elsevier

The Lancet

Volume 368, Issue 9545, 21–27 October 2006, Pages 1457-1465
The Lancet

Series
Mobilising financial resources for maternal health

https://doi.org/10.1016/S0140-6736(06)69383-5Get rights and content

Summary

Coverage of cost-effective maternal health services remains poor due to insufficient supply and inadequate demand for these services among the poorest groups. Households pay too great a share of the costs of maternal health services, or do not seek care because they cannot afford the costs. Available evidence creates a strong case for removal of user fees and provision of universal coverage for pregnant women, particularly for delivery care. To be successful, governments must also replenish the income lost through the abolition of user fees. Where insurance schemes exist, maternal health care needs to be included in the benefits package, and careful design is needed to ensure uptake by the poorest people. Voucher schemes should be tested in low-income settings, and their costs and relative cost-effectiveness assessed. Further research is needed on methods to target financial assistance for transport and time costs. Current investment in maternal health is insufficient to meet the fifth Millennium Development Goal (MDG), and much greater resources are needed to scale up coverage of maternal health services and create demand. Existing global estimates are too crude to be of use for domestic planning, since resource requirements will vary; budgets need first to be developed at country-level. Donors need to increase financial contributions for maternal health in low-income countries to help fill the resource gap. Resource tracking at country and donor levels will help hold countries and donors to account for their commitments to achieving the maternal health MDG.

Section snippets

Why invest in maternal health?

The case for investment in maternal health is compelling. In addition to the proven effectiveness and cost-effectiveness of many maternal health care interventions,4, 5, 6 there are numerous benefits in addition to the maternal lives saved.3 Most maternal interventions also directly benefit newborn babies in terms of reduced mortality and morbidity.7 A maternal life saved also benefits older children. Children whose mothers die have been suggested to be at three to ten times greater risk of

Channelling financial resources to maternal health

The provision of effective maternal health services requires money for staff, drugs, medical supplies, and food.14 These costs will differ between facility and home delivery. Seeking care at a health facility has additional financial implications for the household in terms of travel costs and patients' and their companions' time, which are subject to seasonal variation.15 Here, on the basis of a systematic review of published and unpublished studies of financing and maternal health (see search

Costs of taking maternal health services to scale

To increase coverage of maternal health services, the financial burden faced by many households during pregnancy needs to be urgently addressed. The supply of maternal health services also needs to increase in order to meet the additional demand. Across 75 priority countries, if the MDGs are to be met, an additional 334 000 midwives are estimated to be needed, increasing to 700 000 by 2030, and the skills of 140 000 health professionals need to be upgraded at primary level and those of 27 000

The role of donors and international institutions

The capacity of low-income countries to mobilise substantial additional revenue is questionable. Donors are therefore likely to play an important part in filling the resource gap between what is now being spent and what is needed to take interventions of proven effectiveness to scale. Donors will need to increase investment in the health sector in general and to maternal health in particular. Despite increasing trends in recent years, overall aid commitments from the leading donor countries are

Conclusions

There is a strong case for public investment in maternal health, in view of its multiple health and social benefits (panel 1). Households pay far too great a share of the costs of maternal health services, or do not seek care because they cannot afford the costs. User fees have impeded access to maternal health care, especially for the poor. As a result, several governments are implementing or considering alternative financing methods that help ensure increased funding for maternal health and

Search strategy and selection criteria

We searched PubMed, Popline, Embase, IBSS, Paho, and Lilacs from 1990 to 31 July, 2004. The search terms used were: (Mother* OR Matern* OR Newborn OR Neonat* OR reproduct* OR obstetric) AND (fee OR fees OR charge OR charges OR insurance OR insured OR financ* OR reform) AND (Africa OR Asia OR Latin OR Caribbean OR Soviet OR Eastern Europe). In view of the numerous reforms that took place in the 1980s, we did not include studies published before 1990. The searches were limited to English

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