Achieving universal coverage of maternal health care

Maternal health can only be improved if mothers receive care from pregnancy through to childbirth and beyond. For this to happen, health systems need to be strengthened with maternal, newborn and child health care at the core. For some countries this can be done relatively quickly, for others it will take far longer.

The 75 countries that rank highest in the world in terms of both rates and gross numbers of maternal and newborn deaths account for more than 75 percent of the world's population, 86 percent of births and 97 percent of maternal deaths worldwide.

By 2015 the same countries will represent a total of 137 million births each year. In 2005, 43 percent of mothers and newborns in the 75 countries received some care, but by no means the full package through pregnancy and childbirth to six weeks after birth.

Looking to the future and adding up optimistic, but also realistic, scale-up scenarios for each of these 75 countries would feasibly give access to a full package of care for 73 percent of pregnant women by 2015. This would include care for both normal and complicated births and newborn care, as well as safe abortion and post-abortion services (to the extent allowed by law) and advice on family planning.

Given these projected improvements, the MDG for maternal health would not be reached in every country, but globally mortality reduction for both mothers and babies would be well on the way. The WHO estimates that these 75 countries can reduce the number of maternal deaths from 485 per 100,000 live births in 2000 to 242 by 2015. Newborn deaths likewise could be decreased from 35 to 29 per 1,000 live births over the same period.

Of the 75 countries analysed, 20 highly constrained countries were not, on average, expected to reach 95 percent coverage of care (seen as high enough to be 'universal') until 2030 (See Figure 1).

Figure 1: Feasible averages for the scale-up of maternal-newborn care coverage for births in 75 key countries by category of health system constraint (HSC) (Larger version)

These countries, such as Nepal, Cambodia and Haiti, include many experiencing conflict or recovering from conflict, civil unrest and/or political instability: scaling-up is highly constrained in these fragile states.

Regardless of current maternity care coverage, the situation in many of the 75 countries, weak governance and ineffective government-donor relationships, will cause considerable barriers to scaling-up services even with additional external aid. A country can take at least three to four years after the end of conflict to organise and strengthen its infrastructure, before meaningful development and expansion of maternal health care services can occur. In 2007, 37 percent of the 75 countries had a recent or ongoing humanitarian crisis.

At the other end of the spectrum, 30 of the 75 countries are expected to be fully scaled-up by 2010 or 2015. Twenty-five countries with moderate health system constraints would be expected to follow between 2020 and 2025.

The costs of scaling-up maternal health services in these 75 countries were estimated in 2005 to require an increase in spending in the region of US$39 billion. This corresponds to a 14 percent growth in spending on maternal and newborn health by 2015. In the 20 highly constrained countries public expenditure would have to rise to 43 percent of current and newborn maternal health spending by 2015.

The estimates, however, are based on current health workforce salaries, which are unlikely to be sufficient to recruit, retain and deploy health workers to the areas where they are most needed. This implies that these calculations are probably underestimated and that more public funding is likely to be required if countries are to effectively scale-up high quality accessible maternal and neonatal health services.

Helga Fogstad
Global Health and AIDS Department, Norwegian Agency for Development Cooperation (Norad), P.O. Box 8034, Dep. 0030 Oslo, Norway
helga.fogstad@norad.no

See also

Estimating the Cost of Scaling-Up Maternal and Newborn Health Interventions to Reach Universal Coverage: Methodology and Assumptions, World Health Organisation Departments of Making Pregnancy Safer and Health Systems Financing Technical Working Paper for the World Health Report 2005, March 2005
www.who.int/whr/2005/td_two_en.pdf

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