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The cost of maternal health services in low- income and middle- income countries from a provider’s perspective: a systematic review

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Banke-Thomas, Aduragbemi, Ibukun- Oluwa, Omolade Abejirinde, Ayomoh, Francis Ifeany, Banke-Thomas, Oluwasola, Eboreime, Ejemai Amaize and Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605 (2020) 'The cost of maternal health services in low- income and middle- income countries from a provider’s perspective: a systematic review'. BMJ Global Health, e002371.

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Abstract

Introduction Maternal health services are effective in reducing the morbidity and mortality associated with pregnancy and childbirth. We conducted a systematic review on costs of maternal health services in low-income and middle-income countries from the provider’s perspective.

Methods We searched multiple peer-reviewed databases (including African Journal Online, CINAHL Plus, EconLit, Popline, PubMed, Scopus and Web of Science) and grey literature for relevant articles published from year 2000. Articles meeting our inclusion criteria were selected with quality assessment done using relevant cost-focused criteria of the Consolidated Health Economic Evaluation Reporting Standards checklist. For comparability, disaggregated costs data were inflated to 2019 US$ equivalents. Costs and cost drivers were systematically compared. Where heterogeneity was observed, narrative synthesis was used to summarise findings.

Results Twenty-two studies were included, with most studies costing vaginal and/or caesarean delivery (11 studies), antenatal care (ANC) (9) and postabortion care (PAC) (8). Postnatal care (PNC) has been least costed (2). Studies used different methods for data collection and analysis. Quality of peer-reviewed studies was assessed average to high while all grey literature studies were assessed as low quality. Following inflation, estimated provision cost per service varied (ANC (US$7.24–US$31.42); vaginal delivery (US$14.32–US$278.22); caesarean delivery (US$72.11–US$378.940; PAC (US$97.09–US$1299.21); family planning (FP) (US$0.82–US$5.27); PNC (US$5.04)). These ranges could be explained by intercountry variations, variations in provider type (public/private), facility type (primary/secondary) and care complexity (simple/complicated). Personnel cost was mostly reported as the major driver for provision of ANC, skilled birth attendance and FP. Economies of scale in service provision were reported.

Conclusion There is a cost savings case for task-shifting and encouraging women to use lower level facilities for uncomplicated services. Going forward, consensus regarding cost component definitions and methodologies for costing maternal health services will significantly help to improve the usefulness of cost analyses in supporting policymaking towards achieving Universal Health Coverage.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > WQ 100 General works
WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/ bmjgh-2020-002371
Depositing User: Tina Bowers
Date Deposited: 22 Jun 2020 13:24
Last Modified: 08 Jul 2020 10:37
URI: https://archive.lstmed.ac.uk/id/eprint/14831

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