Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 1 Maternal Mortality in Kenya and Bangladesh...
-
Upload
hannah-oconnell -
Category
Documents
-
view
214 -
download
1
Transcript of Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 1 Maternal Mortality in Kenya and Bangladesh...
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 1
Maternal Mortality inKenya and Bangladesh
A comparative overview & some analysis
Jean-Olivier Schmidt
Compare - what?
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 2
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 3
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 4
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Are we comparing apples and pears....
....”de gustibus non est disputandum”
MDGs: we, ie the World Community, have universally
recognized and accepted MDGs that make it binding for the
countries to achieve these.
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 5
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Compare – why?• Amartya Sen: What can Africa and India learn from each
other (1987)? “There are indeed a great many lessons to be learnt by India and Africa from the experiences of each other.”
• Kuhn (2011): Routes to low Mortality in poor countries revisited.
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 6
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 7
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
1990
Bangladesh: 574
Kenya: 600
2015
Bangladesh: 143
Kenya: 147
2000 2010
Kenya: 418
Bangladesh: 320
Kenya: 488
Bangladesh: 192
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 8
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
OUTCOME
Kenya 418
Bangladesh: 390
OUTCOME
Kenya 488
Bangladesh: 192
10 years
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 9
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
10 yearsOUTCOME
Kenya 418
Bangladesh: 390
OUTCOME
Kenya 488
Bangladesh: 192
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 10
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
OUTCOME
Kenya 488
Bangladesh: 192
Financial Inputs
Kenya: 27 US$
Bangladesh: 15 US$
Kenya: OOP/THE
36%
Bangladesh: OOP/THE
67%
Kenya: GDP/capita: PPP: 1711 US$ Bangladesh: GDP/capita:
PPP: 1600 US$
Outputs by the Health System
K:Institutional delivery/SBA:
43/44%
BD: Institutional delivery/SBA:
20/24%
BD Adult lit. rate: 55%K Adult lit. rate: 87%
Inequity:K: 1 to 5
BD: 1 to 10
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 11
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Maternal deaths are the most common cause of death(about 1/4) among women 20‐34 years, and is also animportant cause of death for women aged 35‐39 years
Source: BMMS 2010
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 12
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Maternal deaths are the most common cause of death(about 1/4) among women 20‐34 years, and is also animportant cause of death for women aged 35‐39 years
Source: BMMS 2010
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 13
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Hemorrhage and eclampsia, despite impressive declines, still cause more than half of maternal deaths
Reasons for fall are several:MedicalSocio‐economicDemographic
Source: BMMS 2010
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 14
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Medical Causes of decline in MMR since 2001 in Bangladesh
• Reduction in Eclampsia (30% of total decline)•Reduction in Haemorrhage (25%)• Reduction Abortion related (10%)• Reduction of cases of Obstructed labour (3%), among others
These cases require facility based treatment and medically trained birth attendants and staff.
Source: BMMS 2010
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 15
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Source: BMMS 2010
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 16
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Source: BMMS 2010
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 17
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Source: BMMS 2010
What accounts for the increased use of
services?
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 18
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Improved Access to Health Services:
Numbers of facilities with maternal health services has increasedImproved road transport (roads, bridges, bus services)Mobile phones available nationally, and at low cost Income at national and household levels haveimproved, including among poor households
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 19
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 20
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Demographic patterns explains a big part of the variance between Bangladesh and Kenya. But fertility does not explain all. Socio-economic factors are rather in favour of Kenya, therefore it seems attention should be turned to the medical factors.
How are the standards of institutional delivery effectively met? Qualification of personnel, equipment of facilities?
Geographic distance?
Non proximal factors? Homogeneity, social consensus, “imagined communities” (cf Kuhn 2011)
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 21
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Caveat: Are definitions and methodologies misleading? BMMS:
“all deaths that occurred during pregnancy and two months after pregnancy, even if the death is due to non-maternal causes."
KDHS
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 22
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Further initiatives in Bangladesh to work on Maternal Health
Pilot on demand side financing
Costing of health services
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 23
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Evaluate “demand-side” DSF program impacts on:- Use of skilled providers at delivery, C-section, ANC, and PNCOut-of-pocket expenditures on MH services
Evaluate “supply-side” DSF program impacts on:- Provider skills and knowledge- Facility quality
Objectives of the evaluation
• Pregnant women get all maternal health services for free• Pregnant women get Tk 2000 cash incentive and gift box (value of
Tk 500) for delivering with a qualified provider, and Tk 500 total transport stipend for 3 ANC visits, delivery, and PNC– Qualified providers for delivery are CSBAs and doctors
• Providers/field workers get cash incentives for registering women and providing MH services (ANC, delivery, PNC, complications)
• Control Districts (Upazilas)
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 24
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
DSF Programme Overview
• Large, significant demand-side impacts
Multi-variate: The likelihood of delivery with skilled provider increased by 42 percentage points in universal DSF upazila (vs. control) and by 50 percentage point in means-tested DSF upazila (vs. control)
Out-of-pocket expenditures for ANC, delivery care, and PNC significantly lower in DSF (Tk 1,442) compared to control (Tk 2,191)
• Less supply side-impact Some evidence of quality differences but mostly non-significant Much larger patient volume in DSF facilities, compared to control “Seed fund” utilized to procure drugs and supplies in some cases
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 25
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Main findings
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 26
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Comparing cost of DSF program to Benefits:
US $ 161-165: Incremental cost per additional delivery with a skilled provider due to DSF program (includes overhead cost and ANC cost)
US $ 67-76: Average cost per voucher distributed/receipt
Government and development partners will need to compare this cost estimate with other MH programs and opportunity cost in Bangladesh
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 27
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Costing of Maternal Health Services and MDG5:
Empirical (unit cost approach) and normative costing
Total “price tag” for key maternal health services at coverage levels consistent with achieving the MDG 5 is 1,704 million USD. About 70% of this amount will be needed to provide the target level and quality of ANC services. The costs of normal delivery are 9% of the total resource requirement, and the costs of treating the leading obstetric emergency complications account for 20%.
This is a five-fold increase for the annual budget for Maternal health services
Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 28
MMR in Kenya and BangladeshMMR in Kenya and Bangladesh
Thanks for your attention!
Donnobad! Asante Sana!