1 / 28

Maternal Mortality in Kenya and Bangladesh A comparative overview & some analysis

Maternal Mortality in Kenya and Bangladesh A comparative overview & some analysis. Jean-Olivier Schmidt. MMR in Kenya and Bangladesh. Compare - what?. Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 2. MMR in Kenya and Bangladesh.

prue
Download Presentation

Maternal Mortality in Kenya and Bangladesh A comparative overview & some analysis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Maternal Mortality inKenya and BangladeshA comparative overview & some analysis Jean-Olivier Schmidt Brown Bag Lunch GIZ Health Programme 31.03.2011. Slide 1

  2. MMR in Kenya and Bangladesh Compare - what? Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 2

  3. MMR in Kenya and Bangladesh Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 3

  4. MMR in Kenya and Bangladesh Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 4

  5. MMR 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

  6. MMR 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

  7. MMR in Kenya and Bangladesh 2015 1990 2000 2010 Kenya: 600 Kenya: 488 Bangladesh: 574 Kenya: 418 Bangladesh: 320 Bangladesh: 192 Kenya: 147 Bangladesh: 143 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 7

  8. MMR in Kenya and Bangladesh OUTCOME OUTCOME 10 years Kenya 488 Kenya 418 Bangladesh: 390 Bangladesh: 192 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 8

  9. MMR in Kenya and Bangladesh OUTCOME OUTCOME 10 years Kenya 488 Kenya 418 Bangladesh: 390 Bangladesh: 192 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 9

  10. MMR in Kenya and Bangladesh OUTCOME Outputs by the Health System Financial Inputs Kenya 488 K:Institutional delivery/SBA: 43/44% Kenya: 27 US$ Kenya: OOP/THE 36% Inequity: K: 1 to 5 BD: 1 to 10 BD: Institutional delivery/SBA: 20/24% Bangladesh: 15 US$ Bangladesh: OOP/THE 67% Bangladesh: 192 Kenya: GDP/capita: PPP: 1711 US$ BD Adult lit. rate: 55% K Adult lit. rate: 87% Bangladesh: GDP/capita: PPP: 1600 US$ Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 10

  11. MMR in Kenya and Bangladesh Maternal deaths are the most common cause of death (about 1/4) among women 20‐34 years, and is also an important cause of death for women aged 35‐39 years Source: BMMS 2010 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 11

  12. MMR in Kenya and Bangladesh Maternal deaths are the most common cause of death (about 1/4) among women 20‐34 years, and is also an important cause of death for women aged 35‐39 years Source: BMMS 2010 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 12

  13. MMR in Kenya and Bangladesh Hemorrhage and eclampsia, despite impressive declines, still cause more than half of maternal deaths • Reasons for fall are several: • Medical • Socio‐economic • Demographic Source: BMMS 2010 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 13

  14. MMR 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 14

  15. MMR in Kenya and Bangladesh Source: BMMS 2010 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 15

  16. MMR in Kenya and Bangladesh Source: BMMS 2010 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 16

  17. MMR in Kenya and Bangladesh Source: BMMS 2010 Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 17

  18. MMR in Kenya and Bangladesh What accounts for the increased use of services? • Improved Access to Health Services: • Numbers of facilities with maternal health services has increased • Improved road transport (roads, bridges, bus services) • Mobile phones available nationally, and at low cost • Income at national and household levels have • improved, including among poor households Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 18

  19. MMR in Kenya and Bangladesh Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 19

  20. MMR 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 20

  21. MMR in Kenya and Bangladesh Caveat: Are definitions and methodologies misleading? BMMS: KDHS “all deaths that occurred during pregnancy and two months after pregnancy, even if the death is due to non-maternal causes." Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 21

  22. MMR 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 22

  23. MMR in Kenya and Bangladesh Objectives of the evaluation • Evaluate “demand-side” DSF program impacts on: • - Use of skilled providers at delivery, C-section, ANC, and PNC • Out-of-pocket expenditures on MH services • Evaluate “supply-side” DSF program impacts on: • - Provider skills and knowledge • - Facility quality Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 23

  24. MMR in Kenya and Bangladesh • 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) DSF Programme Overview Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 24

  25. MMR in Kenya and Bangladesh • Large, significant demand-side impacts • Multi-variate: The likelihood of delivery with skilled provider increased by 42 percentage pointsin 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 Main findings Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 25

  26. MMR 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 26

  27. MMR 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 27

  28. MMR in Kenya and Bangladesh Thanks for your attention! Donnobad! Asante Sana! Brown Bag Lunch GIZ Health Programme 31.03.2011.Slide 28

More Related