Developing and Costing Local Strategies to Improve Maternal and Child Health: The Investment Case Framework

Soto, Eliana Jimenez; Vincente, Sophie La; Clark, Andrew; Firth, Sonja; Morgan, Alison; Dettrick, Zoe; Dayal, Prarthna; Aldaba, Bernardino; Varghese, Beena; Trisnantoro, Laksono; Prasai, Yogendra

doi:10.1371/journal.pmed.1001282

Cited by 20 publications

(18 citation statements)

References 10 publications

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“…The cornerstone of the IC approach is strategic problem-solving for MNCH planning and budgeting [5]. The process starts with a critical assessment of the available evidence on six parameters related to the performance of health systems; three on the supply side, two on the demand side, and one on quality [6].…”

Section: Methodsmentioning

confidence: 99%

“…After key stakeholders have identified the root cause of the problems, feasible strategies required to address those constraints are identified, and the resultant increases in coverage of relevant health services are estimated. An epidemiological and economic decision-support model that builds on the conceptual framework of bottleneck analysis [5] is used to estimate the impact and the associated costs of the different strategies. The model includes sixty six interventions for which there is global evidence on efficacy to reduce the burden of MNCH mortality [7-9].…”

Section: Methodsmentioning

confidence: 99%

“…This approach engages local policymakers and planners in structured problem solving to identify key health system constraints to the provision and uptake of MNCH interventions, and develop strategies to overcome identified problems. A decision-support model that estimates the cost and impact of alternative approaches is used to guide the selection and prioritisation of strategies [5]. We outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach.…”

Section: Introductionmentioning

confidence: 99%

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Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines

Vincente

Aldaba

Firth

et al. 2013

Health Res Policy Sys

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BackgroundResponsibility for planning and delivery of health services in the Philippines is devolved to the local government level. Given the recognised need to strengthen capacity for local planning and budgeting, we implemented Investment Cases (IC) for Maternal, Neonatal and Child Health (MNCH) in three selected sub-national units: two poor, rural provinces and one highly-urbanised city. The IC combines structured problem-solving by local policymakers and planners to identify key health system constraints and strategies to scale-up critical MNCH interventions with a decision-support model to estimate the cost and impact of different scaling-up scenarios.MethodsWe outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach.ResultsLocal officials found the structured analysis of health system constraints helpful to identify problems and select locally appropriate strategies. In particular the process was an improvement on standard approaches that focused only on supply-side issues. However, the lack of data available at the local level is a major impediment to planning. While the majority of the strategies recommended by the IC were incorporated into the 2011 plans and budgets in the three study sites, one key strategy in the participating city was subsequently reversed in 2012. Higher level systemic issues are likely to have influenced use of evidence in plans and budgets and implementation of strategies.ConclusionsEfforts should be made to improve locally-representative data through routine information systems for planning and monitoring purposes. Even with sound plans and budgets, evidence is only one factor influencing investments in health. Political considerations at a local level and issues related to decentralisation, influence prioritisation and implementation of plans. In addition to the strengthening of capacity at local level, a parallel process at a higher level of government to relieve fund channelling and coordination issues is critical for any evidence-based planning approach to have a significant impact on health service delivery.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines

Vincente

Aldaba

Firth

et al. 2013

Health Res Policy Sys

Self Cite

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“…We fully acknowledge the important role of distal determinants such as reproductive health, nutrition, health literacy etc in improving health outcomes [23-26], at least in the medium term, and we recognize that coverage still needs to be improved in many high mortality countries, and for disadvantaged population groups in all countries. However, we believe that more investment needs to be made in quality systems and, within these, in approaches that involve health professionals rather than controlling them [27].…”

Section: Discussionmentioning

confidence: 99%

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments

et al. 2013

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BackgroundGaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments.MethodsImprovements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment.ResultsBetween the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics.ConclusionsImportant improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.

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“…Furthermore, the modified Tanahashi model was used in Papua New Guinea, Nepal, India, Philippines, and Indonesia as part of the Investments Case Framework that supports planning and budgeting [20–22]. It was also used in a field trial in Bangladesh to establish policy opportunities for evidence-based planning for immunization and its limitations [23].…”

Section: Introductionmentioning

confidence: 99%

Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda

Henriksson

Fredriksson

Waiswa

et al. 2017

Global Health Action

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Background: Poor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system.Methods: A modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study.Results: Effective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent.Conclusion: The modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified.

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Developing and Costing Local Strategies to Improve Maternal and Child Health: The Investment Case Framework

Abstract: Eliana Jimenez Soto and colleagues describe the Investment Case framework, a health systems research approach for planning and budgeting, and detail the implementation of the framework in four Asian countries to improve maternal, newborn and child health.

Cited by 20 publications

References 10 publications

Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines

Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments

Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda

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