Evaluation of the impact of the Mother and Infant Health Project in Ukraine

Abstract

This paper exploits a unique opportunity to evaluate the impact of the quality change in the labor and delivery services brought about by the Mother and Infant Health Project in Ukraine. Employing program evaluation methods, we find that the administrative units participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control ones. Among the infant health characteristics, the MIHP impact is most pronounced for infant mortality resulting from deviations in perinatal period. As for the maternal health, the MIHP is the most effective at combating anemia, blood circulation and urinary-genital system complications, and late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 97 taking into account both maternal and infant lives saved as well as cost savings due to the changes in labor and delivery practices.

Is high‐tech care in a middle‐income country worth it?

“…However, the US evidence from admission to the NICU due to marginally smaller weight enabling an infant to meet the admission criteria reduces 0-7 day mortality by 16 percent, 0-28 day mortality by 23 percent and 1 year mortality by 17 percent (Almond et al, 2010), which is higher than we find in Russia. Finally, Nizalova and Vyshnya (2010) also demonstrate a much higher savings of 2.1 lives per 1,000 births vs. 0.391 lives per 1,000 births in our study. Of course, to a large extent this difference may reflect more dire initial conditions in Ukraine.…”

“…Nevertheless, using just measurable lives saved is the standard procedure in the literature: for example, Nizalova and Vyshnya (2010) do not explicitly consider morbidity in their benefits estimation, so the comparison of our results to theirs is accurate. Nevertheless, using just measurable lives saved is the standard procedure in the literature: for example, Nizalova and Vyshnya (2010) do not explicitly consider morbidity in their benefits estimation, so the comparison of our results to theirs is accurate.…”

“…Some low-cost interventions also have been implemented in middle-income countries; analyses find moderate to high reductions in mortality, and high cost effectiveness of these reductions. Nizalova and Vyshnya (2010) estimate how the 'Mother and Infant' programme in Ukraine, which involved training the obstetrics personnel and changes in practices, has reduced infant mortality rate by 3.13 deaths per 1,000 births (23 percent from the baseline rate). Galiani et al (2005) argue that cleaner water from privatization of water facilities saved infant lives in Argentina.…”

“…Considering large monetary investments into the perinatal centres without an a priori obvious return, a cost-benefit analysis is imperative for policy evaluation and comparison with other interventions (for instance, with the return on the Mother and Infant Project in Ukraine (Nizalova and Vyshnya, 2010)). We perform two types of evaluations: a rate of return over the lifetime of a hospital (taken to be 40 years), and an estimation of a cost per life saved or per incremental year of life in order to 16 Tests for a substitution effect are included in Online Appendix Table S6.…”

The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors

“…In contrast, very little is known about how mothers benefit from receipt of adequate prenatal care themselves (see Conway and Kutinova (2006) for a review). A recent study by Nizalova and Vyshnya (2010) demonstrates that a maternal health program in Ukraine reduces the rates of several pregnancy and delivery complications, by enhancing labor, delivery services, and prenatal care. A recent study by Nizalova and Vyshnya (2010) demonstrates that a maternal health program in Ukraine reduces the rates of several pregnancy and delivery complications, by enhancing labor, delivery services, and prenatal care.…”