The Best Way to Address Maternal and Child Health (MCH) Is Not to Build an MCH Focussed Health System

Abstract

This note advances four inter-related arguments to suggest that building a high quality health system that is intended to address only MCH goals is unlikely to deliver on MCH goals in a cost-effective manner. The note argues that, medically, since the most important drivers of infant, child, and maternal mortality, now are complications such as haemorrhage, sepsis, abortion related complications, hypertensive disorders, and prematurity, it is no longer adequate, even from a pure MCH point of view, for a health system to focus on preventive-promotive messages and limited facility based treatment options. Instead, at the community level, there needs to be clinic based comprehensive basic obstetric and emergency care on offer, and, within a reasonable travel distance, hospital based comprehensive emergency care, including surgical care. The note argues that if, indeed, this is the case then building such a system to serve only MCH needs will not be cost-effective on a DALY-per-Dollar (DPD) basis. The note makes a similar argument regarding fixed investments in workforce and infrastructure, suggesting that any good health system, including one that is expected to focus narrowly on MCH concerns, requires a great deal of fixed investments in workforce and physical infrastructure. If all of these fixed investments are costed only from an MCH point of view then the infrastructure that is built would either be inadequate even for MCH, if limited resources are allocated to it, or would have very low levels of capacity utilisations if the required amount of investment has indeed gone into it. The note suggests that in the presence of shareable indivisible inputs such as medical personnel and infrastructure, serving a much wider range of conditions would be the most cost-effective way to organise the health system. From a financing and political point of view the note goes on to suggest that since, in order to get substantial improvements in MCH outcomes it would be necessary to build much stronger health systems, to do so it would be necessary to “take the Turnpike” and build a broader, more universal, health system, because only by doing so will it be possible to get a stronger political commitment to health and an active engagement in a shared health system from the non-poor, through schemes such as Social Health Insurance. Both of these would be essential to secure the funding necessary to build the requisite health system and to ensure strong support for effective quality improvement strategies. For all of these reasons the note argues that focussing on MCH both at a country and a donor level and building health systems to deliver sharply on MCH goals is unlikely to be an effective strategy to achieve MCH goals. It also suggests that such strategies may in fact hinder the development of broader health systems which can serve a wider population and a wider range of conditions and ultimately hurt the ability of the health system to effect improvements in MCH outcomes, the very goals that the original strategy was designed to deliver on.