Making Motherhood Safe (World Bank, 1993, 161 pages): Appendix 8

Making Motherhood Safe (World Bank, 1993, 161 pages)

		(introductory text...)
		Abstract
		Foreword
		Acknowledgements
		Abbreviations
		Executive summary
		Chapter 1 - Maternal morbidity and mortality and the consequences
		Chapter 2 - Essential elements of a safe motherhood program
		Chapter 3 - A strategy for safe motherhood in representative settings
		Chapter 4 - Policy and planning considerations
		Chapter 5 - The costs of safe motherhood
		Chapter 6 - Measuring progress
		Appendix 1 - Effective maternal health care: Family planning and prenatal, labor, delivery, and postpartum care
		Appendix 2 - Country examples of safe motherhood programs
		Appendix 3 - The role of the midwife
		Appendix 4 - Maternity center facilities and equipment
		Appendix 5 - Behavior change: The role of information, education, and communications in safe motherhood programs
		Appendix 6 - Maternal and perinatal health assessment
		Appendix 7 - Issues related to maternal anthropometry
		Appendix 8 - Technical notes and tables
		Bibliography
		Distributors of world bank publications

Appendix 8 - Technical notes and tables

Table 1 Safe Motherhood Scorecard

Table 2 Cost: Summary Worksheet of Estimated Costs of Safe Motherhood Interventions in Three Different Settings.

A. Demographic, economic and maternal health status indicators (pre-intervention)
B. Existing annual operating costs (pre-intervention)
C. Estimated annual costs of interventions
D. Maternal health status after interventions
E. Total annual program costs (existing plus interventions)

Table1 Safe Motherhood Scorecard for Developing Countries

Problem	Pregnant Women	Newborns
Death	495,000	7,000,000 (perinatal)
Pregnancy-related morbidities
Acuteb	54,000,000 (est.)	Asphyxia	3,600,000
		Low birth weight^d	21,000,000
Chronic
Prolapse' (women under 45)	9% (Philippines)	Infection	5% of live births
	10% (Syria)
	19% (Colombia)
	25% (Pakistan)
	56% (Egypt)
Fistula	Not known
Associated
Malaria	Not known
Diabetes	Not known
Hepatitis	Not known
Unhealthy women
Nutrition
Stunted	500,000,000 (est.)	- -> Low birth weight
Underweight (pregnancy weight)	56-63% (India)	- -> Low birth weight
Anemia	71,000,000	- - > Low birth weight/ prematurity
		- - > Vulnerable to infections
Iodine deficiency	250,000,000	- - > Cretinism
Infections
Syphilis	3-22% (Sub-Saharan Africa)	- - > Fetal death (40%)

		- - > Congenital syphilis (33-40%)
Gonorrhea	0.5-22% (Sub-Saharan Africa)	- -> Ophthalmia neonatorum (30-47%)
Chlamydia neonatorum	4-20 % (Sub-Saharan Africa)	- - > Ophthalmia (25-50%)
		- -> Pneumonia (5-10%)
Bacterial vaginosis	10-19% (Sub-Saharan Africa)	- - > Prematurity/low birth weight (20-25%)
ADDS'	2,400,000 (Sub-Saharan Africa)	- - > HIV/AIDS/death (25%)

Source: (a) Lopez 1990; (b) Koblinsky and others 1992; (c) Shah 1990; (d) Tafari 1981; (e) Omran and Standley 1976, Omran and Standley 1981, Zurayk 1991; (f) Bartlett and others 1991; (g) Leslie 1991, Anderson 1989; (h) Schultz and others 1992; (i) Chin 1990.

Table 2 Summary Worksheet of Estimated Costs of Safe Motherhood Interventions in Three Different Settings, Ranging from A, Weakest Health Systems, to C, More-Developed Health Systems

A. Demographic, economic, and maternal health status indicators (Pre-intervention)

Setting	A	B	C
Population	500,000	500,000	500,000
Women age 15-45	75,000	75,000	75,000
Births (annual)	22,500	20,000	15,000
Birth rate (per 1,000 women of reproductive age)	45	40	30
Infant mortality rate (per 1,000 live births)	100	70	40
Maternal deaths (annual)	225	100	30
Maternal mortality ratio (per 100,000 live births)	1,000	500	200
Contraceptive prevalence rate (%)	<5	<10	40
Tetanus immunization coverage (% of women age 15-45)	10	30	60

B. Existing annual operating costs of maternal health program (pre-interventions)

Setting	A	B	C
Staff and costs
Hospital
Number of full-time equivalent staff	0	8.5	17.0
Average salary costs of full-time equivalent staff		$3,795	$5,313
Average salary costs per hospital		$32,258	$90,321
Number of hospitals	0	1	2
Subtotal: annual hospital staff costs	$0	$32,258	$180,642
Health Center
Number of full-time equivalent staff	4.6	4.6	4.6
Average salary costs of full-time equivalent staff	$1,878	$3,131	$4,383
Average salary costs per health center	$8,639	$14,400	$20,162
Number of health centers	1	10	20
Subtotal: annual health center staff costs	$8,639	$144,003	$403,236
Health Post
Number of full-time equivalent staff		2.4	2.4
Average salary costs of full-time equivalent staff		$3,063	$4,289
Average salary costs per health post		$7,351	$10,292
Number of health posts	0	50	50
Subtotal: annual health post staff costs	$0	$367,560	$514,620
Community/Village Level
Number VHWs/outreach workers	300	200	100
Number trained birth attendants	500	250	250
Subtotal: annual community/village level costs (assume communities pay all salary costs)	$0	$0	$0
Program Management
Number of full-time equivalent staff	0	7.1	50.0
Average salary costs of full-time equivalent staff		$5,084	$7,118
Subtotal: annual program management staff costs	$0	$36,093	$355,875
Total staff costsa	$8,639	$579,913	$1,454,373
Related costs: percentage of annual program operating costs	15%	25%	30%
Total related costsb	$1,524	$193,304	$623,303
Total existing annual operating costs	$10,163	$773,218	$2,077,676

a. Staff costs include salaries and benefits.
b. Related costs include transport, in-service training, contraceptives, pharmaceuticals, and consumable equipment
and supplies.

C. Estimated annual costs of interventions Setting

Operating Costs	A	B	C
Staff Costs
Service Delivery
Number of full-time equivalent staff	230	50	70
Average salary costs of full-time equivalent staff	$1,040	$300	$4,316
Subtotal: annual service delivery salary costs	$239,085	$15,000	$302,085
Program Management
Number of full-time equivalent staff	7.0	42.1	20.0
Average salary costs of full-time equivalent staff	$3,050	$2,972	$2,118
Subtotal: annual program management salary costs	$21,347	$125,100	$142,350
Total staff costs	$260,432	$140,100	$444,435
Related Costs
Transportation	$4,042	$31,900	$0
Training	$14,835	$52,068	$12,078
Pharmaceuticals, equipment, and supplies	$88,500	$96,250	$20,000
Other contingencies (5% of columns ABC)	$8,388	$9,011	$1,604
Total related costs	$176,153	$189,299	$33,682
Total operating costs	$436,585	$329,329	$478,117
Investment Costs (annualised)
Initial training	$4,042	$30,500	$27,750
Vehicles	$68,100	$68,000	$2,000
Construction /upgrading/equipment	$21,250	$31,920	$20,000
Total investment costs	$93,392	$130,420	$49,750
Total annual costs of interventions	$529,977	$459,749	$527,867

a. Average salary costs of full-time equivalent staff reflect differences in level and composition of the staff. The type of staff and their salary will vary by setting.

D. Maternal health status after interventions Setting

	A	B	C
Births (annual)	19,125	13,400	9300
Percent of original-level of maternal deaths averted	20	66	80
Contraceptive prevalence rate (%)	16	35	55
Tetanus immunization coverage (% of women age 15-45)	25	60	80

E. Total annual program costs (existing plus interventions)

Operating costs
Staff costs	$269,070	$720,014	$1,898,808
Related costs	$177,678	$382,533	$656,985
Total operating costs	$44S,748	$1,102,547	$2,555,793
Investment costs (annualized)	$93,392	$130,420	$49,750
Total annual program costs	$540,140	$1,232,967	$2,605,543
Intervention cost per unit
Cost per capita	$1.06	$0.92	$1.06
Per woman age 15-45	$7.07	$6.13	$7.04
Per pregnancy	$27.71	$34.31	$56.76
Per maternal death averted	$11,777.26	$6,965.89	$21,994.46
Per maternal and perinatal death averted	$1,682.47	$995.13	$3,142.07