Summary

This paper reviews the evidence on the cost of providing maternal health services, the use of disability-adjusted life years (DALYs) in the evaluation of the cost-effectiveness of these services, and alternative sources of financing maternal health services. The findings suggest that, for most interventions, care can be provided most cheaply at the primary care level. Personnel and drugs are the main components of cost. Community-based studies indicate that for the provision of emergency obstetric care, the focus should be on improving existing facilities. However, cross-study/country comparisons are difficult due to the inconsistency of costing methods and definitions of maternal health. While the use of DALYs as an outcome measure can help to justify the cost-effectiveness of maternal health interventions, compared to interventions, which target other disease areas, DALYs may underestimate the true burden of maternal mortality and undervalue an intervention’s cost-effectiveness due to the infrequency of maternal mortality.

Funding for maternal health services represents approximately 5-11% of total donor contributions to the health sector in developing countries and approximately 4-12% of domestic health expenditure, although it is difficult to determine the trends in these figures over time. The National Health Account framework will facilitate the measurement of expenditure on maternal health and the comparisons across countries. To achieve good maternal outcomes in developing countries, the model of health care financing must facilitate access and guarantee service quality. This can be achieved through a variety of methods: e.g. general taxation and social insurance. The key issue is financial sustainability. At the local level some NGO programmes have been successful in increasing access to essential obstetric care in rural communities and community programmes have been able to generate limited funds to the same end.