Health Impacts and Economic Evaluations of Maternal and Child Health Programs in Developing Countries

• Main Author: Carvalho, Natalie
• Other Authors: Goldie, Sue J.
• Language: en_US
• Published: Harvard University 2013
• Subjects: cost-effectiveness analysis; impact evaluation; maternal and child health; health sciences; public health
• Online Access: http://dissertations.umi.com/gsas.harvard:10264; http://nrs.harvard.edu/urn-3:HUL.InstRepos:10330317

This dissertation is motivated by two of the health-related Millennium Development Goals (MDGs): MDG 4, focused on reducing child mortality, and MDG 5, which aims to improve maternal health. My three papers evaluate the health and economic impact, and cost-effectiveness, of interventions to improve maternal and child health in three areas of the developing world using methods from decision sciences and statistics. In paper 1, I use a decision-analytic model that simulates the natural history of pregnancy and pregnancy-related complications to assess the expected health outcomes, costs, and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan. Increasing family planning was found to be the most effective single intervention to reduce maternal mortality. Further findings suggest that a stepwise approach that couples increased family planning with incremental improvements in access to appropriate intrapartum care could prevent 3 out of 4 maternal deaths and would be cost-effective. Paper 2 explores the value of community-based disease management programs for reducing mortality from childhood pneumonia and malaria in 24 countries of sub-Saharan Africa. I use a model-based framework that combines symptom patterns, care-seeking behavior, and treatment coverage from an empirical assessment of household survey data with information on diagnostic algorithms and disease progression from the literature. Results indicate that a community health worker program modeled on currently-existing programs could avert over 100,000 under-five deaths combined across the 24 countries and would be regarded as cost-effective compared to the status quo under typical benchmarks for international cost-effectiveness analysis. My third paper evaluates the effect of Janani Suraksha Yojana (JSY), a conditional cash transfer program intended to promote the use of reproductive health services in India, on childhood immunizations and other reproductive and child health indicators. Using observational data from the most recent district-level household survey, I conduct a matching analysis with logistic regression to assess the associations of interest. Results show that receipt of financial assistance from JSY led to a significant increase in childhood immunizations rates, post-partum check-ups, and some healthy breastfeeding practices, but no impact was found on exclusive breastfeeding and care-seeking behaviors.