- Average yearly investment equivalent to US$4.7 per person
Avoidable maternal and child deaths could be greatly reduced in a generation by rapid expansion of essential, highly-cost effective health interventions and services, according to some of the world's top maternal and child health experts writing in The Lancet. The research is being presented at the Consortium of Universities for Global Health conference in San Francisco on April 9, 2016.
From improving pregnancy and delivery care, to treating life-threatening infectious diseases like pneumonia, diarrhoea, and malaria, and better childhood nutrition, the three integrated packages of proven interventions focus on a range of health problems that, despite major progress, continue to kill millions of women, newborns, and children every year (figures 2 and 3).
Professor Robert Black from Johns Hopkins Bloomberg School of Public Health, Baltimore, USA and colleagues used a mathematical model called 'The Lives Saved Tool' (panel 2) to examine the potential impact on deaths and costs of scaling up around 66 key health interventions in 74 low- and middle-income countries (LMICs), that together account for more than 95% of all mother and child deaths (figures 4-6).
The authors estimate that satisfying 90% of the global unmet need for contraception in the Reproductive Health package could avert 28 million births each year and consequently prevent around 67000 maternal deaths from childbirth, around 910000 newborn and child deaths, and over 560000 stillbirths every year that would have happened at current rates of fertility and mortality. Alternatively, scaling up all interventions in the additional two packages of Maternal and Newborn Health and Child Health to 90% coverage could save 4 million lives every year -- equivalent to about half of all the maternal, newborn, and child deaths worldwide and a third of all stillbirths.
Despite the enormity of the problem, say the authors, the cost per person is highly affordable and includes the expense of strengthening health systems and service delivery. New estimates produced for this analysis show that all three packages could be immediately scaled up to nearly all people in need with an investment of US$6.2 billion in low-income countries, US$12.4 billion in lower middle-income countries, and US$8 billion in upper middle-income countries. This is equivalent to an average investment per person in 2015 of just US$6.7, US$4.7, and US$3.9, respectively, and US$4.7 overall. These costs would increase slightly by 2035, reflecting population increases (table 2).
Importantly, say the authors, most of these interventions could be delivered by community workers and primary health centres that together could be capable of preventing around three-quarters of preventable maternal, newborn and child deaths, and stillbirths. Hospitals have the potential to avert the remaining deaths by improving management of complicated pregnancies and deliveries, severe infectious diseases, and malnutrition (figure 7).
"Our analysis clearly shows that not only can the majority of these key services be delivered by health workers in the community or in primary health centres, which can increase access and keep even more mothers and children alive and healthy, but that scale-up of capacity is a feasible and highly cost-effective investment," says Professor Black. 
During the past 25 years, global health efforts have halved death rates for children under 5 -- from 90.4 per 1000 live births in 1990 to 42.5 per 1000 live births in 2015 -- and cut the number of maternal deaths by 43% from 532000 to 303000. Despite these sizeable reductions, the UN Millennium Development Goals (MDGs 4 and 5) of reducing the deaths of children under 5 years by two-thirds and maternal deaths by three-quarters by 2015 have not been met, and around 2.6 million stillborn babies and 5.9 million newborn babies and children still died in 2015.
"Many of maternal and child deaths could be prevented with cost-effective solutions, but they are not being widely implemented or targeted towards individuals in the greatest need," explains Professor Black. "With additional investment, a greater focus on high-impact integrated interventions and innovations in service delivery such as task shifting ie, re-assigning tasks from doctors and nurses to less trained health workers, and supply and demand incentives like cash payments for childbirth in a health facility, could help rectify major gaps in accessibility, utilization, and quality of care."
He adds, "The benefits of scaling up these interventions extend well beyond health. For example, improving care at the time of birth gives a quadruple return on investment by saving mothers' and children's lives and preventing stillbirths and disability, whilst investing in nutrition can help children reach their potential in cognitive development."
NOTES TO EDITORS:
This Review summarises the World Bank Disease Control Priorities, 3rd Edition (DCP3) volume on Reproductive, Maternal, Newborn and Child Health.
 Quotes direct from author and cannot be found in text of review.
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