Kate Mossman

Innovating to improve the health of women and children: T-HOPE researches innovative delivery models in maternal and child health

Poor maternal, newborn and child health (MNCH) remains a critical challenge in many countries. Every year, almost 300,000 mothers and 7.6 million children under the age of five die from largely preventable causes, and the vast majority of these deaths occur in developing regions. Innovative solutions are needed to improve the delivery of care in MNCH – but which private sector models are working and have the potential to transform the health of women and children in resource-constrained settings?

On July 6, the Toronto Health Organization Performance Evaluation (T-HOPE) team presented its research on this topic at the Private Sector in Health symposium in Sydney, Australia. This research, prepared in collaboration with the Center for Health Market Innovations (CHMI), aims to better understand innovative models in MNCH and explore the evidence of their impact on the health of women and children.

Exploring the literature

The first step in this research process involved reviewing the literature on MNCH, to identify key challenges and the innovations emerging to address these issues. This was followed by an analysis of 230 MNCH programs profiled in the CHMI database. We assessed program approaches for their novelty, and for their ability or potential to improve MHCH quality, affordability and availability.

This resulted in a subset of promising innovative approaches, which we assessed for evidence of impact by reviewing the academic literature and reported results in CHMI’s database. Through this process, we identified several approaches that provide evidence of effectiveness, as well as several approaches that have been described as promising in the literature but for which there is currently little evidence.

Evidence of impact and promising approaches

There are a number of innovative approaches in MNCH with evidence of impact in the academic literature and CHMI’s reported results framework. Examples of these include:

  • Social franchising: Tinh Chi Em in Vietnam reports an average quality technical assurance score of 93 percent.
  • Microinsurance: Hygeia Community Health Plan (HCHP) in Nigeria covers MNCH services and has a premium that is lower than the average out-of-pocket amount an individual in the poorest quintile spends on health in Kwara State. It also reports an 89 percent satisfaction rate amongst beneficiaries.
  • Vouchers: Bangladesh Demand Side Financing Pilot Program reports total out-of-pocket expenditures for antenatal, postnatal and delivery care that are significantly lower in their program subdistricts than in control areas. It also reports substantially lower incidence of stillbirths (1.37 percent vs. 3.57 percent) and newborn deaths (0.01 percent vs. 0.1 percent) compared to control areas.

The evidence on these approaches suggests that they can improve affordability and increase service utilization by the poor, although concerns remain that the poorest remain out of reach. And while some have shown improvements in quality, both their quality and availability tends to vary.

We also identified a number of innovative approaches with the potential to improve availability, affordability and quality of MNCH care, but for which there is currently little evidence. This includes a number of approaches using information and communication technologies (ICTs), such as:

  • Connecting providers with mobile phones and Internet applications: World Health Partners in India reports that villagers travel 4.4 km to access their doctor at a telemedicine center compared to 10 km on average to reach the nearest qualified private provider.
  • Mobile phone saving schemes: Changamka Microhealth Ltd. in Kenya reports a 30 percent increase in the number of women going to regular visits at designated hospitals.
  • Clinical decisions support software: No programs with reported results.
  • SMS health messaging and reminders for patients: No programs with reported results.

While there is some data in the academic literature suggesting that ICT approaches can improve the availability of services and the capacity of health workers, there is currently little evidence on their impact and performance.

Our work suggests that innovative models are having an impact in MNCH, and new approaches have the potential to improve health care delivery and financing in this area. However, more research is needed on the performance of these and other activities in MNCH, which is vital in determining which innovative models should be supported and scaled up to address the critical health challenges facing women and children in low- and middle-income countries.

T-HOPE is led by Dr. Onil Bhattacharyya at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, and Drs. Anita McGahan and Will Mitchell at the Rotman School of Management, University of Toronto. To learn more about T-HOPE, please contact Kate Mossman at: mossmank at smh.ca.

Kate Mossman is the research coordinator for the T-HOPE team based in Toronto, Canada.

Education, Health Care
public health, research