Investment case for improving maternal and child health: results from four countries

BMC Public Health

Table 4 Results of impact and cost of investment case analysis in Orissa (India)

	Key causes of death		Impact (% Reduction over 5 years)			Cost ($US)
	Maternal	Under-5	Maternal mortality ratio	Neonatal mortality rate	Under-5 mortality rate	Annual marginal recurrent cost (per capita)	First year capital cost (per capita)
Kendrapara	Post-partum Haemorrhage (28%), Sepsis/Infections (11%), Unsafe Abortion (10%), Ante-partum Haemorrhage (9%)*	Preterm birth (17%), Diarrhoea (16%), Pneumonia (16%), Neonatal Sepsis (15%), Birth Asphyxia (13%)‡	34% (30%-38%)	35% (33%-38%)	23% (21%-26%)	$1.61 ($1.61-1.63)	$1.70
Kendrapara			Key Strategies: renovation and construction of sub-health centres, upgrading of emergency maternal and neonatal care facilities, additional training for staff on postnatal care, performance incentives and travel/hardship allowances for staff, workforce planning, supervision and monitoring, ensuring supply of buffer drug stocks, community promotion activities
Rayagada	Anaemia (24%), Post-partum Haemorrhage (17%), Sepsis/Infection (17%), Hypertension (14%) †	Diarrhoea (18%), Pneumonia (17%), Preterm birth (16%), Neonatal Sepsis (14%), Birth Asphyxia (12%)§	28% (23%-33%)	35% (32%-38%)	25% (22%-27%)	$3.92^#	$3.56
			Key Strategies: as above

* Source: (20) Estimate for EAG states. Sample Registration System, Office of the Registrar General of India. Maternal Mortality in India: 1997–2003: Trends, Causes and Risk Factors. 2006:1–40.
† Source: (21). Data for tribal areas in Orissa and Jharkhand. Barnett S, Nair N, et al. A prospective key informant surveillance system to measure maternal mortality – findings from indigenous populations in Jharkhand and Orissa, India. BMC Pregnancy and Childbirth 2008;8(6):1–8.
‡ Source: (15) State estimate. International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-3) 2005–06, India. 2007;1(1–540).
§ Source: (15) Tribal regions estimate. International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-3) 2005–06, India. 2007;1(1–540). # Due to large populations per capita values vary little (not reflected in $US to 2 decimal points)Results are based on point estimates and ranges calculated assuming −/+10% of intervention coverage determined by policymakers.

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