Send to

Choose Destination

Cost-Effectiveness of Interventions for Reproductive, Maternal, Neonatal, and Child Health.


Horton S, Levin C.


In: Black RE, Laxminarayan R, Temmerman M, Walker N, editors.


Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr. Chapter 17.


Substantial efforts and investment have been made in global reproductive, maternal, newborn, and child health (RMNCH) since 2000. The Millennium Development Goals (MDGs) have been one focus for efforts. The establishment of international funds—such as the Global Alliance for Vaccines and Immunization (Gavi, founded in 2000); and smaller foundations, such as the Clinton Health Access Initiative founded in 2007; the Children’s Investment Fund Foundation, which made its first significant investments in 2009; and the Bill & Melinda Gates Foundation, founded in 1997—has brought new resources as well as an emphasis on value for money. The amount of funding has been significant. In 1990, the members of the Development Assistance Committee of the Organisation for Economic Co-operation and Development provided an estimated US$5.6 billion for international health assistance (Ravishankar and others 2009). In 2011, this amount had grown to US$27.7 billion (Leach-Kemon and others 2012). Part of the increase was due to spending for human immunodeficiency virus/ acquired immunodeficiency syndrome human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (US$7.7 billion), but the increase in other areas was also substantial: RMNCH was the second largest component (US$6.1 billion) (IHME 2014). The increase in resources and the growing interest in results combined to greatly increase the number of economic analyses of maternal and child health interventions. This chapter summarizes the findings of a systematic search of the cost-effectiveness literature on RMNCH, which builds on previous work, including several chapters in Disease Control Priorities in Developing Countries, second edition (Jamison and others 2006), as well as other systematic surveys and reviews on specific topics. The chapter’s focus is on the cost-effectiveness of interventions; one section summarizes the findings on cost, building on a longer systematic search on unit cost (Levin and Brouwer 2014). The studies identified in this chapter do not cover all of the interventions that affect maternal and child health. Some are covered in other volumes in this series (see table 17.1). The literature also has biases. Studies tend to concentrate on areas of current policy interest; for example, the literature on vaccines concentrates disproportionately on new vaccines—particularly those for pneumococcus and rotavirus, but also hepatitis B and Haemophilus influenzae B (HiB)—and not on older interventions known to be cost-effective, such as the original Expanded Program of Immunization (EPI) vaccines. Ideally, when resources are allocated across interventions, the full range would be considered. Funding could potentially be reallocated from old but cost-ineffective interventions to promising new ones, or coverage of older and very cost-effective interventions could be completed before new ones that are less cost-effective are incorporated. The next section discusses the methods used for the search and analysis of the literature. The findings are then organized according to the sequence of chapters in this volume: Reproductive health (chapter 6). Maternal and newborn child morbidity and mortality (chapter 7). Febrile conditions (chapter 8). Diarrheal disease (chapter 9). Vaccines (chapter 10). Treatment of severe acute malnutrition (chapter 11). Infant and young child growth (chapter 12). Platforms for the delivery of interventions (chapters 14 and 15). Following a discussion of the literature on the cost and affordability of interventions, we provide conclusions. Throughout the chapter, unless otherwise specified, costs and cost-effectiveness are converted to 2012 U.S. dollars.

© 2016 International Bank for Reconstruction and Development / The World Bank.

Support Center