Incorporating cost and cost - effectiveness into the development of safe motherhood programs

Little information is available on the actual costs of implementing Safe Motherhood programs, or on how these costs vary in different settings. Nor is there a consensus on the precise goal, content, and structure of Safe Motherhood programs. It is difficult to measure the impact of interventions on mortality, and debate continues on the appropriateness of various intermediate or process indicators as proxies for maternal outcome measures. Participants at a recent World Bank workshop on Safe Motherhood agreed that it is essential to develop a better understanding of the cost-effectiveness of Safe Motherhood interventions to design programs and allocate the limited resources available in a way that maximizes their impact on maternal health status. At its simplest, a costing methodology would provide guidelines for estimating the costs of prospective programs, once designed. When combined with information on effectiveness, it could be used to give planners an indication of the potential results achievable through a variety of program options, subject to the resources at their disposal.