In Health Affairs: Moving deliveries to hospitals in low- and middle-income countries

In many low- and middle-income countries, maternal and neonatal mortality remains high. To overcome this problem, in 2005 the World Health Organization (WHO) recommended a “close to client” approach, with delivery for most women in nearby primary care facilities. However, many of the attending providers lack the necessary skills or tools to handle obstetric emergencies. Hospital deliveries could solve this problem, and to determine the feasibility of such a shift, Anna Gage of the Harvard T. H. Chan School of Public Health and coauthors evaluated modeled delivery service redesign in Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania, using country-specific data compiled by the US-based Demographic and Health Survey Program or from the individual countries. Under the authors’ hospital-only redesign, between 72.9 percent (Tanzania) and 98.3 percent (Haiti) of pregnant women would need to travel two hours or less, an increase in average travel time from seven minutes (Kenya) to forty-six minutes (Tanzania). While the authors acknowledge the challenges of implementing these changes, they note that because primary care facilities are not able to consistently provide lifesaving care, it is time to consider a hospital-only approach.

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