Investing in Maternal Health in Malaysia and Sri Lanka

by Padmanathan, Indra; Liljestrand, Jerker; Martins, Jo. M.; Rajapaksa, Lalini C.; Lissner, Craig; de Silva, Amala; Selvaraju, Swarna; Singh, Prabha Joginder

• ISBN13: 9780821353622
• ISBN10: 0821353624
• Edition: 1st
• Format: Paperback
• Copyright: 2003-04-04
• Publisher: World Bank Publications
• More Book Details

Summary

This study provides the most comprehensive and detailed analysis available on factors behind the decline in maternal mortality in Malaysia and Sri Lanka in the past 50 to 60 years and the magnitude of health system expenditures on maternal health. The main findings are that a modest investment in maternal health services, combined with other poverty reduction measures leads to a fairly rapid decline in the maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. The strategies of Malaysia and Sri Lanka changed over time, from an initial emphasis on expanding the provision of services, especially in underserved areas, to increasing utilization and, finally, to emphasizing the improvement of quality. Removing financial barriers to maternal care for clients was an important step in both countries. Professional midwives constitute the backbone of maternal care in Malaysia and Sri Lanka. The MMR reduction in developing countries is feasible with modest public expenditures when appropriate policies are adopted, focused wisely, and adapted incrementally in response to environmental conditions and systems capacity. [World Bank]

Table of Contents

Foreword	ix
Acknowledgments	xiii
Executive Summary	xvii
Overview	1	(1)
Maternal Mortality Can Be Halved in Developing Countries Every 7 to 10 Years	2	(2)
Maternal Mortality Reduction Is Affordable Regardless of Income Level and Growth Rate	4	(1)
Maternal Mortality Declines Rapidly with the Provision of a Synergistic Package of Health and Social Services That Reach the Poor	5	(5)
Governments Can Afford to Provide the Critical Elements of Maternity Care Free of Charge to the Client	10	(2)
Different Tactics Are Needed at Different Stages of Health Systems Development	12	(4)
Official Recognition of Professional Midwifery Is a Crucial Step toward Reducing Maternal Mortality	16	(3)
Raising the Importance of Maternal Death through Recording, Reporting, and Subsequent Advocacy Will Improve Program Performance	19	(1)
Conclusion	20	(1)
Note	21	(2)
The Ingredients of Success	23	(38)
The Conceptual Basis	24	(8)
Aims of the Study	32	(1)
Study Approach	32	(4)
The Evidence	36	(11)
Maternal Mortality Transition: A Model for Action	47	(11)
Conclusion	58	(1)
Notes	59	(2)
Malaysia	61	(44)
Background: Malaysia Today	61	(1)
Political Context	62	(2)
Study Approach	64	(4)
Decline in Maternal Mortality	68	(5)
Key Policies and Program Interventions	73	(29)
Summary	102	(1)
Notes	103	(2)
Sri Lanka	105	(66)
Background: Sri Lanka Today	105	(1)
Political and Social Context	105	(3)
Study Approach	108	(4)
Decline in Maternal Mortality Ratio	112	(1)
Trends in Maternal Mortality Ratio and Female Death Rates	113	(12)
Development of Maternal and Child Health Services	125	(15)
Implementation of Critical Health Policies	140	(5)
Health System Expenditures, Affordability, and Sustainability	145	(5)
Conclusion	150	(1)
Notes	151	(2)
Appendixes
1 Data Availability and Quality in Malaysia	153	(6)
2 Data Availability and Quality in Sri Lanka	159	(4)
3 Assessment of Affordability	163	(2)
2 Key Informants	165	(6)
References	171