Table 3

Results of impact and cost of investment case analysis in Indonesia
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)
Sikka District Hypertension (25%), Post-partum Haemorrhage (20%), Sepsis/Infection (16%), Ante-partum Haemorrhage (13%)* Pneumonia (15%), Diarrhoea (12%), Malaria (12%), Preterm birth (11%), Birth Asphyxia (10%)† 24% (17%-28%) 14% (10%-17%) 7% (5%-11%) $1.63 ($1.53-1.76) $1.64
National Priority Scenario Strategies: Infrastructure upgrade for basic and comprehensive emergency obstetric and neonatal care (BEONC/CEONC), recruitment, training and retention of staff in remote areas, coordination for adequate commodities, community participation for facility-based delivery, monitoring and evaluation activities
28% (22%-32%) 17% (13%-20%) 13% (9%-16%) $3.33 ($3.23, 3.45) $1.74
Full Scenario Strategies: As above plus revitalisation of the Integrated Village Health Post, training of community health workers on signs of pneumonia, use of Oral Rehydration Therapy (ORT), Insecticide Treated Nets (ITN), additional training for primary health care workers, implementation of ‘Clean and Healthy Lifestyle’ in selected villages
Merauke District Hypertension (25%), Post-partum Haemorrhage (20%), Sepsis/Infection (16%), Ante-partum Haemorrhage (13%)* Malaria (19%), Diarrhoea (16%), Pneumonia (15%), Birth Asphyxia (15%), Preterm birth (10%) † 35% (29%-40%) 33% (28%-37%) 13% (11%-15%) $4.29 ($4.14, 4.37) $1.57
National Priority Scenario Strategies: Infrastructure upgrade for BEONC/CEONC, recruitment, training and retention of staff in remote areas, generous allowances for all midwives in the district, contract outreach teams to remote areas, voucher system to cover the cost of transport for pregnant women, coordination for adequate commodities, community participation for facility-based delivery, monitoring and evaluation activities
36% (29%-40%) 34% (29%-38%) 25% (21%-29%) $7.06 ($6.91-7.21) $2.18
Full Scenario Strategies: As above plus revitalisation of the Integrated Village Health Post, training of community health workers on signs of pneumonia, use of ORT, ITN, additional training for primary health care workers, implementation of ‘Clean and Healthy Lifestyle’ in selected villages
Pontianak City Hypertension (25%), Post-partum Haemorrhage (20%), Sepsis/Infection (16%), Ante-partum Haemorrhage (13%)* Diarrhoea (17%), Pneumonia (14%), Preterm birth (11%), Birth Asphyxia (11%), Neonatal Sepsis (5%) † 15% (6%-22%) 12% (7%-17%) 5% (3%-10%) $0.90 ($0.73-1.17) $0.24
National Priority Scenario Strategies: Upgrading of health facilities for CEONC, consultation with private sector on referral and CEONC procedures, training public and private midwives in all critical Maternal, Newborn and Child Health (MNCH) interventions including immunisation, monitoring of private midwives by Midwives Association, active case finding for immunisation, media campaign for immunisation, counselling for health staff on legal protections associated with adverse events of immunisation
17% (8%-24%) 12% (7%-17%) 9% (5%-13%) $1.44 ($1.31-1.73) $0.27
Full Scenario Strategies: As above plus activities to encourage breastfeeding (including regulation of breast-milk substitutes), revitalisation of integrated health post, training of community health workers on signs of pneumonia, use of ORT, ITN, implementation of ‘Clean and Healthy Lifestyle’, partnerships with pharmacies for delivering health messages, and to refer complicated deliveries
Tasikmalaya City Hypertension (25%), Post-partum Haemorrhage (20%), Sepsis/Infection (16%), Ante-partum Haemorrhage (13%)* Birth Asphyxia (13%), Pneumonia (6%), Diarrhoea (5%), Preterm birth (5%), Neonatal Sepsis (5%)† 14% (7%-22%) 15% (9%-20%) 7% (4%-11%) $0.77 ($0.72-0.93) $0.36
National Priority Scenario Strategies: Infrastructure upgrade for additional CEONC, incentives to private midwives on submission of monthly reports, recruitment and training of midwives, monitoring and evaluation particularly at primary health care level, coordination between health levels for referral of high risk deliveries, Mother’s Groups and use of MNCH books, incentives to traditional birth attendants who refer or partner with midwives
16% (7%-23%) 16% (10%-21%) 10% (6%-12%) $1.11 ($1.04-1.21) $0.44
Full Scenario Strategies: As above plus revitalisation of integrated health post, training of community health workers on signs of pneumonia, use of ORT, ITN, implementation of ‘Clean and Healthy Lifestyle’, additional coordination and laboratory staff

* Source: (18) National estimate. Ministry of Health. Survey Kesehatan Rumah Tangga Tahun 2001 (Household Health Survey). Report. Jakarta: Badan Penelitian dan Pengembangan Kesehatan2001.

† Source: National Institute for Health Research and Development, Indonesia (NIHRD), Basic Health Research National Report 20072008. Provincial estimate based on National estimate from (19).

Results are based on point estimates and ranges calculated assuming −/+10% of intervention coverage determined by policymakers.

Jimenez Soto et al.

Jimenez Soto et al. BMC Public Health 2013 13:601   doi:10.1186/1471-2458-13-601

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