Table 5

Results of impact and cost of investment case analysis in Nepal
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)
Terai cluster Hypertension (21%), Post-partum Haemorrhage (28%), Unsafe Abortion (7%), Ante-partum Haemorrhage (6%) * Pneumonia (20%), Birth Asphyxia (10%), Preterm birth (9%), Neonatal Sepsis (8%) † 23% (17%-28%) 39% (35%-43%) 18% (16%-19%) $1.77 ($1.76-1.77) $1.69
District Cluster IC Strategies: Community based education and promotion by Female Community Health Volunteers (FCHV), additional training for staff on family planning, breastfeeding and immunisation, upgrading health posts into primary health care centres, increased staffing to enable 24 hr facilities, capacity building for local logistical management, introduction of pneumococcal and Pentavalent vaccines, introduction of community based neonatal care
31% (27%-35%) 46% (42%-49%) 20% (19%-22%) $2.76 ($2.75-2.77) $9.02
NHSPII Strategies: As above with additional NHSPII targets for coverage and infrastructure
Hills cluster Hypertension (21%), Post-partum Haemorrhage (28%), Unsafe Abortion (7%), Ante-partum Haemorrhage (6%) * Pneumonia (22%), Birth Asphyxia (17%), Preterm birth (16%), Neonatal Sepsis (13%) † 34% (30%-38%) 57% (53%-61%) 33% (31%-36%) $2.03 ($1.98-2.00) $0.72
District Cluster IC Strategies: Community based education and promotion by FCHV, additional training for staff on family planning, breastfeeding and immunisation, upgrading health posts into primary health care centres, increased staffing to enable 24hr facilities, capacity building for local logistical management, introduction of pneumococcal and Pentavalent vaccines, introduction of community based neonatal care
40% (36%-44%) 62% (58%-66%) 36% (33%-38%) $2.42 ($2.18-2.46) $3.65
NHSPII Strategies: As above with additional NHSPII targets for coverage and infrastructure
Mountains cluster Hypertension (21%), Post-partum Haemorrhage (28%), Unsafe Abortion (7%), Ante-partum Haemorrhage (6%) * Pneumonia (32%), Birth Asphyxia (15%), Preterm birth (14%), Neonatal Sepsis (12%) † 26% (19%-32%) 40% (30%-49%) 24% (17%-29%) $3.65 ($3.56-3.67) $2.16
District Cluster IC Strategies: Community based education and promotion by FCHV, additional training for staff on family planning, breastfeeding and immunisation, upgrading health posts into primary health care centres, increased staffing to enable 24hr facilities, capacity building for local logistical management, introduction of pneumococcal and Pentavalent vaccines, introduction of community based neonatal care
40% (35%-45%) 57% (50%-64%) 31% (26%-36%) $4.20 ($4.07-4.28) $4.02
NHSPII Strategies: As above with additional NHSPII targets for coverage and infrastructure

* Source: (22) National Estimate. Suvedi BK, Pradhan A, Barnett S, Puri M, Chitrakar SR, Poudel P, et al. Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of Preliminary Findings. Kathmandu, Nepal.: Family Health division, Department of Health Services, Ministry of Health, Government of Nepal.2009.

† − Source: (13) eco-region estimates for post neonatal causes (not cluster specific), Ministry of Health and Population, New ERA, ORC Macro International Inc. Nepal Demographic and Health Survey 20062007.

(23) national estimate for neonatal causes. WHO. World Health Statistics 2010. Geneva2010.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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