Economic modelling for evaluation of complex interventions to improve maternal & newborn health

Background: Economic evaluation estimates the cost-effectiveness of interventions in a given setting. The extent to which economic evaluation can guide policy and programme decisions depends on whether results can be generalised beyond the study setting. When interventions are complex, as they often are in low-income countries, and target behaviour change or health system strengthening, the assumptions about the context, intensity and scale of implementation are especially important and affect the generalisability of cost-effectiveness results.

Design and methods: The IDEAS project aims to learn about the efficiency of complex interventions to improve maternal and neonatal health implemented by grantee organizations in Ethiopia, North-Eastern Nigeria and Uttar Pradesh in India. The interventions are wide-ranging, though aim to increase the number and quality of interactions between families and frontline workers, and improve the survival of mothers and newborns. An economic model is being developed to provide a framework that can be applied across the three settings.

Results: Research is ongoing. In developing the model we will depict the relationship between behaviour change and health system initiatives, interactions between families and frontline workers, the maternal and neonatal health care received, and expected health outcomes. We aim to incorporate contextual factors, and also the intensity and scale of implementation. The model will bring together data from primary and secondary sources. Sensitivity analysis will be undertaken.

Conclusions: The research will explore the potential for economic modelling to draw lessons about the cost-effectiveness of complex interventions to improve maternal and neonatal health across multiple settings.