ESTIMATING THE RETURNS
OF INVESTING IN RMNCH
Malcolm Bryant and Susan Foster
Overview
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Why calculate ROI
Overall approach
Developing a framework for policy-makers
How it will work
Challenges
Why calculate returns on investment for
RMNCH?
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Economic benefits of investing in health have been
calculated for a range of populations and diseases
Identification of the economic benefits of investing
in HIV, TB, malaria—presented persuasive cases
Financing agencies understood these arguments,
and as a result, increased funding
RMNCH have not benefitted from the same form of
detailed analysis
Country-level decision-makers require tools to
understand and support RMNCH
Overall approach
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Review and list the RMNCH challenges faced by
women and their children in low-income
environments
Identify the major health, social, and other impacts
of each challenge
Identify the economic impact of each challenge
Creating a framework
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Identify the most important costs associated with
each impact
 Use
an expanded cost-of-illness approach;
 Capture direct and indirect costs;
 Individuals
 Households
 Healthcare systems
 Societies
Populate the framework
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What data is required to estimate each cost at the
national level?
What are the possible sources of such data in
typical country settings?
 Current
burden of morbidity and mortality
 Unit costs to estimate the cost of illness
 Estimate current costs of providing RMNCH interventions
and services
 Identify data needed to calculate productivity losses
How will it work?
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1. What are the RMNCH challenges?
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All common maternal, neonatal, and childhood
illnesses and conditions!
How to make sense of them?
 The
Continuum of Care
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Adolescence and before pregnancy
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Stage/Event
Challenges
Outcomes
Impacts
Menarche and Rituals – e.g.
before
FGM
Pain, shame, fear,
psychological and
mental illness,
dyspareunia,
perineal tears
during labor
Burden on health system
Marital discord+/- divorce
Neonatal deaths and
asphyxia, postpartum
hemorrhage and death
Menstruation
Pain,
inconvenience
Early marriage
Lost days at school,
lost days at work,
Decreased female literacy;
increased child mortality;
Lost productivity
Early Sexual
Activity
Unwanted
pregnancy, STI,
HIV/AIDS
Social rejection,
dystocia in young
girls, Infertility,
divorce, early end
of schooling
Burden on health system
Neonatal death and
asphyxia, decreased female
literacy, increased child
mortality
Selecting priorities
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RMNCH is infinitely complex (it makes HIV, TB, and
Malaria seem simple). We have to make rational
choices about which impacts to address
Proposed Criteria:
 Must
be proven interventions to address impact
 Feasibility
 Political visibility
 Attractive
 Evidence
to politicians and can be understood by them
of cost-effectiveness
Possible criteria that could be used
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Health services costs averted
Lives saved – RMNCH is unique in being able to save more
than one life with one treatment episode, e.g. a mother and
the baby
Long term sequelae of birth injuries, e.g. asphyxia - need
for lifetime of care, low or no income earning, etc.
Long term sequelae of maternal injuries e.g. fistula –
divorce, stigma
Indirectly, loss of a mother often means poor survival of
remaining children
Increasing under five survival has a disproportionate effect
on national life-expectancy
Societal costs – low morale, fatalism, orphans, widowers
Who is our target audience
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International funding agencies?
Politicians and policymakers at national level
 Ministry
of Finance
 Ministry of Health
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National medical and nursing staff and thought
leaders
Local politicians and funding groups in
decentralized settings
How closely to link with health and nonhealth solutions
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Where does female education fit in with this?
Next Steps
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Link RMNCH challenges to health, social, economic
and other impacts
Estimate the costs to the individual, household,
community, health system, and country of each
impact
Create a simple tool that can be used to estimate
the costs
 Simple
is key. Methodological soundness is required, but
a balance must be maintained between the perfect and
the practical