Equity-focused investment strategies to reduce maternal mortality in the Philippines: a subnational analysis using EQUIST.

چکیده اصلی

BACKGROUND: Despite sustained national progress in maternal and child health, maternal mortality in the Philippines remains uneven across regions and socioeconomic groups. Women in poor, rural, and conflict-affected areas experience substantially higher maternal mortality than those in higher-income and urban populations. We aimed to assess subnational inequities in maternal mortality and estimate the potential impact and cost-effectiveness of prioritised maternal health interventions in Philippine regions with maternal mortality ratios exceeding the national benchmark. METHODS: We conducted an equity analysis and developed an investment case using the UNICEF Equitable Impact Sensitive Tool (EQUIST). Regional maternal mortality ratios were based on 2019 subnational estimates, with the 2017 national maternal mortality ratio used as the benchmark for regional stratification. Intervention effectiveness estimates were drawn from published evidence syntheses and global clinical guidelines, and EQUIST's costing module draws on LiST and the Marginal Budgeting for Bottlenecks approach. Three intervention packages were modelled: upgrading basic and comprehensive emergency obstetric and newborn care facility readiness; ensuring universal availability of uterotonics and magnesium sulphate; and expanding access to modern contraception among adolescents, women from poor households, and high-parity women. Projected maternal deaths averted, disability-adjusted life years averted, and cost per DALY were estimated through 2030. RESULTS: Our modelling suggested that prioritised intervention packages could avert approximately 1,000-2,500 maternal deaths cumulatively through 2030. Facility readiness upgrades were projected to avert 1,000-1,500 maternal deaths, life-saving commodities 1,500-2,000, and modern contraception expansion 2,000-2,500. Sensitivity analysis varying key inputs by ±15% produced corresponding sensitivity ranges of 850-1,750, 1,275-2,300, and 1,700-2,875 maternal deaths averted, respectively. Modern contraception expansion had the lowest modelled cost per DALY averted at approximately US$150, compared with USD 300 for life-saving commodities and USD 450 for facility readiness upgrades. CONCLUSIONS: Maternal mortality in the Philippines remains concentrated among disadvantaged subnational populations. Equity-targeted investments, combined with strengthened emergency obstetric care, reliable life-saving commodities, and expanded access to modern contraception, can achieve substantial mortality reductions at highly cost-effective levels.

ترجمه فارسی چکیده

با وجود پیشرفت‌های ملی پایدار در سلامت مادر و کودک، مرگ‌ومیر مادران در فیلیپین همچنان ناهمگون است. هدف این مطالعه ارزیابی نابرابری‌های زیرملی و برآورد اثر و هزینه‌فروشی بالقوه مداخلات اولویت‌دار سلامت مادر در مناطقی بود که نسبت مرگ‌ومیر مادران از حد مرجع ملی فراتر می‌رفت. این مطالعه با استفاده از ابزار EQUIST سازمان ملل متحد برای کودکان انجام شد. سه بسته مداخله مدل‌سازی شد: ارتقای آمادگی مراکز مراقبت‌های اورژانسی زایشی و نوزادی، تضمین دسترسی جهانی داروهای ضدتونیک رحمی و سولفات منیزیم، و گسترش دسترسی به contraception مدرن. برآوردها نشان داد که این مداخلات می‌توانند تا سال 2030 بین ۱۰۰۰ تا ۲۵۰۰ مرگ‌ومیر مادر را جلوگیری کنند. گسترش contraception مدرن با کمترین هزینه هر سال زندگی اصلاح‌شده (DALY) جلوگیری شده (حدود ۱۵۰ دلار) همراه بود.

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