Accountable Care Reforms Improve Women’s and Children’s Health in Nepal

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Toplines

    Despite its poverty, Nepal has made significant progress over past decade in reducing maternal and infant mortality
    Under a public-private partnership, Nepal ensures integrated reproductive, maternal, and child health services

Background

Rates of maternal and infant mortality remain troublingly high around the world. But despite being one of the poorest countries in Asia, Nepal has made progress in this area, notably by holding health care providers accountable for the health outcomes of women and children. In one rural region, health officials formed a public–private partnership, relying on local community health workers to deliver integrated reproductive, maternal, newborn, and child health care.


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What the Study Found

Based on an assessment of more than 500 women who had recently given birth, Commonwealth Fund–supported researchers found that the public–private partnership improved the health outlook for mothers and newborns:

  • The share of expecting mothers who completed their prenatal care treatment rose from 83 percent to 90 percent.
  • The rate of children born in health facilities increased from 81 percent of live births to 93 percent.
  • Infant mortality decreased from 18.3 per thousand live births to 12.5 per thousand live births.
  • The rate of postpartum contraception use increased from 19 percent to 47 percent.

The intervention cost $3.40 per person at the population level, and $185 for each pregnant woman who received services.

Conclusions

Nepal’s model succeeded by relying on care teams that had preexisting relationships with the community, by adopting an incremental approach to accountable care, and by using early evidence to guide and refine the reforms. And by linking 20 percent of the partnership contract to patient outcomes, the model created incentives to provide high-quality care.

Publication Details

Publication Date: November 6, 2017
Authors: Duncan Maru, Sheela Maru, Isha Nirola, Jonathan Gonzalez-Smith, Andrea Thoumi, Prajwol Nepal, Pushpa Chaudary, Indira Basnett, Krishna Udayakumar, and Mark McClellan
Contact: Mary Mahon, Vice President, Public Information, The Commonwealth Fund
E-mail: mm@cmwf.org
Summary Writer: Joel T. Dodge
Citation:
D. Maru, S. Maru, I. Nerola et al., “Accountable Care Reforms Improve Women’s and Children’s Health in Nepal,” Health Affairs, Nov. 2017 36(11):1965–72.
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