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



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.


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



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


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.