Returns on Investment in the Continuum of Care for Reproductive, Maternal, Newborn, and Child Health.

Document Type

Book Chapter


Obstetrics and Gynaecology (East Africa)


The continuum of care for reproductive, maternal, newborn, and child health (RMNCH) addresses three key dimensions of service delivery across time, space, and type of care (Kerber and others 2007): Access to needed services throughout the life cycle, including adolescence, pregnancy, childbirth, the postnatal period, and childhood. Access to interventions with functional linkages among levels of care in the health system provided by families and communities, outpatient and outreach services, and health facilities. Access to different types of health services and activities, including prevention, promotion, and curative and palliative care (World Health Assembly 2009). Assessing the returns on investments in the continuum of care for RMNCH requires specification of a package of interventions and an estimate of the full costs incurred in the health system to deliver those interventions. On the benefits side, the outcome of the continuum of care is evidenced in the many dimensions of the health benefits arising from an integrated care program. These benefits are not only lives saved; they also include the improved health and welfare of mothers and children, and the benefits that arise from expanding the ability of women to plan their pregnancies. These diverse health gains will have a wide range of economic and social benefits. Thus, assessing the returns on investment in the continuum of care for RMNCH also requires a comprehensive attempt to measure the various benefits that accrue to communities, at different stages of the life-cycle, as a result of the interventions. The overall analysis compares costs and benefits, taking into consideration their varying patterns over time, to generate benefit-cost ratios and rates of return on investment. This chapter assesses the costs and benefits of delivering a set of integrated RMNCH interventions across the continuum of care in countries with high child and maternal mortality. The purpose is twofold: To demonstrate that very high returns can be achieved by strengthening investments in the delivery of a suite of high-impact interventions. To underscore the importance of an accurate assessment of those returns, including the full range of costs involved in delivering integrated care across the continuum and the full range of benefits that flow from the interventions. This chapter is based on the first attempt, to our knowledge, to undertake such a comprehensive analysis of the returns on investment in the continuum of care for RMNCH (Stenberg and others 2014).


The International Bank for Reconstruction and Development / The World Bank