title: Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5.
abstract: BACKGROUND
  South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved.
  
  
  METHODS
  We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%.
  
  
  RESULTS
  By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23.
  
  
  CONCLUSIONS
  The 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG) 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority setting tools and the potential for evidence-based decision making in the health sector.
authors.affiliation: PRICELESS - MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Lumbwe
authors.initials: L
authors.lastname: Chola
authors.affiliation: South Africa National Department of Health, Pretoria, South Africa.
authors.forename: Yogan
authors.initials: Y
authors.lastname: Pillay
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Peter
authors.initials: P
authors.lastname: Barron
authors.affiliation: PRICELESS - MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Aviva
authors.initials: A
authors.lastname: Tugendhaft
authors.affiliation: Save the Children, Cape Town, South Africa.|School of Public Health, University of the Western Cape, Bellville, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.affiliation: PRICELESS - MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Karen.Hofman@wits.ac.za.
authors.forename: Karen
authors.initials: K
authors.lastname: Hofman
mesh_terms: D001942:Breast Feeding; D002648:Child; D046688:Child Mortality; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission; D006235:Hand Disinfection; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007743:Labor, Obstetric; D008428:Maternal Mortality; D000068101:Maternal-Child Health Services / Q000191:economics / Q000458:organization & administration*; D009026:Mortality; D009035:Mothers; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control; D011322:Primary Prevention / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care; D013019:South Africa
keywords: child health; cost and cost analysis; maternal health