title: Strategic planning for saving the lives of mothers, newborns and children and preventing stillbirths in KwaZulu-Natal province South Africa: modelling using the Lives Saved Tool (LiST).
abstract: BACKGROUND
  KwaZulu-Natal province in South Africa has the largest population of children under the age of five and experiences the highest number of child births per annum in the country. Its population has also been ravaged by the dual epidemics of HIV and TB and it has struggled to meet targets for maternal and child mortality. In South Africa's federal system, provinces have decision-making power on the prioritization and allocation of resources within their jurisdiction. As part of strategic planning for 2015-2019, KwaZulu-Natal provincial authorities requested an assessment of current mortality levels in the province and identification and costing of priority interventions for saving additional maternal, newborn and child lives, as well as preventing stillbirths in the province.
  
  
  METHODS
  The Lives Saved Tool (LiST) was used to determine the set of interventions, which could save the most additional maternal and child lives and prevent stillbirths from 2015-2019, and the costs of these. The impact of family planning was assessed using two scenarios by increasing baseline coverage of modern contraception by 0.5 percentage points or 1 percentage point per annum.
  
  
  RESULTS
  A total of 7,043 additional child and 297 additional maternal lives could be saved, and 2,000 stillbirths could be prevented over five years. Seventeen interventions account for 75% of additional lives saved. Increasing family planning contributes to a further reduction of up to 137 maternal and 3,168 child deaths. The set of priority interventions scaled up to achievable levels, with no increase in contraception would require an additional US$91 million over five years or US$1.72 per capita population per year. By increasing contraceptive prevalence by one percentage point per year, overall costs to scale up to achievable coverage package, decrease by US$24 million over five years.
  
  
  CONCLUSIONS
  Focused attention on a set of key interventions could have a significant impact on averting stillbirths and maternal and neonatal mortality in KwaZulu-Natal. Concerted effort to prioritize family planning will save more lives overall and has the potential to decrease costs in other areas of maternal and child care.
authors.affiliation: Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Shelley-Ann
authors.initials: SA
authors.lastname: McGee
authors.affiliation: Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Lumbwe
authors.initials: L
authors.lastname: Chola
authors.affiliation: Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Aviva
authors.initials: A
authors.lastname: Tugendhaft
authors.affiliation: Department of Health, Province of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Victoria
authors.initials: V
authors.lastname: Mubaiwa
authors.affiliation: Department of Health, Province of KwaZulu-Natal, Pietermaritzburg, South Africa.|Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Neil
authors.initials: N
authors.lastname: Moran
authors.affiliation: Department of Health, Province of KwaZulu-Natal, Pietermaritzburg, South Africa.|Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Neil
authors.initials: N
authors.lastname: McKerrow
authors.affiliation: United Nations Population Fund (UNFPA), Pretoria, South Africa.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kamugisha
authors.affiliation: Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa. karen.hofman@wits.ac.za.
authors.forename: Karen
authors.initials: K
authors.lastname: Hofman
mesh_terms: D000328:Adult; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D005193:Family Planning Services / Q000191:economics / Q000458:organization & administration*; D005260:Female; D015276:Health Care Rationing / Q000191:economics / Q000458:organization & administration*; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D000068101:Maternal-Child Health Services / Q000191:economics / Q000458:organization & administration*; D009035:Mothers; D011247:Pregnancy; D013019:South Africa / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology*