Investing in midwifery for sustainable development goals in low- and middle-income countries: a cost-benefit analysis.

BACKGROUND: Maternal and neonatal mortality in low- and middle-income countries is frequently caused by inadequate management of obstetric and neonatal complications and a shortage of skilled health workers. The availability of these workers is essential for effective and high-quality healthcare. To meet the needs of sexual, reproductive, maternal, new-born, child, and adolescent health by 2030, more than one million health workers, including 900 000 midwives, are required globally. Despite this, uncertainty persists regarding the return on investment in the health workforce. METHODS: The objective of this research was to determine the cost-benefit ratio of increasing investment in midwifery in Morocco from 2021 to 2030. A comparative analysis was conducted between scenarios "with" and "without" the additional investment. The costs and benefits were estimated using relevant data from national and international sources. RESULTS: Following the International Confederation of Midwives' recommendations, it is advised that Morocco recruit 760 midwives annually to achieve 95% of universal health coverage. This increase in midwifery could result in saving 120 593 lives by 2030, including reducing maternal deaths by 3 201, stillbirths by 48 399, and neonatal deaths by 68 993. The estimated economic benefit of investing in midwives was US$ 10 152 287 749, while the total cost was US$ 638 288 820. Consequently, the cost-benefit ratio was calculated as 15.91, indicating that investing in midwifery would provide 16 times more benefits than costs. CONCLUSION: Increasing investment in midwifery appears to be an efficient strategy for achieving comprehensive maternal and child health coverage in low- and middle-income countries.

Inequality in COVID-19 vaccination in Africa.

Background: The COVID-19 pandemic has spread rapidly to all countries with significant health, socioeconomic, and political consequences. Several safe and effective vaccines have been developed. However, it is not certain that all African countries have successfully vaccinated their populations. Objective: To study the distribution and determinants of COVID-19 vaccination in Africa from March 2021 to June 2022. Methods: Using reliable open-access data, we used the proportion of fully vaccinated people with a complete schedule as a reference variable. To analyze the level of inequality in COVID-19 vaccination, we computed common inequality indicators including two percentile ratios, the Generalized Entropy index, the Gini coefficient, and the Atkinson index. We also estimated the Lorenz curve. To identify drivers of COVID-19 vaccination, we estimated univariate and multivariate regression models as a function of COVID-19-related variables, demographic, epidemiologic, socioeconomic, and health system-related variables. To overcome a potential endogeneity bias, we checked our results using simultaneous equation models. Results: 53 African countries with available data were included in the study. The proportion of fully vaccinated people increased during the study period. However, this increase remained unequal across African countries. Based on the inequality indicators and the Lorenz curve, inequalities in COVID-19 vaccination across African countries were high, although they have decreased in recent months. Total COVID-19 cases and human development index were identified as significant determinant factors that were independently associated with COVID-19 vaccination. Conclusions: Inequality in COVID-19 vaccination in Africa was high. Promoting adequate information to the general population and providing financial and logistical support to low-income countries can help expand COVID-19 vaccination in Africa.

Delivery fee exemption and subsidy policies: how have they affected health staff? Findings from a four-country evaluation.

Many countries, especially in Africa, have in recent years introduced fee exemptions or subsidies targeting deliveries and emergency obstetric care. A number of aspects of these policies have been studied but there are few studies which look at how staff have been affected and how they have responded. This article focuses on this question, comparing data from Benin, Burkina Faso, Mali and Morocco. It is nested in wider evaluation of the policies. The article analyses responses to a health worker survey, carried out in 2012 on 683 health staff (doctors, nurses, midwives and others such as auxiliaries) across the four countries. The survey focused on working hours, workloads, pay, motivation and perceptions of the policies, as well as reported changes in workload and remuneration over the period of policy introduction. Self-reported staff output ratios suggest that midwives are over-worked across all settings, but facility data presents lower estimates, making it hard to judge the adequacy of workforces. Staff are generally positive about the policies' effects on the health system (increasing supervised delivery rates, benefiting the poor, improving access to medicines and supplies and improving quality of care). In personal terms, staff in Mali and Burkina Faso report increased satisfaction with work as a result of the policies, while in Benin, there is little change and in Morocco a deterioration (which correlated with recommendations about extending exemption policies in future). Awareness of policies was high amongst staff but only a small minority had received any written guides or training on policy implementation. It is crucial that planned health financing changes engage with their implications for staffing­estimating whether specific cadres can absorb increase demand, for example, as well as how to engage them in the policy implementation such that their personal needs are met and their professionalism enhanced.