Cost-Effectiveness of Interventions to Improve Maternal, Newborn and Child Health Outcomes: A WHO-CHOICE Analysis for Eastern Sub-Saharan Africa and South-East Asia.

BACKGROUND: Information on cost-effectiveness allows policy-makers to evaluate if they are using currently available resources effectively and efficiently. Our objective is to examine the cost-effectiveness of health interventions to improve maternal, newborn and child health (MNCH) outcomes, to provide global evidence relative to the context of two geographic regions. METHODS: We consider interventions across the life course from adolescence to pregnancy and for children up to 5 years old. Interventions included are those that fall within the areas of immunization, child healthcare, nutrition, reproductive health, and maternal/newborn health, and for which it is possible to model impact on MNCH mortality outcomes using the Lives Saved Tool (LiST). Generalized cost-effectiveness analysis (GCEA) was used to derive average cost-effectiveness ratios (ACERs) for individual interventions and combinations (packages). Costs were assessed from the health system perspective and reported in international dollars. Health outcomes were estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. The model was run for 2 regions: Eastern sub-Saharan Africa (SSA-E) and South-East Asia (SEA). RESULTS: The World Health Organization (WHO) recommended interventions to improve MNCH are generally considered cost-effective, with the majority of interventions demonstrating ACERs below I$100/HLY saved in the chosen settings (low-and middle-income countries [LMICs]). Best performing interventions are consistent across the two regions, and include family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine. ACERs below I$100 can be found across all delivery platforms, from community to hospital level. The combination of interventions into packages (such as antenatal care) produces favorable ACERs. CONCLUSION: Within each region there are interventions which represent very good value for money. There are opportunities to gear investments towards high-impact interventions and packages for MNCH outcomes. Cost-effectiveness tools can be used at national level to inform investment cases and overall priority setting processes.

The human rights framework, the school and healthier eating among young people: a European perspective.

OBJECTIVE: To give an account of provisions in the framework of international human rights and intergovernmental policy agreements in relation to eating at school and discuss how these provisions could be invoked to ensure healthy eating at school. DESIGN: A review of provisions in the international and European human rights frameworks and policy documents was performed in order to identify evidence and examples of provisions implying responsibilities of the school as a public service provider to ensure healthy eating. RESULTS: The review of the human rights and policy texts showed that there are a large number of provisions that can be invoked in support of measures at school which can contribute to ensuring healthier eating as well as better education supporting such measures. CONCLUSIONS: The international frameworks of human rights and intergovernmental policy agreements should be invoked and translated into concrete strategies, policies, regulations and accountability mechanisms at national, regional, local and school levels. Ensuring healthy eating should be a top priority among all stakeholders in and around the school environment since it is a good investment in children's short- and long-term health and educational achievements.

Nutrition education in the context of the United Nations Standing Committee on Nutrition activities and publications, 1985-2006.

The United Nations System Standing Committee on Nutrition (SCN) is a forum where United Nations (UN) agencies, bilateral partners, and nongovernmental agencies meet to harmonize and coordinate nutrition policy and programs. This report reviews the positions taken regarding nutrition education throughout SCN publications, annual sessions, and thematic working groups. The first Nutrition Policy Paper, published in 1985, was a State-of-the-Art Review that investigated 6 aspects of a nutrition education system. Later SCN publications and meetings have further addressed how to conduct effective nutrition education to maximize impact. For nutrition education to be worthwhile, it must reach significant audiences and lead to behavioral change, conditions which in turn require feasibility studies and investments in terms of personnel and resources. The SCN plays an important role to these ends through: 1) the advocacy opportunity offered by the SCN Annual Session; 2) the expertise of the working groups; and 3) the dissemination channels offered by the SCN publications and Web site.