Posted by: davidjolson | 07/02/2010

Sustainability: Getting beyond the financial kind in maternal health

NOTE: This article is written by Steven Chapman, senior vice president and chief technical officer of PSI, who leads PSI’s efforts to improve the effectiveness, cost-effectiveness and equity of its interventions, and is taken from the July 2010 issue of “Impact, the magazine of PSI.

On April 10, The Lancet published some of the best news international health had heard in years. Maternal mortality has long been thought not to be decreasing. Yet, using new measurement methods, researchers at the University of Washington found that death rates had in fact dropped significantly. Since 1990, the annual rate of decline of the global maternal mortality rate was 1.3 percent. In 1980, more than 500,000 women died from maternity-related causes; in 2008, fewer than 350,000 did.

For PSI, the significance of this finding was clear. Many more years of effort will be required to bring maternal mortality rates in low-income countries down to high-income country levels. Our single most important challenge as an organization is how to sustain programs over the decades that it takes to solve the world’s most important health challenges, particularly those that affect women.

More than 10 years ago, PSI published its first position statement on sustainability – distancing itself from the almost exclusive focus on financial sustainability used by other social marketing organizations. Instead, we emphasized producing health and quality-of-life benefits at scale and with equity, increasing cost-effectiveness, minimizing financial subsidies, reducing the financial vulnerability of our social marketing partners in the developing world, and building unique competencies needed to address the public health challenges of today and tomorrow.

We recently updated that position statement using new examples, yet reaffirming its central point. For PSI, sustainability is achieving positive public health impact and continuing that impact over time. At PSI, we believe the best way to do this is to use social marketing approaches that make it easier for populations to access products, services and information that address the priority contributors to a country’s burden of disease and unintended pregnancy. We believe that high proportions of the vulnerable and low-income populations over time will adopt healthy behaviors; the burden of disease will decrease and change; and that donor subsidies can be reduced, eliminated or shifted to other priorities over time.

We believe that new financing arrangements, particularly health insurance, will emerge to complement and perhaps replace the need for donor support as we know it today. We know that this will take years. PSI has been working in family planning for 40 years during which contraceptive prevalence rates in the developing world have increased at just 1.5 percent per year.

Since 1988, we have been working with many partners to increase condom use, the age of sexual debut and the number of people having just one sexual partner at a time. An analysis of a nearly 10-year trend in those behaviors among women ages 15-24 in 18 African countries found that condom use increased by 1.4 percent per year and secondary abstinence increased significantly.

We apply three general strategies to achieve sustainability…

See complete article on the PSI website.

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