Improving maternal and newborn survival and health in India

Utkrisht Maternal and Newborn Health Development Impact Bond

At a glance

Despite a significant reduction in maternal and newborn mortality rates over the past 25 years, performance in India remains low by global standards.1 India currently ranks 142 out of 217 countries in terms of maternal mortality and 184 in newborn mortality.2  Four states alone, including Rajasthan, account for 56 percent of newborn deaths, and about 14 percent of newborn deaths globally.3 

The Indian Government has made efforts to address this by increasing institutional deliveries. The world’s first development impact bond in healthcare enables clients to put their capital to work and improve maternity care in India. USAID and Merck for Mothers are the outcomes funders for the three-year program. The UBS Optimus Foundation will raise the risk capital necessary to fund working capital.

The partners

HLFPPT is a social enterprise with more than 600 employees and partnerships with the Indian Ministry of Health and Family Welfare, and 11 state governments. The organization supports the implementation of reproductive child health, HIV prevention and care programs. 

PSI is a global health network of more than 60 local organizations dedicated to improving health of people in the developing world by focusing on serious challenges such as a lack of family planning, HIV and AIDS, barriers to maternal health, and the threats to children under five.

The problem

In Rajasthan, institutional deliveries in both public and private sector facilities have grown from 22 percent of all deliveries to 81 percent (1998-2016).4  The private sector, which accounted for only 6 percent of all deliveries in 1998, now handles 17 percent of all deliveries and 20 percent of institutional deliveries, equivalent to over 300,000 births per year.5 However, the increase in institutional deliveries has not resulted in the expected improvement in maternal health outcomes. Out of 1.8 million births per year in Rajasthan, the mortality rate is approximately 255 per 100,000 live births,6  and 32 per 1,000 live births,7 47 percent and 14 percent above the national average, respectively. 

While the government has focused on improving quality care in the public sector, there is growing recognition that quality of care must be improved for private small healthcare organizations (SHCOs) in the private sector.

The solution

Development Impact Bonds (DIBs8 )  are an innovative way to finance development. They are 100 percent focused on outcomes and have the potential to leverage private investments to address some of the world's greatest challenges. They work by getting a philanthropic investor to pay up front, through the UBS Optimus Foundation, for the costs of an intervention, which is then measured by clear, predetermined metrics. If the intervention succeeds in achieving the goals, the outcome funder will contribute to the program based on the performance. The initial capital plus the performance-related contribution are then repaid to the Foundation and can then be rolled over into future philanthropic programs.

The evidence

The good news is that the recent development of Joint Quality Standards (JQS) for maternal care and a related accreditation program now provides a standardized means for the government to assess maternal and newborn health (MNH) quality and channel funds to private facilities offering quality care. In short, it is a cost-effective approach to saving lives.

The Impact

The Rajasthan Maternal and Newborn Health Development Impact Bond aims to increase long-term maternal and newborn survival. It links third-party payments with quality care in private facilities so that providers are incentivized to achieve and sustain a standard of quality. For private providers who want to grow patient numbers by leveraging government and insurance company payments for services, there is a strong and increasing incentive to be accredited. The development impact bond will help increase the number of quality private facilities in Rajasthan, and demonstrate to the government a cost-effective way to channel funding to facilities that deliver quality and sustained maternal and newborn health (MNH) care.

The development impact bond will assist small healthcare organizations to prepare for accreditation under the JQS supporting the Government of Rajasthan’s commitments to introduce new health improvement programs and increase interest in engaging the private sector in health service delivery.

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