Maternal and child health in sub-Saharan Africa within the context of a health system intervention

Progress in reducing maternal and child mortality has been made globally since the United Nations Millennium Development Goals (MDGs) were defined in 2001 and were succeeded by the Sustainable Development Goals (SDGs) in 2015. Still, maternal and child mortality remain unacceptably high in sub-Saharan Africa (SSA), showing, showing that current programmes are not effective enough. Without novel approaches it is hence unlikely that SDG 3.1 (reduced maternal mortality to less than 70 per 100,000 live births) and SDG 3.2 (reduced child mortality to less than 25 per 1,000 live births) will be achieved by 2030. Moreover, it has only recently been recognized that the SDGs won’t be achieved without a holistic approach that includes the private sector.
The aim of this thesis was to presents data on how a public-private health system intervention (HIF programme), targeting both the demand and supply sides of the health system, may contribute to improving maternal and child health in sub-Saharan Africa. This health system intervention consisted of providing voluntary health insurance covering primary and secondary healthcare, combined with improving the quality of healthcare facilities. The results of four observational studies and one cost-effectiveness study were described in this thesis.