A new way to improve maternal and newborn health

Pregnant women and newborn babies in the state of Rajasthan in northwest India will have access to better care thanks to an initiative backed by the U.S. government and global partners.

The Maternal and Newborn Development Impact Bond is a new way to fund maternal health care improvements in 440 small, private medical facilities in Rajasthan.

This development impact bond uses the private sector to finance the program, but it is repaid by government and international aid agencies and private foundations — with a few conditions.

Here’s how it works: A Swiss grant-making foundation called the UBS Optimus Foundation will provide the money to improve the quality of health services and reduce maternal and newborn deaths in private health facilities in Rajasthan. This will help the facilities reach accreditation standards. The U.S. government and another private foundation will pay back the investment only if certain targets are met. Targets include adhering to infection-prevention protocols and providing education to new mothers.

The effort could increase access to life-saving supplies and improved care during delivery to as many as 600,000 women over the next five years.

“This is the largest development impact bond focused on health ever launched,” said Priya Sharma, a financial health adviser at the U.S. Agency for International Development (USAID) who manages the bond. Sharma said her job is to determine how to “take the best practices from the private sector and apply them to global health and development.”

Why mothers and newborns?

Most maternal deaths are preventable with adequate health care before, during and after the birth of a child. High blood pressure during pregnancy, severe bleeding during childbirth, and infections afterward are some of the major complications that can kill, and all are preventable or treatable with sufficient medical care and monitoring.

“The intervention will make sure the existing facilities have better-quality medicines and are well-prepared for emergencies,” Sharma said, citing the example of a neo-natal resuscitator being made available to treat babies who aren’t breathing. The program will last three years, but Sharma said the benefit will be felt over a longer period because of increased quality of care and medical training among maternity staff.

Why Rajasthan?

Rajasthan has one of the highest maternal and newborn mortality rates in India despite local governments’ attempts to improve health-care facilities. The state government is committed to improving the lives of mothers and their newborns. “They are an active participant in the bond,” Sharma said.

“We see innovative public-private partnerships, and the engagement of private capital, as an essential strategy in our toolkit towards this goal,” said Naveen Jain of the Rajasthan Ministry of Health. 

Partners for success

“This results-based financing mechanism is groundbreaking in that it takes a business approach to development, while still targeting basic needs like improving the quality of care and private facilities,” USAID Administrator Mark Green said in November when he announced the launch of the Rajasthan bond at the Global Entrepreneurship Summit in India.

“By leveraging the assets and skills of a diverse group of partners across the public and private sectors, we are stretching our investments further while saving more lives. This mechanism is just one example of how USAID is doing business differently,” Green said.