Accountable Care Reforms Improve Women's And Children's Health In Nepal

Health Aff (Millwood). 2017 Nov;36(11):1965-1972. doi: 10.1377/hlthaff.2017.0579.


Over the past decade the Ministry of Health of Nepal and the nonprofit Possible have partnered to deliver primary and secondary health care via a public-private partnership. We applied an accountable care framework that we previously developed to describe the delivery of their integrated reproductive, maternal, newborn, and child health services in the Achham district in rural Nepal. In a prospective pre-post study, examining pregnancies at baseline and 541 pregnancies in follow-up over the course of eighteen months, we found an improvement in population-level indicators linked to reducing maternal and infant mortality: receipt of four antenatal care visits (83 percent to 90 percent), institutional birth rate (81 percent to 93 percent), and the prevalence of postpartum contraception (19 percent to 47 percent). The intervention cost $3.40 per capita (at the population level) and $185 total per pregnant woman who received services. This study provides new analysis and evidence on the implementation of innovative care and financing models in resource-limited settings.

Keywords: Access To Care; Developing World < International/global health studies; Maternal And Child Health; Organization and Delivery of Care; Rural Health Care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child Health
  • Child Health Services / economics*
  • Cost-Benefit Analysis / economics
  • Delivery of Health Care, Integrated / economics*
  • Female
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Maternal Health Services / economics*
  • Nepal
  • Pregnancy
  • Prenatal Care
  • Prospective Studies
  • Public-Private Sector Partnerships / economics
  • Social Responsibility*