| Abstract: | Objectives: To measure levels and types of effort for national maternal and neonatal health programs in 55 developing countries, in 2002, as a replication of a 1999 study. Methods: Thirteen components of program effort were covered, based on 81 items in questionnaires completed by 10–25 expert respondents in each country. Results: With 100% representing maximum effort, the international average was 58–60%, and the 13 component averages varied from 48 to 72%. The components included health center and district hospital capacities, services provided, proportion of the rural and urban populations with actual access to the services, together with the support functions of policy, training, education, resources, and evaluation. Scores are high for policies but low for access, resources, training, and public education. Conclusions: National programs to improve maternal health are far from satisfactory, as assessed here, with negligible improvement from 1999–2002. Efforts fall short in general, but considerably more so for some program features than others. Literal access to basic services is poor, and is especially lacking in rural areas. Regions differ much more in the access they provide to services than in other respects. |
