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DFID programmes have expanded access to family planning and some maternal health services, but a renewed effort is required to reach young women and girls and to generate lasting impacts on quality of care and maternal health outcomes.
Every year, more than 300,000 women die from complications related to pregnancy and childbirth, with 99% of these deaths occurring in developing countries. It is the number one killer of young women aged between 15 and 19 in the developing world and yet most maternal deaths, injuries and illnesses are easily preventable with the provision of appropriate, good quality sexual, reproductive and maternal health services.
Improving maternal health has been a longstanding objective for the UK aid programme. In 2010, DFID published its Results Framework on reproductive, maternal and newborn health, setting targets for DFID’s contribution to family planning, safe delivery and maternity services. The Framework set a headline goal of saving 50,000 women’s lives during pregnancy and childbirth by 2015.
During this time, DFID spent £4.6 billion on programmes related to reproductive, maternal, neonatal and child health. Within this, £1.3 billion was spent on programmes more specifically related to family planning, reproductive health care and maternal and neonatal health. By the end of the period, DFID announced that it had achieved more than double its targets on safe delivery and maternal lives saved.
Scope and methodology
We examined the impact and sustainability of DFID’s contribution to improving maternal health and assessed the validity of DFID’s results claims. We looked at country-level and centrally managed programming designed to improve maternal health services for women and to expand family planning, which were operational between 2011 and 2015. We also reviewed DFID policy, strategy and guidance documents on maternal health. This analysis was underpinned by a review of published literature to establish a consensus on what works and was framed by the global results targets that DFID set in its 2010 Results Framework.
We undertook two case study visits to Malawi and the Democratic Republic of the Congo (DRC). These countries made a significant contribution to DFID’s overall results claims during the Results Framework and are representative of the countries in sub-Saharan Africa where accelerated progress will be needed to achieve the Sustainable Development Goals and where UK aid is increasingly focused.
Findings
DFID developed a comprehensive Results Framework for 2011-2015 that included targets to improve maternal health. DFID has been an important champion of family planning and reproductive rights at the international level, and helped to extend access to family planning to nearly 10 million women and girls during the Results Framework period. However, its maternal health portfolio was not well balanced across family planning, health services and other interventions so as to maximise impact in the medium- and long-term. In the face of severe shortages of skilled personnel, equipment and supplies, DFID has struggled to raise service quality to the extent needed to improve maternal health outcomes. We were unable to confirm DFID’s global results claim on saving maternal lives, owing to shortcomings in the way it estimated the impacts of its programmes. DFID’s policies prioritised reaching poor and young women but only a few programmes identified specific mechanisms or set targets for reaching these key groups. Furthermore, very few programmes disaggregated their results, making it impossible to determine the impact of DFID programming on poor, young or otherwise hard-to-reach women and girls. DFID has been a strong advocate for women’s and girls’ rights internationally but could do more to reinforce this at community level in priority countries. We found that DFID’s maternal health programming during the Results Framework period had a limited focus on the long-term development of health system infrastructure and institutions. DFID has begun to adapt its maternal health programming in response to learning, and the design of some new programmes suggests that lessons from the Results Framework period are being applied.
Recommendations
As part of its commitment to the Sustainable Development Goals, DFID should develop a long-term approach to improving maternal health, planning through to 2030 in focus countries with high maternal mortality. These plans should focus on improved quality and continuity of care, cross-sectoral interventions and efforts to empower women and girls. DFID should clarify its approach to health systems strengthening, prioritising improvements in the availability and accessibility of good quality, respectful care for women and their babies. DFID should directly monitor the impact of its sexual, reproductive and maternal health services programmes on adolescents and the poorest women. This means including design features in programmes that target adolescents and the poorest women, monitoring whether they are effective and adjusting course where they are not. When using models to generate outcome data, DFID should test its assumptions and triangulate its results claims using other quantitative and qualitative data. As part of its commitment to the Sustainable Development Goal data revolution, DFID should prioritise and invest in international and country-level efforts to gather data on the quality of maternal health services and outcomes, including disaggregated data relating to key target groups.
Government response
The government publishes a response to all ICAI reviews. The government response will be published in due course.
International Development Committee
There will be an International Development Committee hearing into this review in due course.