Short Summary
In 2020, out of the 135 million births worldwide there were approximately 1.4 million stillbirths, 2.4 million neonatal deaths, and 300,000 maternal deaths. Most of this burden occurs in low and middle-income countries.
PLA groups are facilitated self-help groups that use a specific framework to guide member participants in identifying, executing, and evaluating the most promising solutions to their problems. Meta-analysis of many randomized studies suggests that running a PLA group reduces maternal mortality by 49% and neonatal mortality by 33% amongst all births in the entire community that the group serves. Yet few countries in sub-Saharan Africa, where the burden is highest, have implemented this intervention.
We recommend launching an organization focused on training facilitators and running these groups in rural villages would be highly cost-effective, with a large potential for positive externalities.
The Problem
Maternal and neonatal disorders are significant causes of global mortality. In 2020, out of the 135 million births worldwide, there were approximately 1.4 million stillbirths and 2.4 million neonatal deaths. Maternal mortality is also high, with an estimated 300,000 women dying during pregnancy.
Despite strides in maternal and neonatal health (MNH), the burden remains disproportionately high in low- and middle-income countries (LMICs). Over 90% of maternal deaths occur in these regions – Sub-Saharan Africa and Southern Asia, in particular, account for 68% and 19% of these deaths, respectively.
Although the maternal and neonatal space is not as neglected, the proposed intervention is a relatively neglected intervention within the space. Growing attention and funding are devoted to maternal and neonatal health, and the burden is slowly decreasing. However, this intervention has only been implemented in about 15 countries, with few at scale.
The Solution
What’s the proposed solution?
A community-based interventions represent a promising approach that is better suited for rural populations, where access to institutional healthcare is poor. There is often a significant difference between mortality rates in rural and urban areas, and access to care is much worse in rural areas.
Participatory learning and action (PLA) groups are a simple yet well-evidenced community-based intervention that could be promising to reduce maternal and neonatal deaths.
This involves holding facilitated group meetings for women of reproductive age, particularly pregnant women, to foster local strategies that enhance care-seeking behaviors and adopt preventive health practices for better maternal and newborn health. PLA groups are facilitated to develop their own solutions to health challenges. Common solutions that the groups develop include pooling community funds into an emergency fund, community bicycle ambulance services, and community-based health campaigns.
What is the evidence for and why do we trust this solution?
There is strong evidence supporting the effectiveness of PLA in reducing neonatal and maternal mortality. A meta-analysis conducted by Prost et al. (2013), which included seven trials involving approximately 119,000 births, found that when >30% of all pregnant women participated in groups, PLA reduced maternal mortality by 49% and neonatal mortality by 33% amongst all births in the community. In such cases, pregnant women who did not participate also benefited from the group-led solutions.
Based on this evidence, it is the only community-based newborn and maternal health intervention that the WHO recommends. Yet few countries in sub-Saharan Africa, where the burden is highest, have implemented this intervention.
The Impact
PLA is estimated to be highly cost-effective. The groups can be extremely low-cost to run. Our cost-effectiveness analysis estimated that hiring community workers to run PLA groups full-time would cost ~$20-$70 per DALYs averted. This is equivalent to ~14-47 DALYs per $1000 spent.
In addition to the intervention's promise in reducing maternal and neonatal mortality, we are also excited by the potential positive externalities that PLA groups may have. There is weak evidence that PLA groups could benefit maternal mental health, family planning, under-five child health, community resilience to crop failures, and individual and community agency.
Who is best suited to do this?
We think that there are not any very specific skills that a founder must have to start this charity.
Some nice-to-have qualities, but not required traits are:
Experience operating in rural areas in sub-Saharan Africa or running community-based interventions.
Experience training health workers or running training programs for health workers
Global health and development background
Maternal and neonatal health background
Please refer to section 8.2 of the research report.
