A Composite Framework for Evaluating Maternal and Child Mortality in Low-Income Countries: An International Comparison

Low maternal mortality and under-5 mortality rates form part of Sustainable Development Goal 3. Its extensive prevalence in low-income countries calls for a reliable method to measure the effectiveness of government expenditure in the area, especially because many countries underperform or overperform on maternal and child health relative to health spending. This review establishes the Basic Health Infrastructure Index (BHII), constructed from normalized indicators of hospital beds, physician and midwifery personnel distribution, as a better matrix towards the predictability of maternal and child health statistics compared to the mere traditional health expenditure as % of Gross Domestic Product (GDP) proxy in determining associations. Results and case studies from 7 countries support the thesis that basic health infrastructure is a vital determinant of constraints, targeting optimizes outcomes, and GDP serves as a context rather than an indicator of reduced maternal mortality and under-5 mortality. This study recommends a three-step investment strategy for low-income countries: ensuring countries meet their determined minimum infrastructure threshold, then layering targeting programs for high-risk populations, followed by monitoring return-on-investment metrics. These are justified by philosophical approaches for the least advantaged.