Effort levels of national maternal and neonatal health programs: 2005 measures and six year trends.

OBJECTIVE: To assess efforts by national programs in developing countries to improve maternal and neonatal health in 2005 in the context of the six-year trend.
METHODS: A total of 14 components of effort based upon 81 questionnaire items were measured for 49-55 countries in 1999, 2002, and 2005, covering about 85% of the developing world's population. A standard questionnaire was completed by 10-25 experts in each country, with all questionnaires analyzed centrally and results returned to each country. The 2005 round includes new items and analysis for malaria and newborn interventions.
FINDINGS: An overall index of effort showed no significant improvement over the six-year period. The patterns of effort across the 14 components were quite similar in the three rounds, supporting the usefulness of the methodology while also confirming the consistency of non-improvement. Rural access to services, in essentially all countries, is very inferior to urban access. Effort scores for antenatal and neonatal care were among the highest while those for health center capacities were among the lowest.
CONCLUSION: Effort levels by maternal health programs in developing countries remain seriously deficient. Even by the standard set by the best scoring countries the ratings show only about 75% of maximum effort achieved. The overall average is just above half of maximum effort, at about 56% in all three years, whether countries are weighted equally or by their population sizes.