Public-Private Partnerships can help Nigerian hospitals improve maternal health; Here's how

Rural hospitals across the country often struggle to stay open in states where Medicaid has not been expanded, but a method known as "swing beds" has helped two critical-access hospitals in Georgia to avoid this fate. This method, which allows hospitals to swing beds from "only patients in need of acute care to those who no longer require the emergency department but still needed more treatment before a nursing home," allowed for the hospitals to pay off debt and expand services.

Maryland's health care system is based on three pillars – all-payer rate setting, a global budget, and total cost of care – that, together, have shown positive results both for the patients and for the state's hospitals. Although evidence of success with regard to health care costs is limited, the model of incentiving investment in community health and preventive care has shown success in reducing readmission rates for hospitals across the state.

Hansen Family Hospital in Iowa Falls is one of the rare rural hospitals that has defied the odds and remained open, thanks in part to creative collaborations and the CEO's entrepreneurial attitude. From converting its obstetrics department into an outpatient mental health program for senior citizens in order to better match the demographics of the city to implementing a profit-sharing model with a local coffee shop, the hospital is doing what it can to remain open while also supporting the health of the community.

Enrolling local agents allows global partners to connect underserved and remote communities to healthcare. A partnership between Rwanda’s Health Ministry and the Boston-based nonprofit, Partners in Health, trains community-based health workers to communicate and connect people on the ground to health services across the country. Rwanda has also implemented reforms and services such as government-subsided healthcare, which has helped improve the life expectancy of its citizens.

In Karachi, Pakistan’s Jinnah hospital, a private-public partnership between the government and the business sector have brought in over $35 million in donations. Those donations have led to new equipment, buildings, and systems infrastructure to make sure the patients – nearly 5,000 per day – are receiving modern medical care. While the partnership is underscored by the risk of one party backing out, both sides have clear roles and responsibilities to make sure the regions residents receive the care they need.

The rate of Cesarean sections is on the rise in the United States, despite the higher risks of hysterectomy, hemorrhage, and infection, as well as the elevated expense. San Francisco General’s maternity ward, however, stands as an outlier by following evidence-based medicine that suggests decreasing C-sections and has also shifted from a pay-per-service incentive for the doctors to a salary or shift position.

Switzerland is home to the world's lowest avoidable mortality rate and residents of the country live longer lives and are healthier than those who live in the United States. Health policy experts credit the Swiss health care system for playing a significant role. Despite the high cost and the penalty for not carrying insurance, the system is praised as guarateeing access to quality health-care and "unlike the U.S., people rarely go bankrupt from medical bills."

To reduce maternal mortality in the Masai region of Tanzania, Catholic nuns with Sisters of Notre Dame are building hospitals and educating local women about the importance of giving birth in a medical setting. Although this goes against the community's use of a "traditional birth attendant," delivering in a hospital allows for emergency situations to be better addressed and is receiving positive feedback from women in the region.

Keeping hospitals open and operating in rural Iowa isn't an easy task, but short-term proposals, pilots, and demonstration projects are all helping to explore the possibilities. One particular example that is showing promise is the Avera Merrill Pioneer Health Campus which was "bankrolled through a combination of community donations, hospital association funding and a loan from the U.S. Department of Agriculture."

Providing door-to-door health care for mothers and children under five years of age greatly reduces mortality. Thanks to a program of home visits by community health care workers funded by the Clinton Health Access Initiative, the Yirimadio neighborhood of Mali’s capital city, Bamako, has succeeded in dramatically reducing childhood mortality. The government intends to scale the pilot program into a nationwide campaign by 2022.