Beyond Health Technology Assessments: Evaluating the Impact of Scaling Up Technology Interventions in Maternal and Child Health

Abstract

This dissertation undertakes the task of going beyond traditional health technology assessments in areas of reproductive and child health. In my first paper, I evaluate a reproductive health technology intervention program intended to integrate postpartum family planning services into routine maternity care in Nepal using primary data from a randomized controlled trial. I find that the integration is feasible, and it could benefit women with need for spacing or limiting their births. Expanding counseling services of higher quality could further increase access to, and uptake of postpartum contraception. The second paper investigates the discrepancies in the impact of expanding family planning access on unintended pregnancies when the heterogeneity of the population being treated is not considered. Current methods that estimate observed failure rates do not account for women selecting the method they use. Correcting for this user heterogeneity, I find that women who are not using contraception despite unmet need have lower risk of pregnancy, and the program impact of expanding family planning access is higher than currently estimated. The final paper models and appraises the relative importance of contextual factors that could modulate the impact of scaling up Rapid Diagnostic Tests (RDTs) for malaria using a static deterministic decision model and global sensitivity analysis techniques. I find that behavioral parameters such as compliance to disease diagnosis, uptake of RDTs by providers and patients during scale up, overall effectiveness of Artemisinin Combination Therapies (the first line treatment for malaria), and epidemiological parameter of co-incidence of malaria and bacterial pneumonia are the most important factors influencing the impact and effectiveness of RDTs on under-five malaria and pneumonia burden in 24 malaria endemic Sub-Saharan African countries given their current disease epidemiology and care-seeking patterns.