Skip to main content Skip to main navigation menu Skip to site footer

The impact of health reform on maternal and child health indicators in developing countries: A systematic review

  • Hossein Jabbari Beyrami ,
  • Salaheddin Asadi ,
  • Leila Doshmangir ,



Objective: The aim of the study has been designed and implemented aiming at investigating the impact of reform program on maternal and child health indicators in developing countries.

Method: This study was done as a systematic review by searching on SID, Magiran, Pubmed, Science Direct, and Scopus during 2000-2017. The searched keywords in Farsi databases: health reforms, impact of reforms on health, consequences of health reforms, maternal and child health indicators, and their Latin equivalences on English databases. Then data were entered in summary tables and at the next step were investigated and concluded.

Result: According to inclusion and exclusion criteria, the result of search was 2837 articles refined step by step and finally 19 articles were selected and analyzed. The results of national studies showed that after executing health reform program, the rate of cesarean section decreased about 2.5-4% in the country in the first three-month period of execution of the program and total status of realization of indicators was in a desirable level. Natural childbirth promotion program (free natural childbirth franchise indicator) was 90.8%. Global experiences also show that mortality rate of newborns decreased from 11.1% to 9.1% after reform and promotion of health system in Mozambique. Also, health reforms in Pakistan for developing health of mothers and newborns showed that beneficiaries should support evidence-based interventions for the sake of health of mothers and newborns. Finally, health reform in Indonesia, Nepal, Philippines, and India showed that the rate of mortality of mothers, newborns, and stillbirth has been reduced.

Conclusion: Results show that reforms have had a positive impact on maternal and child health indicators and the status of realization of indicators has reached an acceptable level through execution of reform and the main reasons for improvement in indicators are: extension of health system, increase in labour force, and more support by government for health system.

Keywords: Health reforms, Maternal and child health indicators, Developing countries, Systematic review


  1. Reference
  2. Sokhanvar M, Hasanpoor E, Kakemam E, Arab-zozani M, Haghgoshayei E. A critique of the hospital services provision in Iran after implementing Health Sector Evolution Plan: A case report. International Journal of Epidemiologic Research. 2017;4(2):176-81.
  3. Bateman A, Fonagy P. Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. American Journal of Psychiatry. 2003;160(1):169-71.
  4. Luce BR, Elixhauser A. Standards for the socioeconomic evaluation of health care services: Springer Science & Business Media; 2012.
  5. Aikins Ad-G, Kushitor M, Koram K, Gyamfi S, Ogedegbe G. Chronic non-communicable diseases and the challenge of universal health coverage: insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana. BMC Public Health. 2014;14(2):S3.
  6. Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, et al. Improving responsiveness of health systems to non-communicable diseases. The Lancet. 2013;381(9867):690-7.
  7. Day C, Chaudhry S, Van Schaik N, Groenewald P, Laubscher R, Bradshaw D. Monitoring of non-communicable diseases such as hypertension in South Africa: Challenges for the post-2015 global development agenda. South African medical journal. 2014;104(10):680-7.
  8. Keckley PH, Coughlin S. Deloitte 2012 survey of US health care consumers: the performance of the health care system and health care reform. Washington DC: Deloitte Center for Health Solutions (available at file:///D:/Users/mzyxjmn3/Downloads/Deloitte+-+ Health+ Care+ Reform+-+ Center+ Stage+ 2012 pdf). 2012.
  9. Squires DA. Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. Issue brief (Commonwealth Fund). 2012;10:1-14.
  10. Vlassoff M, Musange SF, Kalisa IR, Ngabo F, Sayinzoga F, Singh S, et al. The health system cost of post-abortion care in Rwanda. Health policy and planning. 2014;30(2):223-33.
  11. Akinci F, Mollahaliloğlu S, Gürsöz H, Öğücü F. Assessment of the Turkish health care system reforms: A stakeholder analysis. Health Policy. 2012;107(1):21-30.
  12. Balabanova D, Roberts B, Richardson E, Haerpfer C, McKee M. Health care reform in the former Soviet Union: beyond the transition. Health services research. 2012;47(2):840-64.
  13. Leggat SG, Bartram T, Stanton P. High performance work systems: the gap between policy and practice in health care reform. Journal of Health Organization and Management. 2011;25(3):281-97.
  14. Rosoff AJ. The role of clinical practice guidelines in healthcare reform: An update. Annals Health L. 2012;21:21.
  15. Rafiei M, Ezzatian R, Farshad A, Sokooti M, Tabibi R, Colosio C. Occupational health services integrated in primary health care in Iran. Annals of global health. 2015;81(4):561-7.
  16. Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. The Lancet. 2004;364(9437):900-6.
  17. Fay M, Leipziger D, Wodon Q, Yepes T. Achieving child-health-related Millennium Development Goals: The role of infrastructure. World Development. 2005;33(8):1267-84.
  18. Wyss K. An approach to classifying human resources constraints to attaining health-related Millennium Development Goals. Human resources for health. 2004;2(1):11.
  19. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity reviews. 2004;5(s1):4-85.
  20. Karoly LA, Levaux HP. Investing in our children: What we know and don't know about the costs and benefits of early childhood interventions: Rand Corporation; 1998.
  21. Freedman L. Strategic advocacy and maternal mortality: moving targets and the millennium development goals. Gender & Development. 2003;11(1):97-108.
  22. Pinfold J. Analysis of different communication channels for promoting hygiene behaviour. Health Education Research. 1999;14(5):629-39.
  23. Hashemi B, Baratloo A, Forouzafar MM, Motamedi M, Tarkhorani M. Patient satisfaction before and after executing health sector evolution plan. Iranian Journal of Emergency Medicine. 2015;2(3):127-33.
  24. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health sector evolution plan in Iran; equity and sustainability concerns. International journal of health policy and management. 2015;4(10):637.
  25. Abolhallaje M, Mousavi SM, Anjomshoa M, Nasiri AB, Seyedin H, Sadeghifar J, et al. Assessing health inequalities in Iran: a focus on the distribution of health care facilities. Global journal of health science. 2014;6(4):285.
  26. Fazaeli S, Ahmadi M, Rashidian A, Sadoughi F. A Framework of a Health System Responsiveness Assessment Information System for Iran. Iranian Red Crescent Medical Journal. 2014;16(6).
  27. Piroozi B, Moradi G, Esmail Nasab N, Ghasri H, Farshadi S, Farhadifar F. Evaluating the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers: A case study in Kurdistan province between 2013-2015. Journal of hayat. 2016;22(3):245-54.
  28. Zarei E, Majidi S, Bay V. Achievement of health sector evolution objectives in the vaginal delivery promotion plan: A study in a large public hospital in Tehran. Journal of Health in the Field. 2017;3(2).
  29. Ostovar R, Rashidian A, Pourreza A, Rashidi BH, Hantooshzadeh S, Ardebili HE, et al. Developing criteria for cesarean section using the RAND appropriateness method. BMC pregnancy and childbirth. 2010;10(1):52.
  30. Torloni MR, Daher S, Betrán AP, Widmer M, Montilla P, Souza JP, et al. Portrayal of caesarean section in Brazilian women’s magazines: 20 year review. Bmj. 2011;342:d276.
  31. Wanyonyi SZ, Karuga RN. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation. BMC pregnancy and childbirth. 2010;10(1):62.
  32. Khosrovi M, Arnat M, Khadem N. The Assessment of Prevalence of Cesarean and Related Factors. J of Nurs and Midwif. 2006;58(16):21-7.
  33. Chauhan SP, Martin JN, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: a review of the literature. American journal of obstetrics and gynecology. 2003;189(2):408-17.
  34. Fernandes QF, Wagenaar BH, Anselmi L, Pfeiffer J, Gloyd S, Sherr K. Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique. The lancet global health. 2014;2(8):e468-e77.
  35. Mazhar A, Shaikh BT. Reforms in Pakistan: Decisive times for improving maternal and child health. Healthcare Policy. 2012;8(1):24.
  36. Vora KS, Mavalankar DV, Ramani K, Upadhyaya M, Sharma B, Iyengar S, et al. Maternal health situation in India: a case study. Journal of health, population, and nutrition. 2009;27(2):184.
  38. Rooeintan F, Borzabad PA, Yazdanpanah A. The Impact of Healthcare Reform Plan on the Rate of Vaginal Delivery and Cesarean Section in Shiraz (Iran) in 2015. Electronic physician. 2016;8(10):3076.
  39. Soto EJ, La Vincente S, Clark A, Firth S, Morgan A, Dettrick Z, et al. Investment case for improving maternal and child health: results from four countries. BMC public health. 2013;13(1):601.
  40. Naderimagham S, Jamshidi H, Khajavi A, Pishgar F, Ardam A, Larijani B, et al. Impact of rural family physician program on child mortality rates in Iran: a time-series study. Population Health Metrics. 2017;15(1):21.
  41. Gupta M, Angeli F, Bosma H, Prinja S, Kaur M, van Schayck OC. Utilization of Intergovernmental Funds to Implement Maternal and Child Health Plans of a Multi-Strategy Community Intervention in Haryana, North India: A Retrospective Assessment. PharmacoEconomics-Open. 2017:1-14.

How to Cite

Beyrami, H. J., Asadi, S., & Doshmangir, L. (2019). The impact of health reform on maternal and child health indicators in developing countries: A systematic review. Bali Medical Journal, 8(1), 9–17.




Search Panel

Hossein Jabbari Beyrami
Google Scholar
BMJ Journal

Salaheddin Asadi
Google Scholar
BMJ Journal

Leila Doshmangir
Google Scholar
BMJ Journal