Evaluations conducted by MET are generating evidence on the use, quality, equity and market dynamics of private maternal health services, and whether interventions such as social franchising can increase access to lifesaving care for all women.
MET is currently working on evaluation of MSD for Mothers: a 10-year, $500 million initiative focused on improving the quality of care women receive at health facilities during childbirth, and on increasing access to family planning.
MET have published more than 20 academic papers in the last four years, covering family planning provision, equity and quality of care in maternal health, and extensive secondary data analyses using the Demographic and Health Surveys.
The Maternal healthcare markets Evaluation Team at the London School of Hygiene & Tropical Medicine is conducting multidisciplinary research on the role of public and private health sectors in delivering maternal healthcare. MET is led by Dr Caroline Lynch and Dr Catherine Goodman. They are supported by a Scientific and Policy Advisor, Dr Veronique Filippi, and guided by a Steering Committee made up of Prof Anne Mills, Prof Mark Petticrew, Prof Simon Cousens and Prof Joanna Schellenberg.
Our findings have important implications locally, nationally and globally as governments and key stakeholders around the world consider how to integrate private providers into their strategies for achieving universal health coverage. Our results have been published since 2014 in formal peer-reviewed publications and through conference presentations, dissemination workshops, reports and policy briefs.
In an effort to contribute knowledge to advance the maternal health field, the evaluations conducted by MET LSHTM are generating evidence on the use, quality, equity and market dynamics of private maternal health services, and whether interventions such as social franchising can increase access to lifesaving care for all women. Our research will help to answer questions on how to improve the affordability and quality of both private and public maternal health services, including how and why interventions work, whether they are cost-effective, and their potential impact on maternal and reproductive health if replicated in other contexts.
Working alongside in-country research partners, MET has developed an evidence base in two main areas:
Contextual analyses to better understand the private health sector
- Largest ever analysis of Demographic and Health Surveys from 57 countries to identify where women are seeking family planning, antenatal care and labour and delivery services, as well as the quality and equity of those services in the public and private sectors (SAGE)
- Characterisation of the market dynamics at play in providing private maternal health services in Uttar Pradesh, India (Nature of Competition)
Evaluations of MSD for Mothers interventions
- Impact and process evaluations of market-based interventions to improve the delivery of high quality maternal health and family planning services in India (Matrika) and Senegal (PROCEED)
- Case studies of three social franchising models for maternal health in India and Uganda to distil lessons learned and answer questions on cost and effectiveness (Case Studies)
- Lessons learned from a multi-institutional collaboration to collect routine M&E data on a set of harmonised indicators from private sector maternal healthcare programmes in India and Uganda (DATA-HI)
MET includes experts in health economics, epidemiology, anthropology, and statistics. The team is led by Dr Caroline Lynch and Dr Catherine Goodman. MSD for Mothers is a 10-year, $500 million global initiative to reduce maternal mortality.
This research was supported by funding from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, through its MSD for Mothers programme. MSD had no role in the design, collection, analysis, and interpretation of data, in writing of the manuscripts, or in the decision to submit the manuscripts for publication. The content of these publications is solely the responsibility of the authors and does not represent the official views of MSD or MSD for Mothers.
Dr Caroline Lynch is the principal investigator for the Maternal healthcare markets Evaluation Team (MET). She is an epidemiologist with over the last 15 years’ experience working in Sub-Saharan Africa and the Asia-Pacific.
Her work within MET focuses on Family Planning, and she is technical lead on the evaluation of a supply chain model for Family Planning in Senegal. More broadly, Caroline has a keen interest in impact evaluation and the effect of migration on health.
Dr Catherine Goodman is a Reader in health economics and policy in the Department of Global Health and Development at the LSHTM, where she is head of the Health Economics and Systems Analysis Group (HESA). She has 18 years’ experience in applied health systems research in low- and middle-income settings, with a focus on private sector provision, health care financing and governance, and the economics of malaria control.
Professor Veronique Filippi is a demographer and epidemiologist with expertise in health outcomes measurement and evaluation of complex interventions in RMNCH. Her interests include methods for measuring maternal morbidity in low-income countries; long term consequences of obstetric complications on mothers and babies; learning from maternal and neonatal near-miss events; birth and postpartum preparedness; and design and evaluation of complex interventions.
Project Lead (Case Studies)
Loveday Penn-Kekana is a medical anthropologist and the qualitative lead for the MET. She previously worked at the Global Health & Development Unit at the LSHTM, where she helped complete the Good Health at Low Cost Project and develop a distance-learning course on health systems. Prior to that, she worked for 10 years at the Centre for Health Policy at the University of the Witwatersrand, South Africa, leading a number of projects focusing on maternal health and health systems.
Dr Timothy Powell-Jackson is a health economist based in the Department of Global Health and Development, with over 12 years of experience working as a researcher in low- and middle-income countries. He first developed an interest in the economics of health systems while working at the Ministry of Health, Rwanda. Tim is trained as an economist with expertise in the evaluation of complex health interventions using both experimental and quasi-experimental econometric methods. His core interest is health systems research and the study of innovative demand- and supply-side financial incentive schemes.
Dr Lenka Beňová is a quantitative social scientist with training in management, economics, Middle East studies and demography. Lenka leads the SAGE project. Previously, she headed operations in a start-up company in eldercare in the United States and worked as project coordinator with Médecins Sans Frontières in Nigeria, the West Bank and South Sudan. Lenka has a keen interest in maternal health research and evaluation in low- and middle-income countries.
Dr Isabelle Lange is a medical anthropologist and a qualitative Research Fellow in the Department of Infectious Diseases Epidemiology at the LSHTM. Her work in maternal health centres around understanding women’s experiences of quality of care, the influence of hospital environments on health worker performance and satisfaction, and health policy development and transfer.
Emma Radovich is a Research Assistant on the SAGE project, using DHS data to understand the role of the private sector in reproductive healthcare in low- and middle-income countries. She holds an MSc in Demography & Health from LSHTM with a focus on family planning.
Kerry Wong is a Research Fellow in Health and Statistics. She is involved with analysis of DHS data for assessment of global maternal health. She also contributes to other analysis and writing of research outputs for MET. Kerry holds a Master’s degree in biostatistics from the University of Melbourne.
Camilla Fabbri is a Research Fellow in Health Economics. She is working on two field experiments embedded in the Matrika project, which evaluates a social franchise programme in Uttar Pradesh, India. The first of these looks at whether giving accurate information on the effectiveness of health care affects household perceptions and the demand for services. The second examines whether feedback and public reporting on performance of health providers improves the coverage of maternal health interventions.
Manon Haemmerli is a Research Fellow in Health Economics at the LSHTM. She is working on the cost evaluation of three social franchising programs in Uganda, Rajasthan and Uttar Pradesh. Manon holds a Masters in Physics from the Swiss Federal Institute of Technology in Lausanne and an MSc in Public Health from the LSHTM, with a focus on Health Economics.
Dr Francesca Cavallaro is a Research Fellow in Quantitative Methods for Programme Evaluation and will conduct quantitative analyses to evaluate the impact of the Informed Push Model in Senegal. She completed her undergraduate degree in Human Sciences at Oxford University. Francesca then worked in a sexual and reproductive health programme in western Kenya before joining the evaluation team at the PACT Project/Partners in Health in Boston, where she helped design the evaluation of a complex intervention using community health workers to improve chronic disease management.
Dr Diane Duclos is a qualitative Research Fellow at the LSHTM. She is working on the qualitative component of the evaluation of the Informed Push Model for Family Planning in Senegal. Diane holds a Masters degree and a PhD in Development Studies from the Graduate Institute of International and Development Studies (GIIDS, Geneva, Switzerland).
Dr Meenakshi Gautham is a Research Fellow in Health Systems and Policy Analysis. She is researching the private health sector in maternal healthcare in Uttar Pradesh, India.
Justine Marshall is the Communications Officer for MET. She is responsible for developing and implementing MET’s communications strategy, and supporting the team with all dissemination and advocacy activities.
MET-LSHTM has developed an evidence base in two main areas: Contextual analyses to better understand the private health sector; and in-depth impact and process evaluations of MSD for Mothers interventions in Uganda, Senegal and India.
Specific research areas are:
Impact and process evaluations of a family planning supply chain using performance-based contracting of private sector logisticians in Senegal.
Impact and process evaluations of a Social Franchise in Uttar Pradesh, India.
Case studies of three social franchising models for maternal health in India and Uganda to distil lessons learned and answer questions on cost and sustainability.
Contextual analyses to characterise of the market dynamics at play in providing private maternal health services in Uttar Pradesh, India.
Contextual analyses using Demographic and Health Surveys from over 60 countries to identify where women are seeking family planning, antenatal care and labour and delivery services, as well as the quality and equity of those services in the public and private sectors.
Lessons learned from a multi-institutional collaboration to collect routine M&E data on a set of harmonised indicators from private sector maternal healthcare programmes in India and Uganda.
Our national and regional research partners
We have developed strong research collaborations both at national and regional levels. At national levels, MET-LSHTM has worked with the Université Cheikh Anta Diop in Senegal, PADRI in Uganda, and TRIOs, IMPACT partners and Sambodhi in India. At the regional level, MET-LSHTM has collaborated with the East, Central and Southern African health community (ECSA) – a body that feeds data and information to Ministry of Health permanent secretaries and directors of health throughout the region.