Maternal Health Infrastructure Investments in Zambia: Leveraging Geospatial Evidence to Inform Planning and...

Area of Science:

• Public Health
• Geospatial Analysis
• Health Systems Strengthening

Background:

• Maternal health inequities in low- and middle-income countries (LMICs) are exacerbated by poor spatial access to healthcare facilities.
• In Zambia, a high maternal mortality ratio (187 per 100,000 live births) is linked to delays in seeking, reaching, and receiving care, particularly in rural areas.
• Significant portions of the rural population in Zambia live beyond the recommended 5-kilometer radius from health facilities.

Purpose of the Study:

• To describe a geospatial prioritization approach for guiding investments in maternal health infrastructure in Zambia.
• To identify high-priority sites for new facilities and upgrades to improve maternal healthcare access and continuity of care.
• To optimize the impact of limited resources for maternal health infrastructure development.

Main Methods:

• A geospatial prioritization approach was applied using cross-sectional data from 692 public health facilities in Zambia's Eastern and Southern Provinces.
• Data integration included routine Health Management Information System (HMIS) data, maternal mortality records, facility infrastructure assessments, and geospatial analysis.
• Facilities were screened using eligibility criteria for maternal deaths and ranked using a weighted scoring model based on infrastructure readiness for maternal care continuity.

Main Results:

• While labor and delivery services are widespread, capacity for recommended 48-hour postnatal observation care is inadequate.
• Maternal deaths were concentrated in a small percentage of facilities (28% in Eastern Province, 19% in Southern Province).
• The prioritization framework reduced the number of potential investment sites from 606 to 27 high-priority facilities, cutting projected costs from US$41.8 million to approximately US$2 million.

Conclusions:

• Targeted infrastructure investments, informed by geospatial and routine health system data, can enhance equity and continuity of maternal care.
• The applied framework offers a practical and scalable model for evidence-informed infrastructure planning in resource-constrained settings.
• This approach optimizes the impact of limited resources, addressing critical gaps in maternal healthcare delivery.