{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:55:44Z","timestamp":1782755744114,"version":"3.54.5"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T00:00:00Z","timestamp":1499990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005924","name":"International Association for the Study of Pain","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005924","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Lacy Foundation"},{"name":"Obstetric Anaesthetists' Association (GB)"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"DOI":"10.1371\/journal.pone.0180929","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T13:41:09Z","timestamp":1500039669000},"page":"e0180929","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana"],"prefix":"10.1371","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0180-4911","authenticated-orcid":true,"given":"David M.","family":"Goodman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Ramaswamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Jeuland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel K.","family":"Srofenyoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril M.","family":"Engmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeyemi J.","family":"Olufolabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medge D.","family":"Owen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2017,7,14]]},"reference":[{"key":"ref1","article-title":"Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group","author":"L Alkema","year":"2015","journal-title":"Lancet"},{"key":"ref2","article-title":"Stillbirths: rates, risk factors, and acceleration towards 2030","author":"JE Lawn","year":"2016","journal-title":"Lancet"},{"issue":"Suppl 1","key":"ref3","first-page":"S65","article-title":"Linking families and facilities for care at birth: what works to avert intrapartum-related deaths?","volume":"107","author":"ACC Lee","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"key":"ref4","article-title":"Demand Side Financing in Health: How far can it address the issue of low utilization in developing countries?","author":"Indrani Gupta","year":"2010"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/1472-6963-12-319","article-title":"Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India","volume":"12","author":"SS Gopalan","year":"2012","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1093\/heapol\/czt100","article-title":"Cost-effectiveness analysis of a voucher scheme combined with obstetrical quality improvements: quasi experimental results from Uganda","volume":"30","author":"YN Alfonso","year":"2015","journal-title":"Health Policy Plan"},{"issue":"9","key":"ref7","doi-asserted-by":"crossref","first-page":"e0139048","DOI":"10.1371\/journal.pone.0139048","article-title":"Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria","volume":"10","author":"GB Gomez","year":"2015","journal-title":"PLoS One"},{"key":"ref8","unstructured":"WHO | Monitoring emergency obstetric care [Internet]. WHO. [cited 2015 Nov 9]. Available from: http:\/\/www.who.int\/reproductivehealth\/publications\/monitoring\/9789241547734\/en\/<\/ext-link>"},{"key":"ref9","unstructured":"Jahn A, De Brouwere V. Referral in Pregnancy Concepts and Strategies [Internet]. John Snow International|Europe; Available from: http:\/\/www.jsieurope.org\/safem\/collect\/safem\/pdf\/s2940e\/s2940e.pdf<\/ext-link>"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/j.midw.2012.11.018","article-title":"Place of birth or place of death: an evaluation of 1139 maternal deaths in Nigeria","volume":"29","author":"AA Adegoke","year":"2013","journal-title":"Midwifery"},{"issue":"5","key":"ref11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-002326","article-title":"Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data","volume":"3","author":"L Vesel","year":"2013","journal-title":"BMJ Open"},{"issue":"11","key":"ref12","doi-asserted-by":"crossref","first-page":"e81089","DOI":"10.1371\/journal.pone.0081089","article-title":"Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana","volume":"8","author":"RC Nesbitt","year":"2013","journal-title":"PLoS One"},{"issue":"9940","key":"ref13","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0140-6736(14)60792-3","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?","volume":"384","author":"ZA Bhutta","year":"2014","journal-title":"Lancet"},{"issue":"10","key":"ref14","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/S1701-2163(16)30029-9","article-title":"Transforming Maternal and Neonatal Outcomes in Tertiary Hospitals in Ghana: An Integrated Approach for Systems Change","volume":"37","author":"R Ramaswamy","year":"2015","journal-title":"J Obstet Gynaecol Can"},{"issue":"9543","key":"ref15","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/S0140-6736(06)69381-1","article-title":"Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works","volume":"368","author":"OMR Campbell","year":"2006","journal-title":"Lancet"},{"issue":"7525","key":"ref16","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1136\/bmj.331.7525.1107","article-title":"Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries","volume":"331","author":"T Adam","year":"2005","journal-title":"BMJ"},{"key":"ref17","article-title":"Disease Control Priorities in Developing Countries","author":"WJ Graham","year":"2006"},{"key":"ref18","article-title":"Strengthening essential public health functions in support of the achievement of universal health coverage"},{"issue":"3","key":"ref19","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1108\/09526861311311436","article-title":"Cost-effectiveness of a quality improvement collaborative for obstetric and newborn care in Niger","volume":"26","author":"E Broughton","year":"2013","journal-title":"Int J Health Care Qual Assur"},{"issue":"1","key":"ref20","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0020-7292(03)00072-9","article-title":"A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care","volume":"81","author":"C McCord","year":"2003","journal-title":"Int J Gynaecol Obstet"},{"issue":"2","key":"ref21","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0020-7292(02)00389-2","article-title":"The FIGO Save the Mothers Initiative: the Uganda-Canada collaboration","volume":"80","author":"AB Lalonde","year":"2003","journal-title":"Int J Gynaecol Obstet"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1111\/j.1471-0528.2007.01443.x","article-title":"Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique","volume":"114","author":"ME Kruk","year":"2007","journal-title":"BJOG Int J Obstet Gynaecol"},{"issue":"4","key":"ref23","doi-asserted-by":"crossref","first-page":"e34595","DOI":"10.1371\/journal.pone.0034595","article-title":"Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention","volume":"7","author":"BC Alkire","year":"2012","journal-title":"PLoS One"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1186\/1471-2458-12-786","article-title":"Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria","volume":"12","author":"DO Erim","year":"2012","journal-title":"BMC Public Health"},{"issue":"1","key":"ref25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijgo.2011.08.010","article-title":"Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement","volume":"116","author":"E Srofenyoh","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"issue":"8","key":"ref26","first-page":"1091","article-title":"Too far to walk: maternal mortality in context","volume":"38","author":"S Thaddeus","year":"1994","journal-title":"Soc Sci Med 1982"},{"issue":"2","key":"ref27","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ijgo.2015.11.026","article-title":"Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital","volume":"134","author":"EK Srofenyoh","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"key":"ref28","unstructured":"Eliezer Yudkowsky. Harry Potter and the Methods of Rationality [Internet]. Self-published; [cited 2016 Nov 18]. Available from: http:\/\/hpmor.com<\/ext-link>"},{"key":"ref29","unstructured":"Kybele, Inc. [Internet]. Kybele, Inc. [cited 2016 Apr 30]. Available from: http:\/\/www.kybeleworldwide.org\/<\/ext-link>"},{"key":"ref30","unstructured":"United States Department of Labor, Bureau of Labor Statistics. Occupational Employment Statistics [Internet]. 2014. Available from: http:\/\/www.bls.gov\/oes\/current\/oes_nat.htm#29-0000<\/ext-link>"},{"issue":"3","key":"ref31","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1093\/heapol\/16.3.326","article-title":"Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis","volume":"16","author":"JA Fox-Rushby","year":"2001","journal-title":"Health Policy Plan"},{"issue":"10010","key":"ref32","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1016\/S0140-6736(15)00128-2","article-title":"Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"386","author":"MH Forouzanfar","year":"2015","journal-title":"Lancet"},{"key":"ref33","unstructured":"WHO | Metrics: Disability-Adjusted Life Year (DALY) [Internet]. WHO. [cited 2015 Oct 23]. Available from: http:\/\/www.who.int\/healthinfo\/global_burden_disease\/metrics_daly\/en\/<\/ext-link>"},{"issue":"9859","key":"ref34","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1016\/S0140-6736(12)61899-6","article-title":"GBD 2010: design, definitions, and metrics","volume":"380","author":"CJL Murray","year":"2012","journal-title":"Lancet"},{"key":"ref35","unstructured":"Susan Horton, Carol Levin. Reproductive, Maternal, Newborn, and Child Health. In: Disease Control Priorities [Internet]. Third. [cited 2016 Oct 25]. p. 338. Available from: http:\/\/dcp-3.org<\/ext-link>"},{"key":"ref36","unstructured":"Global Health Observatory Data Repository [Internet]. WHO. [cited 2015 Oct 23]. Available from: http:\/\/apps.who.int\/gho\/data\/view.main.60630?lang=en<\/ext-link>"},{"issue":"3","key":"ref37","first-page":"545","article-title":"Paying the price: the cost and consequences of emergency obstetric care in Burkina Faso","volume":"66","author":"KT Storeng","year":"2008","journal-title":"Soc Sci Med 1982"},{"issue":"1","key":"ref38","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0020-7292(00)00236-8","article-title":"Maternal survival in developing countries: what has been done, what can be achieved in the next decade","volume":"70","author":"F Donnay","year":"2000","journal-title":"Int J Gynaecol Obstet"},{"key":"ref39","article-title":"Countdown to 2015: Decade Report (2000\u20132010) Taking stock of maternal, newborn and child survival","author":"J Requejo","year":"2010"},{"key":"ref40","article-title":"A Framework for Estimating Benefits of Investing in Maternal, Newborn, and Child Health","author":"S Foster","year":"2013"},{"issue":"9546","key":"ref41","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0140-6736(06)69384-7","article-title":"Maternal health in poor countries: the broader context and a call for action","volume":"368","author":"V Filippi","year":"2006","journal-title":"Lancet"},{"issue":"2","key":"ref42","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3329\/jhpn.v30i2.11294","article-title":"Maternal morbidity and disability and their consequences: neglected agenda in maternal health","volume":"30","author":"M Koblinsky","year":"2012","journal-title":"J Health Popul Nutr"},{"issue":"11","key":"ref43","doi-asserted-by":"crossref","first-page":"e712","DOI":"10.1016\/S2214-109X(15)00069-8","article-title":"Disability weights for the Global Burden of Disease 2013 study","volume":"3","author":"JA Salomon","year":"2015","journal-title":"Lancet Glob Health"},{"key":"ref44","unstructured":"WHO | Global Health Estimates [Internet]. WHO. [cited 2015 Nov 5]. Available from: http:\/\/www.who.int\/healthinfo\/global_burden_disease\/en\/<\/ext-link>"},{"issue":"6","key":"ref45","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/bioe.12120","article-title":"Valuing Stillbirths","volume":"29","author":"J Phillips","year":"2015","journal-title":"Bioethics"},{"issue":"7","key":"ref46","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/OLQ.0000000000000291","article-title":"Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa","volume":"42","author":"A Kuznik","year":"2015","journal-title":"Sex Transm Dis"},{"key":"ref47","unstructured":"WHO | WHO-CHOICE [Internet]. WHO. [cited 2016 May 1]. Available from: http:\/\/www.who.int\/choice\/cost-effectiveness\/en\/<\/ext-link>"},{"issue":"7525","key":"ref48","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/bmj.331.7525.1137","article-title":"Methods to assess the costs and health effects of interventions for improving health in developing countries","volume":"331","author":"DB Evans","year":"2005","journal-title":"BMJ"},{"issue":"8","key":"ref49","doi-asserted-by":"crossref","first-page":"e750","DOI":"10.1371\/journal.pone.0000750","article-title":"The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico","volume":"2","author":"D Hu","year":"2007","journal-title":"PLoS One"},{"key":"ref50","unstructured":"Gross Domestic Product per capita [Internet]. Available from: http:\/\/data.worldbank.org\/indicator\/NY.GDP.PCAP.PP.CD<\/ext-link>"},{"issue":"9947","key":"ref51","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/S0140-6736(14)60696-6","article-title":"Global, regional, and national levels and causes of maternal mortality during 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"NJ Kassebaum","year":"2014","journal-title":"Lancet"},{"issue":"2","key":"ref52","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ijgo.2013.05.017","article-title":"Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana","volume":"123","author":"K Adu-Bonsaffoh","year":"2013","journal-title":"Int J Gynaecol Obstet"},{"issue":"1","key":"ref53","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/j.1600-0412.2011.01249.x","article-title":"Maternal mortality in Ghana: a hospital-based review","volume":"91","author":"QY Lee","year":"2012","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"6","key":"ref54","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/1471-0528.12241","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement","volume":"120","author":"D Husereau","year":"2013","journal-title":"BJOG Int J Obstet Gynaecol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/dx.plos.org\/10.1371\/journal.pone.0180929","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T14:00:11Z","timestamp":1540216811000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0180929"}},"subtitle":[],"editor":[{"given":"Alash'le G.","family":"Abimiku","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2017,7,14]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2017,7,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0180929","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7,14]]}}}