Neglected tropical diseases in the post-2015 health agenda.

www.thelancet.com Vol 383 May 24, 2014 1803 obstetric surgical and anaesthetic care, including for caesarean section and blood product services. Although excluded from the Investment Framework proposed by Stenberg and colleagues, these are evidence-based interventions to reduce maternal mortality in high-income and in lowincome and middle-income countries (LMICs). They have been included in previous publications on essential interventions for maternal health, but are typically excluded from investment frameworks and economic modelling. Such neglect shows a broader aversion in the global health community to fund the development of hospital-level services in LMICs, including those for essential surgery and anaesthesia. Cost and complexity are often cited as major barriers to the scale-up of hospital-level care, yet closer examination shows caesarean section for obstructed labour prevents maternal mortality and obstetric fistula, has favourable cost-benefit ratios, is highly cost eff ective by WHO standards, and can be delivered safely at district-level facilities, including by non-physician providers. Failure to include hospital-based obstetric surgical and anaesthetic services, and to support infra structure such as blood banks within maternal health investment frameworks for LMICs, underestimates the true investment required to reduce maternal mortality to acceptable global standards. Furthermore, such an approach weakens investment in secondary care services generally, threatening progress towards a diverse range of health and development goals in the medium to long term.