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This document is focused on improving government expenditure in the health sector, particularly on the maternal and neonatal health expenditure. For this purpose the central section of this work is a Cost Effectiveness Analysis (CEA) of government expenditure and policies to increase institutional deliveries -deliveries in health establishments. This analysis is particularly important as the budget for maternal and neonatal health has entered a reform process in the framework of the Result Based Budget. This reform intent to change the way budget is assigned and thus the distribution of money for different health policies. Policy recommendations for this particular subsector are fundamental at the time.

This document is focused on improving government expenditure in the health sector, particularly on the maternal and neonatal health expenditure. For this purpose the central section of this work is a Cost Effectiveness Analysis (CEA) of government expenditure and policies to increase institutional deliveries -deliveries in health establishments. This analysis is particularly important as the budget for maternal and neonatal health has entered a reform process in the framework of the Result Based Budget. This reform intent to change the way budget is assigned and thus the distribution of money for different health policies. Policy recommendations for this particular subsector are fundamental at the time.

Ten steps are identified and explained to assist the performance of a cost-effectiveness analysis (CEA) study. The article is presentedfrom the standpoint of an important social problem that can be elucidated by the CEA procedure. The ten steps outlined generally follow the scientific method, beginning with stating the problem and defining objectives, continuing through identifying alternatives, establishing measures of effectiveness, and formulating and testing a model program. A discussion of selecting alternatives based on different approaches used to conduct the CEA evaluation itself concludes the article.

The growing demand for prospective evaluation enhances the popularity of cost-effective ness analysis, a technique for identifying best uses of scarce resources. Defined in diverse ways during its short history, cost-effectiveness analysis is now seen as the evaluative comparison of monetary and nonmonetary dimensions of impact. The cost-effectiveness ratio for health programs divides monetary effects by health effects. Decisions on com peting alternative programs should be resolved by regarding cost-effectiveness ratios on the differences between programs.

When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in costeffectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-ordeath implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle.