participants felt that the priority was to show that maternal mortality can be reduced, in a variety of settings, quickly and at minimum cost. There was recognition of political impediments to using scarce resources for research, and of the importance of using ongoing and planned surveys whenever possible.

Others felt that in a limited number of settings, tightly-controlled demonstration projects should be undertaken, as it is imperative that we be able to make fully informed judgements on the best approaches to reducing maiernal mortality under different circumstances, and to argue convincingly for greater allocation of resources to Safe Motherhood. It was concludec that a balance should be reached between rigorous research efforts in a limited number of settings and a range of smaller-scale, less costly studies of a variety of demonstration projects in different settings. Participants noted, however, that there are 'I problems with data from pilot projects, which are often self-selected and not always , .sentative. Nor are they always replicable: their success or failure is often based on a few key personnel or other unique attributes.

All agreed that there is no substitute for some investment in the data collection process. Intensive field-level work will be required to "tease out" the data, which, however important, is tedious, time consuming, and expensive. There may be costing success stories we can learn from, as well as costing approaches that can be incorporated into this work. There are also model programs operating now that were not in existence in 1987, which should be identified and used for costing research. The existing network of health economists should be encouraged to work on this issue in collaboration with other social scientists, epidemiologists, and health care professionals. There was consensus that the World Bank should continue its work in this area, in collaboration with other agencies; indeed there may be prospects for Bank financing for project research components. Several other donors expressed a willingness to be more involved in costing activities, and Columbia University, the MotherCare Project, and Family Care International suggested collecting data in pilot projects in which they are involved.

One difficulty noted for costing work was the basic difference in approach between physicians and economists. Physicians are trained to do the most that they can for each individual patient without regard to resource constraints; this is central to the medical ethic. Economists are trained to make the best choices subject to those constraints; while this may not maximize the welfare of each individual, it should maximize sccial welfare. It was noted that it is essential that -lore doctors and economists gain an understanding of one another's perspective.

The role of the Safe Motherhood Operations Research Program (SMOR) of WHO was also discussed. To evaluate the effectiveness of interventions, WHO has convened six technical working groups dealing with the four major causes of mortality, health systems, and epidemiological, social and behavioral aspects of maternal mortality. The need for SMOR to be more proactive in the costing arena, as an essential component of operations research, was emphasized. WHO's role would be greatly enhanced if an economist were added to its operational research staff.

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