Affordability, cost-effectiveness and efficiency of primary health care: the Bamako Initiative experience in Benin and Guinea

Soucat, Agnès; Lévy-Brühl, Daniel; Béthune, X de; Gbedonou, Placide; Lamarque, Jean‐Pierre; Bangoura, Ousmane; Camara, Ousmane; Gandaho, Timothee; Ortiz, Christine; Kaddar, Miloud; Knippenberg, Rudolf

doi:10.1002/(sici)1099-1751(199706)12:1+<s81::aid-hpm467>3.0.co;2-5

Cited by 4 publications

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“…48,49,50 Moreover, though prior work on the cost-effectiveness of such strategies is limited, our findings align in magnitude with prior health system level initiatives that have been deemed cost-effective in increasing rates of guidelinerecommended antenatal care. 28,51 PROMPTS also impacts a broader array of domains in a more targeted fashion than initiatives with a lower cost profile (e.g., national media campaigns). 52 As for danger signs, prior work has suggested difficulty in improving care seeking for maternal illnesses in the absence of comprehensive health system level support, including CHW home visits, counseling, and danger sign recognition.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Empowering patients across the maternal-newborn care continuum: A cluster randomized controlled trial testing a digital health platform in Kenya

Vatsa,

Chang,

Akinyi

et al. 2024

Preprint

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BackgroundAccelerating improvements in maternal and newborn healthcare is a major public health priority in Kenya. While utilization of formal healthcare has increased, many pregnant and postpartum women do not receive the recommended number of maternal care visits. Even when they do, visits are often short with many providers not offering important elements of evaluation and counseling, leaving gaps in women’s knowledge and preparedness. Digital health tools have been proposed as a complement to care that is provided by maternity care facilities, with the potential to empower patients to receive the right care at the right place and time. However, there is limited evidence of the impact of digital health tools at scale on patients’ knowledge, preparedness, and the content of care they receive. We evaluated a digital health platform (PROMPTS) composed of informational messages, appointment reminders, and a two-way clinical helpdesk that has been implemented at scale in Kenya on six domains across the pregnancy-postpartum care continuum.Methods and FindingsWe conducted an unmasked, 1:1 parallel arm cluster randomized controlled trial in 40 health facilities (clusters) across eight counties in Kenya. 6,139 pregnant individuals were consented at baseline and followed through pregnancy and postpartum.Individuals recruited from treatment facilities were invited to enroll in the PROMPTS platform, with roughly 85% reporting take-up. Our outcomes were derived from phone surveys conducted with participants at 36-42 weeks of gestation and 7-8 weeks post-childbirth. Among eligible participants, 3,399/3,678 women completed antenatal follow-up, and 5,509/6,128 women completed postpartum follow-up, with response rates of 92% and 90%, respectively. Outcomes were organized into six domains: knowledge, preparedness, routine care seeking, danger sign care seeking, newborn care, and postpartum care content. We generated standardized summary indices to account for multiple hypothesis testing but also analyzed individual index components.Intention-to-treat analyses were conducted for all outcomes at the individual level, with standard errors clustered by facility. Participants recruited from treatment facilities had a 0.08 standard deviation (SD) (95% CI: 0.03, 0.12) higher knowledge index, a 0.08 SD (95% CI: 0.02, 0.13) higher preparedness index, a 0.10 SD (95% CI: 0.05, 0.16) higher routine care seeking index, a 0.09 SD (95% CI: 0.07, 0.12) higher newborn care index, and a 0.06 SD (95% CI: 0.01, 0.12) higher postpartum care content index than those recruited from control facilities. No significant effect on the danger sign care seeking index was found (95% CI: -0.01, 0.08).A limitation of our study was that outcomes were self-reported, and the study was not powered to detect effects on health outcomes.ConclusionsDigital health tools indicate promise in filling gaps in pregnant and postpartum women’s health care, amidst systems that fail to deliver a minimally adequate standard of care. Through providing patients with critical information and empowering them to seek recommended care, such tools can ensure that individuals are prepared for a safe childbirth and receive access to comprehensive, high quality postpartum care. Future work is needed to ascertain the impact of at-scale digital platforms like PROMPTS on health outcomes.Trial RegistrationClinicalTrials.gov ID:NCT05110521; AEA RCT Registry ID:R-0008449

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Empowering patients across the maternal-newborn care continuum: A cluster randomized controlled trial testing a digital health platform in Kenya

Vatsa,

Chang,

Akinyi

et al. 2024

Preprint

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Strengthening health services to control epidemics: empirical evidence from Guinea on its cost‐effectiveness

Damme

Lerberghe

2004

Tropical Med Int Health

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Summaryobjective To assess the cost-effectiveness of control measures implemented against epidemics in Guinea, West Africa.methods We collected all routine data available on incidence, mortality, control measures implemented and their cost during epidemics of cholera, measles and meningococcal meningitis in 1993-95. Then we estimated for one prefecture the effectiveness and cost-effectiveness of epidemic control measures for three scenarios: (i) 'natural' situation, (ii) 'routine' health services and (iii) 'intervention'.Where uncertainty was considerable, we used sensitivity analysis and estimated ranges.findings Routine health services reduced potential deaths by 51% (67%, 37% and 60% for cholera, measles and meningitis, respectively), and additional interventions further decreased potential deaths by 28% (28%, 27% and 30% for cholera, measles and meningitis, respectively). The marginal costeffectiveness of epidemic control measures in routine health services was US$29 per death averted. The marginal cost-effectiveness of additional interventions was US$93 per death averted.conclusion Even with the data weaknesses that characterize situations of epidemics it is possible to show that strengthening health services to control epidemics as was performed in Guinea was highly cost-effective. Moreover, sensitivity analysis over a range of assumptions confirms that (i) well-functioning health services averted the major part of avoidable deaths, (ii) combining existing health services with additional interventions minimizes the health impact of epidemics and (iii) case management should be a cornerstone of control of epidemics of cholera, measles and meningococcal meningitis.

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Aliu

Chung²

2012

Plastic &Amp; Reconstructive Surgery

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Affordability, cost-effectiveness and efficiency of primary health care: the Bamako Initiative experience in Benin and Guinea

Cited by 4 publications

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Empowering patients across the maternal-newborn care continuum: A cluster randomized controlled trial testing a digital health platform in Kenya

Empowering patients across the maternal-newborn care continuum: A cluster randomized controlled trial testing a digital health platform in Kenya

Strengthening health services to control epidemics: empirical evidence from Guinea on its cost‐effectiveness

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