Cost analysis of large-scale implementation of the ‘Helping Babies Breathe’ newborn resuscitation-training program in Tanzania

Abstract

BackgroundHelping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania.MethodsWe used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation.ResultsTotal costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support.ConclusionHBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

“…Since evaluating outcomes among this population is challenging ethically and logistically, additional study is necessary to evaluate the reproducibility of these results. However, given the empowering nature of the education for midwives and the relatively low cost of the program [17], these results should complement existing findings demonstrating that when used appropriately, the Helping Babies Breathe program can be a beneficial and cost-effective intervention.…”

A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare

“…The Vossius et al study was not randomized and used a pre-and post-intervention control in a cohort setting, making interpretation of the effect challenging. Chaudhury et al 19 focused on estimating costs associated with a large-scale implementation of the…”

“…At present, SBE in low-income settings tends to focus on basic maternal health, newborn health, and neonatal care processes, such as HBB or ENC and their implementation. 18,19 However, our systematic evaluation of the SBE cost-related literature indicates that high-quality, long-term studies of training and subsequent care-quality outcomes for trainees or patient health outcomes linked to training are sparse. An additional challenge of cost studies in healthcare is the subsidization of training and clinical care, particularly in low-income countries.…”

Implementation of “Helping Babies Breathe”: A 3-Year Experience in Tanzania

“…6 The mean OSCE score was highest (mean 18.9; SD 3.3), and the greatest percentage of providers passed the OSCE (87.1%) immediately after HBB training, compared with the follow-up visits ( Table 4). The mean OSCE score dropped at the 4-to 6-week follow-up 10 ).…”

“…Some of these results are reported elsewhere, and the current analysis will focus on findings from the OSCEs, facility checklists, and focus group discussions. 7,10 Trained evaluation team members conducted OSCEs on all HBBtrained staff present at a facility during the 4-to 6-week and 4-to 6-month facility follow-up visits. The sampling method was a stratified, purposive sample of facilities within all 15 districts receiving the CIFFsupported HBB program.…”