Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study

Abstract

<jats:title>Abstract</jats:title> <jats:p>The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the response. Cost data, which are currently lacking, may support programme adaptation and system scale up of such NCD services. This descriptive costing study from the provider perspective explored financial costs of the MSF NCD programme. We estimated annual total, per patient and per consultation costs for 2015–17 using a combined ingredients-based and step-down allocation approach. Data were collected via programme budgets, facility records, direct observation and informal interviews. Scenario analyses explored the impact of varying procurement processes, consultation frequency and task sharing. Total annual programme cost ranged from 4 to 6 million International Dollars (INT$), increasing annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to 1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209 to 253 (2015–17). Annual cost increases reflected growing patient load and increasing service complexity throughout 2015–17. A scenario importing all medications cut total costs by 31%, while negotiating importation of high-cost items offered 13% savings. Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more sensitive to reducing clinical review frequency than to task sharing review to nurses. Over 1000 extra patients could be enrolled without additional staffing cost if care delivery was restructured. Total costs significantly exceeded costs reported for NCD care in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or restructuring consultation models could confer cost savings or facilitate cohort expansion. Cost effectiveness studies of adapted models are recommended.</jats:p>

MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

“…From the patient perspective, the mean SBP in hypertensive patients decreased by 6.6 mmHg within the first 6 months, from mean 137.9 mmHg (95% CI 137.1 to 138.7) at entry/new diagnosis to 131.3 mmHg (95% CI 130.3 to 132.3) Similarly, there was a marked improvement in FBG level by 1.43 mmol/l from a mean of 10.40 mmol/l (95% CI 10.19 to 10.62) at entry/new diagnosis to 8.97 mmol/l (95% CI 8.67 to 9.26) by 6 months; most of this improvement occurred within the first 3 months. These results and those related to treatment interruption are elaborated on in our companion paper [ 38 ].…”

“…We explored trends in intermediate clinical outcomes and treatment interruption from programme and patient perspectives, and the factors associated with these trends. We included patients 18 years and older with hypertension and/or diabetes type II (DM II), exploring control of systolic blood pressure (SBP < 140 mmHg) and glycaemia [fasting capillary blood glucose (FBG) ≤ 180 mg/dL or HbA1c < 8%] [21]. We plotted monthly means for each outcome (SBP, FBG, HbA1c or treatment delay) and the proportion of monthly visits at which targets were achieved.…”

“…We used Generalised Linear Mixed-Effects Models (GLMM) to explore factors associated with each outcome. The analysis is elaborated on in our related paper [21]. Routine paper-based clinical data were collected by MSF data clerks and entered into a bespoke password-protected Microsoft Excel software database.…”

“…UNHCR funded registered Syrian refugees to access MOH primary care services and limited referral services. However, financial barriers [20,21] c" Active patients" means continued to attend the service and not exited [i.e. died, departed the area or defaulted (i.e.…”

“…We hoped to learn lessons to both improve the current care model and to inform the design of future NCD programmes in Jordan and elsewhere. Detailed analyses of cohort, qualitative and costing data are reported in separate papers [20,21,32]. The aim of this paper was to summarise the full evaluation, which used the RE-AIM implementation framework to examine the Reach; Effectiveness; Adoption and acceptance of the programme; Implementation fidelity, adaptations and costs; and programme Maintenance over time [33].…”