Implementing standard antenatal care interventions: health system cost at primary health facilities in Tanzania

Abstract

Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries. Conclusion Introduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.

Determinants of Focused Antenatal Care Utilization Among Women in Simiyu Region Tanzania

“…The underlying principle of the FANC model is the integration of care through health promotion, prevention of diseases, screening and treatment, and birth preparedness. These services are provided at the primary health facilities (dispensaries and health centers) by nurses and midwives but when pregnant women need special care are referred to higher levels (district hospital) ( Chamani et al, 2021 ). A previous study shows that, during screening, laboratory tests missing at the dispensary are requested from a health center or hospital ( Konje et al, 2018 ).…”

Peningkatan Morbiditas dan Mortalitas pada Kehamilan Low Middle Country

“…Data yang disampaikan WHO di negara maju mengalami AKI sebesar 11/100.000 kelahiran hidup dan Angka kematian ibu (AKI) di negara berkembang sebesar 462/100.000 kelahiran hidup [25]. preeklampsia dalam kehamilan lalu, riwayat preeklampsia dalam keluarga [27]. Selain itu wanita dengan pendidikan rendah memiliki risiko lebih besar 5,12 kali lebih besar berisiko mengalami preeklampsia dibanding dengan wanita dengan pendidikan tinggi.…”