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 is unknown, particulary 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. Cost were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services was US$185,282 under the focused model and the cost increased by about 90% at health centres and 97% at dispensaries to US$358,290 for the standard model. Personnel cost accounted for more than one third of the total cost for both models. With the standard model, 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 healthcare facilities in Tanzania will double resources use compared to current practice. While resources availability has been one of the challenge to effective implementation of the focused ANC model, more research is required, to consider whether these costs are reasonable compared to the additional value for maternal and child health.