Incremental cost and health gains of the 2016 WHO antenatal care recommendations for Rwanda: results from expert elicitation

Hitimana, Regis; Lindholm, Lars; Mogren, Ingrid; Krantz, Gunilla; Nzayirambaho, Manassé; Sengoma, Jean Paul Semasaka; Pulkki-Brännström, Anni-Maria

doi:10.1186/s12961-019-0439-9

Cited by 9 publications

(11 citation statements)

References 38 publications

(41 reference statements)

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“…They recorded 5,962 visits across eleven facilities while we recorded 19,342 visits across six facilities. However, the estimation by Hatimana et al for the focused model (US$10.65) and the standard model (US$10) (19,20), is at about the same level as US$9.6 and US$8.5 per visit that we found.…”

Section: Discussionsupporting

confidence: 63%

“…Another study in rural areas of southern Tanzania (2009) reported a cost of US$16.4 per visit from a health system perspective (18). In 2015, a study in the neighbouring country Rwanda estimated a cost of US$10.65 per visit (19) under the focused model and US$9.9 per visit after addition of some recommendations from the standard model (20), both from a health system perspective. WHO's recommendations in uences guideline updates in developing countries, yet country level economic evidence to support such decisions are scarce while resources for implementation are limited.…”

Section: Introductionmentioning

confidence: 99%

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Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

Chamani¹,

Mori²,

Robberstad³

2021

Preprint

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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.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

Chamani¹,

Mori²,

Robberstad³

2021

Preprint

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“…22–25 Overall, the applicability of the calculators covered by this review was limited to more affluent countries. 27 Furthermore, the selected studies did not describe the contents of health and well-being promotion interventions comprehensively. Despite this, the outcome of cost savings was relevant, clearly understood and could be compared with other interventions.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review

Hult

Halminen

Linna

et al. 2021

European Journal of Public Health

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Background The health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety. Methods Our systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis. Results The searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used. Conclusion This review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.

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“…A study by Saronga (2014) in rural areas of southern Tanzania, reported a cost of US$16.4 per visit from a health system perspective [ 18 ]. In 2015, a study in the neighboring country Rwanda estimated a cost of US$10.65 per visit [ 19 ] under the focused model and US$9.9 per visit after addition of some recommendations for the standard model [ 20 ], both from a health system perspective.…”

Section: Introductionmentioning

confidence: 99%

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

Chamani

Mori

Robberstad

2021

Cost Eff Resour Alloc

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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.

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Incremental cost and health gains of the 2016 WHO antenatal care recommendations for Rwanda: results from expert elicitation

Cited by 9 publications

References 38 publications

Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review

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

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