Workforce Cost Model for Expanding Congenital and Rheumatic Heart Disease Services in Kenya

Abstract

Background: Cardiovascular disease is the number one global killer, with over three quarters of these deaths arising from the populations of low-and middle-income countries (LMICs). Addressing the burden of cardiovascular disease in LMICs must include medical and surgical services for these patients. In this article, we model the needs and costs to scale up the cardiac provider workforce in Kenya, which can be adapted to other LMICs based on country-specific workforce hours and workforce salaries. Methods: Using published epidemiological reports from sub-Saharan Africa, we structured the model based on the expected disease burden of congenital and rheumatic disease in a simulated 1,000-person population. Services modeled include clinic visits, echocardiograms, diagnostic cardiac catheterizations, interventional catheterizations, and heart surgery. Costs were modeled based on Kenyan public sector salaries. After scaling the model, we created a sensitivity analysis of change in service duration and salaries. Results: Based on a 1,000-person Kenyan population, we estimate that 2.5 heart surgeries will be needed every year, with a corresponding annual workforce cost of US$526. Including accompanying services of clinic visits, echocardiograms, and both diagnostic and interventional cardiac catheterizations, the total annual workforce cost is US$899. Based on estimated productive hours for public sector workforce, 196 full-time equivalent cardiac surgeons will be needed for the entire population of Kenya (2017 figure). Conclusions: We present a model for appropriate cardiovascular service staffing based on disease burden and workforce costs. This model can be scaled up as needed to plan for local capacity building.

Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan

“…Based on that approach, this study's results combined with additional stakeholder interviews in Sudan could be used to design community-based interventions to increase patient Edwards et al glob health res policy (2021) 6:35 trust in RHD healthcare services. Another approach to achieving policy change could involve guidance from cost-effectiveness models, which may inform policymakers of the prudent investment in primary and secondary prevention costs as compared to the workforce and surgical repair costs associated with severe RHD, as was proposed by researchers in Kenya [48].…”

Micro-Costing Estimation of Workforce Needs: Will That Work for Cardiac Services in Kenya?

“…In this context, Dr Kontchou and colleagues proposed a model using country-specific labor practices and regional heart disease epidemiology designed to project workforce requirements and cost estimates to deliver surgical treatments for CHD and RHD in Kenya. 5 The authors built their model based on existing data on stable incidence of CHD, prevalence of RHD data from SSA regions, birth rates in Kenya, and expected number of patients who may require surgical interventions. They advocated a bottom-up approach of costing out resources needed to provide a spectrum of cardiac care for patients with CHD or RHD including preoperative clinic evaluations, diagnostics with echocardiograms, cardiac catheterizations, and heart surgeries, with and without cardiopulmonary bypass.…”

“…In this context, Dr Kontchou and colleagues proposed a model using country-specific labor practices and regional heart disease epidemiology designed to project workforce requirements and cost estimates to deliver surgical treatments for CHD and RHD in Kenya. 5…”