Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

Corinna Vossius,Jeffrey Perlman,Editha Lotto,Sara Lyanga,Estomih Mduma,Georgina Msemo,Hege L Ersdal,Craig Rubens

doi:10.1371/journal.pone.0102080

Abstract

ObjectiveThe Helping Babies Breathe” (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania.MethodsData about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health.FindingsCosts per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated.ConclusionThe HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

Highlights

Neonatal mortality is defined as death before one month of age and recent global estimates range from 2.9 to 3.6 million deaths per year [1,2,3,4]
The ‘‘Helping Babies Breathe’’ Training Program HBB is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries [14]
The hospital is a 420-bed hospital owned by the Mbulu Diocese of the Evangelical Lutheran Church in Tanzania, and is fully incorporated in the national health plan under the Ministry of Health and Social Welfare (MOHSW)

Summary

Introduction

Neonatal mortality is defined as death before one month of age and recent global estimates range from 2.9 to 3.6 million deaths per year [1,2,3,4]. A major factor contributing to the high mortality is a global lack of trained providers in neonatal stabilization and/or resuscitation. This is most acute in Sub-Saharan Africa with the highest neonatal mortality [13]. The program includes an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries [14]. The program was developed by the Global Implementation Task Force of the American Academy of Pediatrics. In September 2009, the Tanzanian Ministry of Health and Social Welfare (MOHSW) launched the National HBB program by implementing HBB training and data collection at eight study-sites in Tanzania. Haydom Lutheran Hospital (HLH) was the only rural site, located in the in the Manyara region in Northern Tanzania

Methods

Results

Conclusion