Abstract
BackgroundPoor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a “know-do gap” where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers.MethodsThis retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations.ResultsTotal financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations.ConclusionsOur study presents financial and economic cost estimates of installing and operating an electronic CDSS for maternal health care in six rural health centres. From these findings one can understand exactly what goes into a similar investment and thus determine sorts of input modification needed to fit their context.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0780-9) contains supplementary material, which is available to authorized users.
Highlights
Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania
Financial cost of clinical decision support system (CDSS) intervention Total financial cost of CDSS intervention in all the six health centers amounted to 185,927.78 United States Dollars (USD) (Table 2), equivalent to 30,987.96 USD per health center. 77.2% of these costs were incurred during the installation phase, which included all activities in preparation for the actual use of the CDSS for client care
Total capital costs made up about half (48.9%) of total financial cost of which the largest portion (32.3%) was cost of the CDSS software, 12.1% was the cost of one project vehicle, 4.2% was the cost of seven laptop computers and 0.2% cost of furniture for CDSS workstation (Table 2)
Summary
Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a “know-do gap” where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and improve quality of maternal health care. An electronic clinical decision support system (CDSS) was piloted in six rural primary health centers in Tanzania to aid in making correct decisions during routine antenatal care (ANC) and childbirth (reduce the “know-do gap”). Electronic CDSS have been used in developed countries and recently been applied in developing countries [8]
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