Abstract
BackgroundQUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania.MethodsThis was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider’s perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios.ResultsEconomic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes.ConclusionsAlthough the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system.Trial registrationRegistered clinical trial at www.clinicaltrials.gov (NCT01409824). Registered May 2009.
Highlights
Quality of Maternal Care (QUALMAT) project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries
In 2009 Antenatal Care (ANC) consumed an average of 7140 United States Dollars (USD) per health centre and childbirth care consumed 7389 USD per health centre
Post-intervention total facility cost amounted to 560,556 USD with an average cost per health centre at 93,426 USD, ANC cost per health centre was 6811 USD and childbirth care cost per health centre was 6107 USD
Summary
QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. Poor quality of health care is among the causes of high maternal and newborn morbidity and mortality burden in Tanzania. Poor performance is very often a result of low motivation among the health care providers compounded by shortage of financial and well trained human resources, low retention of staff, shortage of infrastructure and supplies, poor transport and communication infrastructure, weak governance and management [5, 6]. This is a sensitive problem in the maternal and newborn health care provision. The lack of motivation leads to an insufficient translation of knowledge into optimal utilization of resources in the health sector (know-do gap) and to the provision of suboptimal maternal and newborn health care
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