Cost-Effectiveness of Two Government District Hospitals in Sub-Saharan Africa

Caris E Grimes,Thaim B Kamara,Peter M George,Andrew J M Leather,Rebekah Law,Anna Dare,Michael Murowa,Christopher B D Lavy,Nyengo C Mkandawire,Sophie Reshamwalla,Nigel Day

doi:10.1007/s00268-017-4007-6

Abstract

BackgroundDistrict hospitals in sub-Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030. Previous studies have suggested that government hospitals are likely to be highly cost-effective and therefore worthy of investment.MethodsA retrospective analysis of the inpatient logbooks for two government district hospitals in two sub-Saharan African hospitals was performed. Data were extracted and DALYs were calculated based on the diagnosis and procedures undertaken. Estimated costs were obtained based on the patient receiving ideal treatment for their condition rather than actual treatment received.ResultsTotal cost per DALY averted was 26 (range 17–66) for Thyolo District Hospital in Malawi and 363 (range 187–881) for Bo District Hospital in Sierra Leone.ConclusionThis is the first published paper to support the hypothesis that government district hospitals are very cost-effective. The results are within the same range of the US$32.78–223 per DALY averted published for non-governmental hospitals.

Highlights

We have previously argued for investment in district hospitals in low-income countries, as key to the development of sustainable, long-term healthcare solutions [1]
Background District hospitals in sub-Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030
Total cost per disability-adjusted life year (DALY) averted was 26 for Thyolo District Hospital in Malawi and 363 for Bo District Hospital in Sierra Leone. This is the first published paper to support the hypothesis that government district hospitals are very cost-effective

Summary

Introduction

We have previously argued for investment in district hospitals in low-income countries, as key to the development of sustainable, long-term healthcare solutions [1]. District hospitals are key to strengthening surgical care, or universal coverage of essential surgery (UCES) [4]. One LCoGS target is that 80% of the global population should have access within 2 h to a facility that can perform the Bellwether Procedures (emergency caesarean section, laparotomy or open fracture fixation). This ambitious target will require significant investment in district hospital care. Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030. Estimated costs were obtained based on the patient receiving ideal treatment for their condition rather than actual treatment received

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