Abstract
BackgroundThere is a pressing need to include cost data in the Lives Saved Tool (LiST). This paper proposes a method that combines data from both the WHO CHOosing Interventions that are Cost-Effective (CHOICE) database and the OneHealth Tool (OHT) to develop unit costs for delivering child and maternal health services, both alone and bundled.MethodsFirst, a translog cost function is estimated to calculate factor shares of personnel, consumables, other direct (variable or recurrent costs excluding personnel and consumables) and indirect (capital or investment) costs. Primary source facility level data from Kenya, Namibia, South Africa, Uganda, Zambia and Zimbabwe are utilized, with separate analyses for hospitals and health centres. Second, the resulting other-direct and indirect factor shares are applied to country unit costs from the WHO CHOICE unit cost database to calculate those portions of unit cost. Third, the remainder of the costs is calculated using default data from the OHT. Fourth, we calculate the effect of bundling services by assuming that a LiST intervention visit takes an average of 20 minutes when delivered alone but only incremental time in addition to the basic visit when delivered in a bundle.ResultsPersonnel costs account for the greatest share of costs for both hospitals and health centres at 50% and 38%, respectively. The percentages differ between hospitals and health centres for consumables (21% versus 17%), other direct (7.5% versus 6.75%), and indirect (22% versus 23%) costs. Combining the other-direct and indirect factor shares with the WHO CHOICE database and the other costs from OHT provides a comprehensive cost estimate of LiST interventions. Finally, the cost of six recommended antenatal care (ANC) interventions is $69.76 when delivered alone, but $61.18 when delivered as a bundle, a savings of $8.58 (12.2%).ConclusionsThis paper proposes a method for estimating a comprehensive cost of providing child and maternal health interventions by combining labor, consumables and drug costs from OHT with indirect and other-direct proportional costs from WHO CHOICE. In addition, we demonstrate the potential cost savings that can be achieved from bundling the delivery of essential antenatal care interventions rather than delivering the same interventions alone.
Highlights
There is a pressing need to include cost data in the Lives Saved Tool (LiST)
We combine these costs with the default costs for personnel, drugs and consumables available from OneHealth Tool (OHT) to calculate the unit cost for the interventions being examined
We present aggregated costs in three major categories: 1) the unit cost of an antenatal care (ANC) visit delivered at a health centre; 2) the unit cost per pregnancy to provide the recommended number of visits to each case assuming the different types of ANC visits are provided separately; and
Summary
There is a pressing need to include cost data in the Lives Saved Tool (LiST). This paper proposes a method that combines data from both the WHO CHOosing Interventions that are Cost-Effective (CHOICE) database and the OneHealth Tool (OHT) to develop unit costs for delivering child and maternal health services, both alone and bundled. Integrating health care services is hypothesized to result in both cost savings and better outcomes [1]. The improved use of preventive and curative interventions should lead to better outcomes. Empirical evidence supports these hypotheses: a recent study from Zambia has shown that integrating antiretroviral therapy (ART) into antenatal care (ANC) clinics doubled uptake of ART in pregnant women. An updated review of reports evaluating the impact of integrating immunization with other maternal and child health interventions found that coverage of the other interventions increased, not to the same level as the original immunization coverage rates [4]. A recent Cochrane review, found mixed evidence on the impact of integrating services; there was some evidence that utilization and outputs improved, no significant impact was found on overall health status [5]
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