Parental costs for in-patient neonatal services for perinatal asphyxia and low birth weight in Ghana.

Christabel C Enweronu-Laryea,Francis M Asenso-Boadi,Hilary D Andoh,Audrey Frimpong-Barfi,Emma Sacks

doi:10.1371/journal.pone.0204410

Christabel C Enweronu-Laryea, Francis M Asenso-Boadi + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0204410

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Abstract

The major causes of newborn deaths in sub-Saharan Africa are well-known and countries are gradually implementing evidence-based interventions and strategies to reduce these deaths. Facility-based care provides the best outcome for sick and or small babies; however, little is known about the cost and burden of hospital-based neonatal services on parents in West Africa, the sub-region with the highest global neonatal death burden. To estimate the actual costs borne by parents of newborns hospitalised with birth-associated brain injury (perinatal asphyxia) and preterm/low birth weight, this study examined economic costs using micro-costing bottom-up approach in two referral hospitals operating under the nationwide social health insurance scheme in an urban setting in Ghana. We prospectively assessed the process of care and parental economic costs for 25 out of 159 cases of perinatal asphyxia and 33 out of 337 cases of preterm/low birth weight admitted to hospital on the day of birth over a 3 month period. Results showed that medical-related costs accounted for 66.1% (IQR 49% - 81%) of out-of-pocket payments irrespective of health insurance status. On average, families spent 8.1% and 9.1% of their annual income on acute care for preterm/LBW and perinatal asphyxia respectively. The mean out-of-pocket expenditure for preterm/LBW was $147.6 (median $101.8) and for perinatal asphyxia was $132.3 (median $124). The study revealed important gaps in the financing and organization of health service delivery that may impact the quality of care for hospitalised newborns. It also provides information for reviewing complementary health financing options for newborn services and further economic evaluations.

Highlights

Efforts to improve child health indices in sub-Saharan Africa have focused on the major direct causes of neonatal deaths including, perinatal asphyxia, preterm /low birth weight (LBW) and infections [1]
Parental costs for in-patient neonatal services in Ghana health system gaps in low- and middle- income countries (LMIC) undermine effective delivery of quality facility-based neonatal care and the burden of inpatient newborn services on families has received little attention globally [7, 8]
Bottom-up micro-costing approach based on the Kaplan and Anderson Time-Driven Activity Based Costing (TDABC) method [20] was used to collect clinical data and a patient resource-use measurement tool adapted from Thompson et al [21] was used to collect parental cost and activity data

Summary

Introduction

Efforts to improve child health indices in sub-Saharan Africa have focused on the major direct causes of neonatal deaths including, perinatal asphyxia, preterm /low birth weight (LBW) and infections [1]. Parental costs for in-patient neonatal services in Ghana health system gaps in low- and middle- income countries (LMIC) undermine effective delivery of quality facility-based neonatal care and the burden of inpatient newborn services on families has received little attention globally [7, 8]. Like other LMIC, physical access and financial constraints are major barriers to facility-based neonatal care in Ghana despite a nationwide social health insurance scheme with a fee for service (FFS) payment mechanism for medicines [12]

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