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Cost effectiveness analysis of alternative training strategies for improving access to emergency obstetric care in Burkina Faso. Hounton S 1,2 , Belemsaga D 3 , Newlands D 2 , Meda N 3 , De Brouwere V 4 1 WHO-MDSC, Burkina Faso, 2 University of Aberdeen, UK

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Cost effectiveness analysis of alternative training strategies for improving access to emergency obstetric care in Burkina Faso

Hounton S1,2, Belemsaga D3, Newlands D2 , Meda N3, De Brouwere V4

1WHO-MDSC, Burkina Faso, 2University of Aberdeen, UK

3Centre MURAZ, Burkina Faso, 4ITM, Antwerp, Belgium


Background strategies for improving access to emergency obstetric care in Burkina Faso

Maternal and newbornmortalityveryhigh. How to ensureskilled ?

Skilledhealthhuman

resources (number, coverage, availability, access)

Effectiveness and cost- effectiveness of strategies to addressshortage ?


OBJECTIVES strategies for improving access to emergency obstetric care in Burkina Faso

Effectiveness of surgical teams led by specialists, medical doctors, and clinical officers in providing life saving interventions

Value for money

Policy recommendation for effective coverage of emergency obstetric care in rural areas


Methods 1
Methods (1) strategies for improving access to emergency obstetric care in Burkina Faso

  • Study design: Cost-effectiveness analysis (surgeries: c-sections)

    - Strategy 1: Team led by a specialist (OBGY, surgeon)

    - Strategy 2: Team led by a general practitioner

    - Strategy 3: Team led by a clinical officer

    Comparability of case-mix and supporting environment

  • Place and participants

    - Burkina Faso (6 / 13 regions)

    - All district hospitals

  • Study period: Oct – Dec 2007

  • Perspective: health system

  • Time horizon: 15 years


Methods 2
Methods (2) strategies for improving access to emergency obstetric care in Burkina Faso

  • Effectiveness measures

    - Maternal and newborn case fatality rates

    - Post caesarean complications

    (haemorrhage, infections, loosening of sutures)

  • Costing methodology aims

    - Average annual cost of training and deployment of providers

    - Average annual costs of putting in place a surgical team

  • Incremental Cost Effectiveness Ratio (ICER)


Methods 3
Methods (3) strategies for improving access to emergency obstetric care in Burkina Faso

  • Data sources, data collection

    - Retrospective case extraction of registries (Jan - Dec 2006)

    - Reports (MOH, University), interviews of stakeholders on

    barriers and facilitators of the substitutes strategies

  • Data analysis

    - Descriptive statistics, multivariate analysis (case-mix)

    - Macro costing, annual costs estimates (useful lifespan of items,

    3% discount rate, allocation of total costs to caesarean section

    by appropriate proxies of the volume and time)

    - Sensitivity analysis on major costs categories


Results 1 cases profile
Results (1): cases profile strategies for improving access to emergency obstetric care in Burkina Faso


Results 2 outcomes

250 strategies for improving access to emergency obstetric care in Burkina Faso

200

150

100

50

0

Obstetricians

General practitioners

Clinical officers

80

70

60

50

40

30

20

10

0

Obstetricians

General practitioners

Clinical officers

Results (2) : outcomes

  • Case fatality rates of caesarean deliveries by provider, district hospitals, 2004-2005, Burkina Faso

  • Newborns

    (/1000 c-sections)

  • Mothers

    (/1000 c-sections)


Results (3) : costing strategies for improving access to emergency obstetric care in Burkina Faso

ICER of caesarean deliveries by providers’ teams, district hospitals, 2006


RESULTS (4): “Enhanced strategies” strategies for improving access to emergency obstetric care in Burkina Faso

ICER of caesarean deliveries by providers’ teams, district hospitals, 2006


Discussions strategies for improving access to emergency obstetric care in Burkina Faso

  • Comparable skills & practices of c-section (thus life saving interventions) between obstetricians and trained doctors

  • Results comparable to those in Mozambique, Malawi, Zambia, however higher CFR with clinical officers in our settings

  • Delegation of surgical tasks from specialists to substitutes: necessary, effective and cost-effective in rural areas

  • HRH : incentives are primarily about career path, supportive environment, degree (prestige), and monetary incentives

  • Limitations: comparability of settings, providers, cases


Conclusion strategies for improving access to emergency obstetric care in Burkina Faso

  • All current options for providing emergency surgeries are viable

  • Trained doctors: most cost effective option

  • Potential for improved cost-effectiveness of trained doctors if career paths and incentives provided

  • In Burkina Faso, given shortage will remain for foreseeable future, delegation of surgical tasks from specialists to middle level health substitutes has proven to be effective, is cost effective in the short and mid runs


Acknowledgements
Acknowledgements strategies for improving access to emergency obstetric care in Burkina Faso

  • West Africa Health Organization (WAHO)

    Grant WAHO, N°13 Centre MURAZ, 2005

  • Ministry of health, Centre MURAZ (Burkina Faso)

  • Collaborators: Sombie I, Cecile Tamini, Mamadou Barro, Fadima Bocoum, Abdoulaye Traore, Moctar Ouédraogo, Peter Byass