Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites
Introduction Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the le...
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BMJ Publishing Group
2024-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/3/e013643.full |
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| author | AKM Fazlur Rahman Oliva Bazirete Emily J Callander Abdul Halim Abu Sayeed Abdullah Caroline Homer Andrea Nove Sabera Turkmani Mandy Forrester Alayna Carrandi Sally Pairman Scovia Nalugo Mbalinda Vanessa Scarf Sheila Clow Rose Chalo Nabirye Saad Ibrahim Rasheed Arslan Munir Turk Shree Mandke Martin Boyce |
| author_facet | AKM Fazlur Rahman Oliva Bazirete Emily J Callander Abdul Halim Abu Sayeed Abdullah Caroline Homer Andrea Nove Sabera Turkmani Mandy Forrester Alayna Carrandi Sally Pairman Scovia Nalugo Mbalinda Vanessa Scarf Sheila Clow Rose Chalo Nabirye Saad Ibrahim Rasheed Arslan Munir Turk Shree Mandke Martin Boyce |
| author_sort | AKM Fazlur Rahman |
| collection | DOAJ |
| description | Introduction Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes.Methods The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars.Results Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted.Conclusion MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority. |
| format | Article |
| id | doaj-art-c33ac6ba632e47b8876caa199a6ac5ca |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-c33ac6ba632e47b8876caa199a6ac5ca2025-08-20T02:50:55ZengBMJ Publishing GroupBMJ Global Health2059-79082024-03-019310.1136/bmjgh-2023-013643Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sitesAKM Fazlur Rahman0Oliva Bazirete1Emily J Callander2Abdul Halim3Abu Sayeed Abdullah4Caroline Homer5Andrea Nove6Sabera Turkmani7Mandy Forrester8Alayna Carrandi9Sally Pairman10Scovia Nalugo Mbalinda11Vanessa Scarf12Sheila Clow13Rose Chalo Nabirye14Saad Ibrahim Rasheed15Arslan Munir Turk16Shree Mandke17Martin Boyce181 Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B162, Road 23, New DOHS, Mohakhali, Dhaka 1206, BangladeshNovametrics Ltd, Duffield, UK1 University of Technology Sydney, Sydney, New South Wales, AustraliaCentre for Injury Prevention and Research, Dhaka, Bangladesh1Centre for Injury Prevention and Research, BangladeshMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, AustraliaNovametrics Ltd, Duffield, UKacademicInternational Confederation Of Midwives, The Hague, The NetherlandsMonash University School of Public Health and Preventive Medicine, Melbourne, Victoria, AustraliaInternational Confederation Of Midwives, The Hague, The NetherlandsMakerere University, Kampala, UgandaFaculty of Health, University of Technology Sydney, Sydney, New South Wales, AustraliaUniversity of Cape Town, Cape Town, South AfricaBusitema University, Tororo, UgandaResearch and Development Solutions, Islamabad, PakistanResearch and Development Solutions, Islamabad, PakistanInternational Confederation Of Midwives, The Hague, The NetherlandsNovametrics Ltd, Duffield, UKIntroduction Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes.Methods The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars.Results Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted.Conclusion MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.https://gh.bmj.com/content/9/3/e013643.full |
| spellingShingle | AKM Fazlur Rahman Oliva Bazirete Emily J Callander Abdul Halim Abu Sayeed Abdullah Caroline Homer Andrea Nove Sabera Turkmani Mandy Forrester Alayna Carrandi Sally Pairman Scovia Nalugo Mbalinda Vanessa Scarf Sheila Clow Rose Chalo Nabirye Saad Ibrahim Rasheed Arslan Munir Turk Shree Mandke Martin Boyce Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites BMJ Global Health |
| title | Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites |
| title_full | Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites |
| title_fullStr | Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites |
| title_full_unstemmed | Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites |
| title_short | Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites |
| title_sort | midwife led birthing centres in bangladesh pakistan and uganda an economic evaluation of case study sites |
| url | https://gh.bmj.com/content/9/3/e013643.full |
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