Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya
Introduction Improvements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, re...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/3/e002452.full |
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| author | Edwine Barasa Meghan Bruce Kumar Jason J Madan Miriam Taegtmeyer Nelly Muturi Lilian Otiso Peter Auguste Christian B Ochieng Elizabeth Mgamb |
| author_facet | Edwine Barasa Meghan Bruce Kumar Jason J Madan Miriam Taegtmeyer Nelly Muturi Lilian Otiso Peter Auguste Christian B Ochieng Elizabeth Mgamb |
| author_sort | Edwine Barasa |
| collection | DOAJ |
| description | Introduction Improvements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya.Methods We estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses.Results We found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars).Conclusions This analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas. |
| format | Article |
| id | doaj-art-fdf024f683c44428811ddbdf3024903c |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-fdf024f683c44428811ddbdf3024903c2025-08-20T02:50:36ZengBMJ Publishing GroupBMJ Global Health2059-79082021-03-016310.1136/bmjgh-2020-002452Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in KenyaEdwine Barasa0Meghan Bruce Kumar1Jason J Madan2Miriam Taegtmeyer3Nelly Muturi4Lilian Otiso5Peter Auguste6Christian B Ochieng7Elizabeth Mgamb8Center for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UKCenter for Humanitarian Emergencies, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UKInternational Rescue Committee, Nairobi, KenyaLiverpool School of Tropical Medicine, Liverpool, UKWarwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK7 Research and Strategic Information, LVCT Health, Nairobi, Kenya8 Department of Health, Migori County Government, Migori, KenyaIntroduction Improvements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya.Methods We estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses.Results We found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars).Conclusions This analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.https://gh.bmj.com/content/6/3/e002452.full |
| spellingShingle | Edwine Barasa Meghan Bruce Kumar Jason J Madan Miriam Taegtmeyer Nelly Muturi Lilian Otiso Peter Auguste Christian B Ochieng Elizabeth Mgamb Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya BMJ Global Health |
| title | Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya |
| title_full | Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya |
| title_fullStr | Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya |
| title_full_unstemmed | Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya |
| title_short | Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya |
| title_sort | cost effectiveness of community health systems strengthening quality improvement interventions at community level to realise maternal and child health gains in kenya |
| url | https://gh.bmj.com/content/6/3/e002452.full |
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