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. 2019 Mar 13;7(Suppl 1):S104-S122.
doi: 10.9745/GHSP-D-18-00429. Print 2019 Mar 11.

The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia

Benjamin Johns  1 , Peter Hangoma  2 , Lynn Atuyambe  3 , Sophie Faye  4 , Mark Tumwine  5 , Collen Zulu  6 , Marta Levitt  7 , Tannia Tembo  8 , Jessica Healey  9 , Rui Li  10 , Christine Mugasha  11 , Florina Serbanescu  10 , Claudia Morrissey Conlon  12
Affiliations

The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia

Benjamin Johns et al. Glob Health Sci Pract. .

Abstract

The primary objective of this study was to estimate the costs and the incremental cost-effectiveness of maternal and newborn care associated with the Saving Mothers, Giving Life (SMGL) initiative-a comprehensive district-strengthening approach addressing the 3 delays associated with maternal mortality-in Uganda and Zambia. To assess effectiveness, we used a before-after design comparing facility outcome data from 2012 (before) and 2016 (after). To estimate costs, we used unit costs collected from comparison districts in 2016 coupled with data on health services utilization from 2012 in SMGL-supported districts to estimate the costs before the start of SMGL. We collected data from health facilities, ministerial health offices, and implementing partners for the year 2016 in 2 SMGL-supported districts in each country and in 3 comparison non-SMGL districts (2 in Zambia, 1 in Uganda). Incremental costs for maternal and newborn health care per SMGL-supported district in 2016 was estimated to be US$845,000 in Uganda and $760,000 in Zambia. The incremental cost per delivery was estimated to be $38 in Uganda and $95 in Zambia. For the districts included in this study, SMGL maternal and newborn health activities were associated with approximately 164 deaths averted in Uganda and 121 deaths averted in Zambia in 2016 compared to 2012. In Uganda, the cost per death averted was $10,311, or $177 per life-year gained. In Zambia, the cost per death averted was $12,514, or $206 per life-year gained. The SMGL approach can be very cost-effective, with the cost per life-year gained as a percentage of the gross domestic product (GDP) being 25.6% and 16.4% in Uganda and Zambia, respectively. In terms of affordability, the SMGL approach could be paid for by increasing health spending from 7.3% to 7.5% of GDP in Uganda and from 5.4% to 5.8% in Zambia.

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Figures

FIGURE 1
FIGURE 1
Results of Sensitivity Analysis for Uganda and Zambia
See this image and copyright information in PMC

References

    1. Alkema L, Chou D, Hogan D, et al. ; United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462–474. 10.1016/S0140-6736(15)00838-7. - DOI - PMC - PubMed
    1. Lifetime risk of maternal death. World Bank Open Data website. https://data.worldbank.org/indicator/SH.MMR.RISK Accessed September 15, 2018.
    1. Miller S, Belizán JM. The true cost of maternal death: individual tragedy impacts family, community and nations. Reprod Health. 2015;12(1):56. 10.1186/s12978-015-0046-3. - DOI - PMC - PubMed
    1. Kirigia JM, Mwabu GM, Orem JN, Muthuri RDK. Indirect cost of maternal deaths in the WHO African Region in 2010. BMC Pregnancy Childbirth. 2014;14(1):299. 10.1186/1471-2393-14-299. - DOI - PMC - PubMed
    1. Countdown to 2030 Collaboration. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet. 2018;391(10129):P1538–1548. 10.1016/S0140-6736(18)30104-1. - DOI - PubMed

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