A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso

Abstract

BackgroundThe aim of this paper was to evaluate the effectiveness and cost-effectiveness of alternative training strategies for increasing access to emergency obstetric care in Burkina Faso.MethodsCase extraction forms were used to record data on 2305 caesarean sections performed in 2004 and 2005 in hospitals in six out of the 13 health regions of Burkina Faso. Main effectiveness outcomes were mothers' and newborns' case fatality rates. The costs of performing caesarean sections were estimated from a health system perspective and Incremental Cost-Effectiveness Ratios were computed using the newborn case fatality rates.ResultsOverall, case mixes per provider were comparable. Newborn case fatality rates (per thousand) varied significantly among obstetricians, general practitioners and clinical officers, at 99, 125 and 198, respectively. The estimated average cost per averted newborn death (x 1000 live births) for an obstetrician-led team compared to a general practitioner-led team was 11 757 international dollars, and for a general practitioner-led team compared to a clinical officer-led team it was 200 international dollars. Training of general practitioners appears therefore to be both effective and cost-effective in the short run. Clinical officers are associated with a high newborn case fatality rate.ConclusionTraining substitutes is a viable option to increase access to life-saving operations in district hospitals. The high newborn case fatality rate among clinical officers could be addressed by a refresher course and closer supervision. These findings may assist in addressing supply shortages of skilled health personnel in sub-Saharan Africa.

Professional skills development in a resource-poor setting: the case of pharmacy in Malawi

“…There was research evidence about nonprofessional health providers being associated with a higher in-country (and rural) retention rate, cheaper training cost and lower costs for employment (Lehmann et al, 2009;Dovlo, 2004). Furthermore, studies that compared clinical skills between professional and nonprofessional clinicians demonstrated a similar success rate in surgeries carried out by clinical officers, who are technician equivalents to surgeons (Hounton et al, 2009;Chilopora et al, 2007).…”

“…In practice, role transformation has been a struggle in many countries, including the industrialised ones, hence resulting in pharmacists reverting to a dispensing role in many cases. Many pharmacists therefore felt their skills were under-utilised (Humphrys and O'Brien, 1986).…”

Quality of care provided by mid-level health workers: systematic review and meta-analysis

“…Many African and Asian countries have successfully invested in these workers. [12][13][14][15] Our aim was to test the hypothesis that mid-level health workers are as effective as higher level health workers at providing good quality care in priority areas of the health service. We also hoped to increase understanding of their effectiveness and of how they can best be integrated into national healthcare systems.…”

Analyzing Markets for Health Workers: Insights from Labor and Health Economics

“…Similarly, Huicho et al (2008) showed that health workers with shorter training performed at least as well and sometimes substantially better than those with longer training in assessing, classifying, and managing episodes of routine childhood illness and in counseling the children's carers in Bangladesh, Brazil, Tanzania, and Uganda. On the other side, Hounton et al (2009) found significantly higher newborn case fatality rates when cesarean section was performed by clinical officers rather than by obstetricians and general practitioners.…”