Ambulance service within a comprehensive intervention for reproductive health in remote settings: a cost‐effective intervention

Abstract

The cost-effectiveness profile of an ambulance service within a series of interventions aimed at improving reproductive health in remote settings is very attractive.

Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review

“…Three reduced the cost of maternal care: user fees for intra-partum care were removed in Senegal to encourage women to deliver in facility, a nominal fixed charge was introduced for all maternal health services in The Gambia [34,57] and the third study combined vouchers for pregnant women to access free maternal care, cash to cover transport costs and in-kind items [19]. A further two studies evaluated emergency transport schemes, which had been established to facilitate referral for women with pregnancy or obstetric complications [55,61]. …”

“…The majority of studies adopted a health service provider perspective, and relatively few took into account the costs incurred by households to access MNH care. Some studies analysed only recurrent costs, having excluded any initial set-up costs [23,36,46,61], and several analysed the cost of the strategy without taking into account the cost implications of delivering maternal and newborn care [18-21,32,37,39,41,47,49,51,54,55]. For example, use of women’s groups resulted in increases in the uptake of antenatal care in Malawi and Nepal and institutional deliveries in Nepal, but the additional cost of this increase in service utilization was not taken into account [14].…”

“…Thirteen of these studies focused on newborns, one on infants [33] and two estimated lives saved in both women and newborns [34]. Seven studies reported the cost per life-year saved (or cost per year of life lost averted) in either women or their newborns [33,34,38,49,51,61]. This measure takes into account not only the number of lives saved but also the number of years of life, based on the beneficiary’s age and their expected length of life.…”

Ambulance services as part of the district health system in low‐income countries: a feasibility study from Cambodia

“…This compares well with the $49 spent per useful and successful case in Niger (Bossyns et al , ). However, we did not perform a formal costing exercise and did not consider depreciation of the vehicle, unlike Bossyns et al () and Somigliana et al (), whereby our figures are at best indicative of the real cost. Additionally, we relied on hospital staff's perceived severity of the condition of ambulance users to classify them as time‐sensitive, which may be prone to personal interpretations and thus not accurate.…”

“…We also divided the total costs for collecting emergency and non‐emergency cases by emergency cases only, which may misleadingly give the impression that non‐emergency cases have no value. Although the creation of an ambulances system is mostly advocated for promoting access to emergency obstetric care (Somigliana et al , ; Tayler‐Smith et al , ), their employment should not be limited to such cases. This is because transport of non‐emergency cases generates considerable political support and trust in the health system, benefits that are difficult to value monetarily.…”