Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda

Abstract

Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented postpartum intrauterine device (PPIUD) and postpartum (PP) implant promotional counseling and service delivery procedures between May-July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. The goal of the present analysis is to detail implementation expenditures and estimate incremental costs per insertion and couple years of protection (CYP) for PPIUD and PP implant users. Methods: We detail the incremental costs during the implementation from the health system perspective (including both the implementation costs and the cost of contraceptive methods) and use of standard methods to estimate the cost per insertion and CYP for PPIUD and PP implant users. In addition to the incremental costs of labor and supplies, the costs of promotional activities are included. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.

Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs

“…The estimated cost per insertion of USD 34 is in-line with other similar costing assessments of pilot LARC programs conducted in the region. For example, a recent analysis in Rwanda of a new program for postpartum IUD and postpartum implant insertion calculated an estimate per insertion cost of USD 25 for postpartum IUDs and USD 77 per implant, although in that case, the analysis included the cost of the commodities 28 . Currently, SFH receives donated LNG-IUS commodities in Nigeria, but if the program becomes responsible for buying the LNG-IUS in the future, the cost to the program will increase.…”

Assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

“…31, and that fertility-goal based family planning provided to couples when access to LARC is ensured increases uptake of both IUDs and implants (22,32,33). More recently, post-partum IUD (PPIUD) insertion has been feasible and acceptable in Kigali (34,35). Promotions for PPIUD would ideally take place prior to labor and involve male partners.…”