Economic evaluation of emergency obstetric care training: a systematic review

Abstract

BackgroundTraining healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings.MethodsPeer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness.ResultsFourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult.ConclusionsEconomic evaluations of EmOC training are limited. There is a need to scale-up and standardise processes that capture both cost and effectiveness of training and to agree on suitable economic evaluation models that allow for comparability across settings.Trial registration PROSPERO_CRD42016041911.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1586-z) contains supplementary material, which is available to authorized users.

Social return on investment of emergency obstetric care training in Kenya

“…This approach was chosen because it is known to be more accurate compared with the alternative top-bottom costing approach 24. Direct costs of implementation included for the analysis were costs of training venue, training manual, training equipment, daily subsistence allowance (DSA) for trainees, DSA for trainers (National and UK-based faculty) and travel support for UK-based faculty 15…”

“…As such, SROI will be relevant in demonstrating the impact of EmOC training, an intervention which is typically expected to yield benefits beyond those for trained healthcare providers 10. However, to date no such study has been conducted 15. This study sought to assess the social impact and VfM of EmOC training implemented in Kenya, using the SROI methodology.…”

A mixed-methods evaluation of a cluster randomized controlled trial on simulation-based low-dose, high-frequency plus mobile mentoring training versus traditional group-based training of health workers in Ebonyi and Kogi States, Nigeria

“…Studies on BEmONC in-service training have demonstrated the value of simulation and continuous practice in improving knowledge and skills competency [1,2,7]. This has led to adaptation of various approaches to determine which ones lead to the greatest returns on investment [1][2][3][4][8][9][10][11]. Our findings are consistent with those of previous studies that reported TRAD offsite training may improve the trainees' competencies, but knowledge and skills may not be transferred to other co-workers at the facility, nor translated into practice or performance [12,13].…”

“…Considering the high maternal and newborn mortality and morbidity figures in Nigeria, there is need to train birth attendants on high-impact interventions using competency-based approaches to improve the quality of maternal and newborn care and reduce maternal and perinatal/neonatal mortality [8][9][10][11].…”

Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers in Nigeria; a cluster randomized controlled trial

“…Health workers absenteeism from work to attend offsite training is also a concern for health facility managers [9,10]. Moreover, since only a few health workers are trained each time through the current offsite workshop approach, the quality of care may not be improved to the desired level [3]. Health workers also find it difficult to practice new or updated skills because the entire team members have not been trained on the relevant skills and approaches.…”