Estimating the cost-savings associated with bundling maternal and child health interventions: a proposed methodology

Abstract

BackgroundThere is a pressing need to include cost data in the Lives Saved Tool (LiST). This paper proposes a method that combines data from both the WHO CHOosing Interventions that are Cost-Effective (CHOICE) database and the OneHealth Tool (OHT) to develop unit costs for delivering child and maternal health services, both alone and bundled.MethodsFirst, a translog cost function is estimated to calculate factor shares of personnel, consumables, other direct (variable or recurrent costs excluding personnel and consumables) and indirect (capital or investment) costs. Primary source facility level data from Kenya, Namibia, South Africa, Uganda, Zambia and Zimbabwe are utilized, with separate analyses for hospitals and health centres. Second, the resulting other-direct and indirect factor shares are applied to country unit costs from the WHO CHOICE unit cost database to calculate those portions of unit cost. Third, the remainder of the costs is calculated using default data from the OHT. Fourth, we calculate the effect of bundling services by assuming that a LiST intervention visit takes an average of 20 minutes when delivered alone but only incremental time in addition to the basic visit when delivered in a bundle.ResultsPersonnel costs account for the greatest share of costs for both hospitals and health centres at 50% and 38%, respectively. The percentages differ between hospitals and health centres for consumables (21% versus 17%), other direct (7.5% versus 6.75%), and indirect (22% versus 23%) costs. Combining the other-direct and indirect factor shares with the WHO CHOICE database and the other costs from OHT provides a comprehensive cost estimate of LiST interventions. Finally, the cost of six recommended antenatal care (ANC) interventions is $69.76 when delivered alone, but $61.18 when delivered as a bundle, a savings of $8.58 (12.2%).ConclusionsThis paper proposes a method for estimating a comprehensive cost of providing child and maternal health interventions by combining labor, consumables and drug costs from OHT with indirect and other-direct proportional costs from WHO CHOICE. In addition, we demonstrate the potential cost savings that can be achieved from bundling the delivery of essential antenatal care interventions rather than delivering the same interventions alone.

Training and financial intervention for encouraging maternal health service utilization

“…Further planning is necessary to design strategies such that healthcare facilities can be accessed by even economically backward populations, particularly essential antenatal care. [24,25]…”

Costs and Cost Drivers of Providing Option B+ Services to Mother‐Baby Pairs for PMTCT of HIV in Health Centre IV Facilities in Jinja District, Uganda

“…A time horizon of 2 years was used to cover an antenatal period of six months and a postnatal period of 18 months, after which the mother-baby pairs would be discharged from the mother-baby care point. Costing was done using the ingredient-based approach, i.e., costing each component of an activity, including capital and recurrent costs [27,28]. This approach identifies each resource input required and values its market or economic costs [26,29].…”

Offering progesterone contraceptive vaginal rings for postpartum women through integrated family planning and immunization services

“…The FP/I program is an effective method of reducing the labor and indirect cost of services, and it also reduces the overall cost and time of clients in procuring these packaged services at the same time (Adesina and Bollinger, 2013). Determining the right pricing strategy for the PCVR when integrated with other FP/Immunization services will be important for this integrated service delivery model to be successful.…”