Evaluating services for perinatal asphyxia and low birth weight at two hospitals in Ghana: a micro-costing analysis

Abstract

Background: Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes. Objective: To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana. Methods: A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider's perspective. Results: Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched. Conclusion: TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana.

Challenges Faced by Healthcare Providers in Delivering High-Quality Care to Neonates in Ghana and West Africa

“…Another important guideline is proper infection prevention measures within neonatal units. Studies [259][260][261][262][263][264][265][266] have shown that implementing strict hand hygiene protocols significantly reduces infection rates among neonates. In resource-limited settings like West Africa, where access to clean water and sanitation facilities may be limited, it becomes even more crucial to prioritize infection prevention measures within neonatal units.…”

The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana

“…To date, a number of hospital-based interventions targeting improved newborn care in sub-Saharan Africa have been assessed for cost-effectiveness, yet a gap remains in the current literature around costs associated with systems-strengthening activities. Rather, much of the existing research focuses on service-based or provider-level interventions [15][16][17][18]. For example, cost analysis of an aligned clinician-training intervention, part of MEBCI implementation in other regions, found that the cost per capita was 984 United States Dollars (US $)-a significant overall cost [19].…”