Social return on investment of emergency obstetric care training in Kenya

Abstract

IntroductionEmergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology.MethodsMixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions.ResultsTrained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred.ConclusionEmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.

Prehospital emergency obstetric and neonatal care train‐the‐trainers program in Rwanda

“…A review of 116 1‐ to 5‐day simulation‐based studies from around the world on emergency obstetric care training for hospital staff at all levels, demonstrated that similar to our course, short competency‐based training can result in a change in clinical practice and significant improvement in skills and knowledge 17 . Similarly, in Kenya, a study of the cost effectiveness of emergency obstetric trainings using both interviews and focus groups of participants from emergency obstetric training sessions determined that short workshops are a worthwhile investment because of significant knowledge uptake over a short period of training with little cost 18 . Equally as important, the study of 3‐ to 5‐day emergency obstetric and neonatal courses focusing on interactive learning sessions with short lectures, simulation training, role play workshops, and mentoring in sub‐Saharan Africa and Asia revealed improved knowledge and skills for levels of healthcare providers, including all cadres of providers giving maternity care, after the course 19 .…”

Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub‐Saharan Africa: A systematic review

“…For specific interventions being implemented, training of varying length of days were generally reported as being effective for improving identification and decision making. Training such as these have been shown to be cost‐effective [40] and guarantee value for money across multiple stakeholders [41]. However, as our review shows these trainings need to be targeted at the right personnel who have been motivated and equipped sufficiently to be able to make the right decision on referral for the women.…”

The impact of improving haemophilia A management within the Spanish National Healthcare System: a social return on investment analysis

“…The results of the present study may provide valuable information to guide decision-making associated with the HA management. Compared to traditional frameworks, the SROI incorporates a broader concept of value into the evaluation of healthcare interventions through engaging multiple stakeholders to account for all relevant perspectives, using financial proxies to account for complex outcomes which are difficult to monetize, and considering both positive and negative impacts [ 43 ]. Moreover, the chain of events going from the investment in specific activities to their impact can be easily followed for each stakeholder and proposal within the SROI framework [ 43 ].…”

“…Compared to traditional frameworks, the SROI incorporates a broader concept of value into the evaluation of healthcare interventions through engaging multiple stakeholders to account for all relevant perspectives, using financial proxies to account for complex outcomes which are difficult to monetize, and considering both positive and negative impacts [ 43 ]. Moreover, the chain of events going from the investment in specific activities to their impact can be easily followed for each stakeholder and proposal within the SROI framework [ 43 ]. Regarding stakeholders, patients and informal caregivers were included as stakeholders for both the identification and evaluation of proposals.…”

“…The Social Return on Investment (SROI) provides the ideal framework to assess the multidimensional impact that such decisions would have relative to the investment required to put them into practice [ 20 – 22 ]. Previous experiences using this method have been used to guide decision-making in multiple healthcare areas such as chronic conditions [ 23 ], disability [ 24 ], loneliness [ 25 ], substance abuse [ 26 ], surgery [ 27 ], oncology [ 28 , 29 ], cardiology [ 30 , 31 ], nephrology [ 32 ], neurology [ 33 – 36 ], dermatology [ 37 ], ageing [ 38 – 40 ], or maternity [ 41 – 43 ], among others [ 44 – 48 ]. To our knowledge, no other study to date has used the SROI method in HA.…”