Anatole Manzi1,2,3, Jean Claude Mugunga2,3, Laetitia Nyirazinyoye1, Hari S Iyer4,5, Bethany Hedt-Gauthier1,2,6, Lisa R Hirschhorn2,4,6,7, Joseph Ntaganira1. 1. Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, KK 19 Avenue 101, Kigali, Rwanda. 2. Department of Maternal and Child Health, Partners In Health/Inshuti Mu Buzima, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda. 3. Department of Clinical Operations, Partners In Health, 800 Boylston Street Suite 300, Boston, MA, USA. 4. Department of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA. 5. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA. 6. Department of Global Health and Social Medicine, Harvard Medical School, 55 Shattuck Street, Boston, MA, USA. 7. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, Room 14-013, IL, USA.
Abstract
OBJECTIVE: To estimate cost-effectiveness of Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) intervention to strengthen the quality of antenatal care at rural health centers in rural Rwanda. DESIGN: Cost-effectiveness analysis of the MESH-QI intervention using the provider perspective. SETTING: Kirehe and Rwinkwavu District Hospital catchment areas, Rwanda. INTERVENTION: MESH-QI. MAIN OUTCOME MEASURES: Incremental cost per antenatal care visit with complete danger sign and vital sign assessments. RESULTS: The total annual costs of standard antenatal care supervision was 10 777.21 USD at the baseline, whereas the total costs of MESH-QI intervention was 19 656.53 USD. Human resources (salary and benefits) and transport drove the majority of program expenses, (44.8% and 40%, respectively). Other costs included training of mentors (12.9%), data management (6.5%) and equipment (6.5%). The incremental cost per antenatal care visit attributable to MESH-QI with all assessment items completed was 0.70 USD for danger signs and 1.10 USD for vital signs. CONCLUSIONS: MESH-QI could be an affordable and effective intervention to improve the quality of antenatal care at health centers in low-resource settings. Cost savings would increase if MESH-QI mentors were integrated into the existing healthcare systems and deployed to sites with higher volume of antenatal care visits.
OBJECTIVE: To estimate cost-effectiveness of Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) intervention to strengthen the quality of antenatal care at rural health centers in rural Rwanda. DESIGN: Cost-effectiveness analysis of the MESH-QI intervention using the provider perspective. SETTING: Kirehe and Rwinkwavu District Hospital catchment areas, Rwanda. INTERVENTION: MESH-QI. MAIN OUTCOME MEASURES: Incremental cost per antenatal care visit with complete danger sign and vital sign assessments. RESULTS: The total annual costs of standard antenatal care supervision was 10 777.21 USD at the baseline, whereas the total costs of MESH-QI intervention was 19 656.53 USD. Human resources (salary and benefits) and transport drove the majority of program expenses, (44.8% and 40%, respectively). Other costs included training of mentors (12.9%), data management (6.5%) and equipment (6.5%). The incremental cost per antenatal care visit attributable to MESH-QI with all assessment items completed was 0.70 USD for danger signs and 1.10 USD for vital signs. CONCLUSIONS: MESH-QI could be an affordable and effective intervention to improve the quality of antenatal care at health centers in low-resource settings. Cost savings would increase if MESH-QI mentors were integrated into the existing healthcare systems and deployed to sites with higher volume of antenatal care visits.