scholarly journals Estimating the cost of implementing a facility and community score card for maternal and newborn care service delivery in a rural district in Uganda

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anthony Ssebagereka ◽  
Rebecca Racheal Apolot ◽  
Evelyne Baelvina Nyachwo ◽  
Elizabeth Ekirapa-Kiracho
Keyword(s):  
Service Delivery ◽  
Average Cost ◽  
Scale Up ◽  
Newborn Care ◽  
Technical Support ◽  
Rural District ◽  
Total Annual Cost ◽  
District Health ◽  
Score Card ◽  
The Cost

Abstract Introduction This paper aimed at estimating the resources required to implement a community Score Card by a typical rural district health team in Uganda, as a mechanism for fostering accountability, utilization and quality of maternal and child healthcare service. Methods This costing analysis was done from the payer’s perspective using the ingredients approach over five quarterly rounds of scoring between 2017 and 2018. Expenditure data was obtained from project records, entered and analyzed in Microsoft excel. Two scale-up scenarios, scenario one (considered cost inputs by the MakSPH research teams) and scenario two (considering cost inputs based on contextual knowledge from district implementing teams), were simulated to better understand the cost implications of integrating the Community Score Card (CSC) into a district health system. Results The total and average cost of implementing CSC for five quarterly rounds over a period of 18 months were USD 59,962 and USD 11,992 per round of scoring, respectively. Considering the six sub-counties (including one Town Council) in Kibuku district that were included in this analysis, the average cost of implementating the CSC in each sub-county was USD 1998 per scoring round. Scaling-up of the intervention across the entire district (included 22 sub-counties) under the first scenario would cost a total of USD 19,003 per scoring round. Under the second scaleup scenario, the cost would be lower at USD 7116. The total annual cost of scaling CSC in the entire district would be USD 76,012 under scenario one compared to USD 28,465 under scenario two. The main cost drivers identified were transportation costs, coordination and supervision costs, and technical support to supplement local implementers. Conclusion Our analysis suggests that it is financially feasible to implement and scale-up the CSC initiative, as an accountability tool for enhancing service delivery. However, the CSC design and approach needs to be embedded within local systems and implemented in collaboration with existing stakeholders so as to optimise costs. A comprehensive economic analysis of the costs associated with transportation, involvement of the district teams in coordination, supervision as well as provision of technical support is necessary to determine the cost-effectiveness of the CSC approach.

COST ANALYSIS OF EXPANDED PROGRAM ON IMMUNIZATION AT BASIS HEALTH LEVEL IN THUA THIEN HUE PROVINCE, VIETNAM

2016 ◽  
pp. 128-136
Author(s):  
Hoang Lan Nguyen ◽  
Thi Tinh Nguyen
Keyword(s):  
Average Cost ◽  
Service Providers ◽  
Vaccine Delivery ◽  
Sensitivity Analyses ◽  
District Health ◽  
Total Cost ◽  
Health Level ◽  
Expanded Program On Immunization ◽  
The Cost ◽  
The Impact

Background: In Vietnam, expanded program on immunization (EPI) has vaccinated freely 8 vaccines to children under one year old to protect from tuberculosis, diphtheria, pertussis, tetanus, hepatitis B, polio, measles and pneumonia/ meningitis caused by Hib. The study aims to 1) identify total cost and cost items of EPI at basis health level of Thua Thien Hue province within the first 6 months of the year 2014 and 2) estimate average cost of vaccine delivery per dose and cost per fully vaccinated child (FVC). Materials and method: This is a descriptive cross sectional study. Costs were analyzed on the basis of perspective of health service providers. A direct allocation method was used to estimate average cost of vaccine delivery per dose and cost per FVC. Data of the program within the first 6 months of the year 2014 was collected in provincial preventive medicine center, 3 district health centers and 9 CHCs in TT Hue province to estimate cost. The price of capital assets was adjusted by inflation with time and was annualized using a discount rate of 3%. One-way sensitivity analyses investigated the impact of cost items and wastage ratio on cost of vaccine delivery. Results: The total cost of EPI within 6 months in 9 CHCs was 452.947.417 VND (US$ 21.532) in which vaccine price shared the largest component cost (41.3%). The average cost per FVC was 456.059VND (US$ 21.68) that is higher than of US$ 15 per FVC only for 6 vaccines as recommendation of WHO. The cost was sensitive to wastage ratio of vaccines. Conclusion: The cost of US$ 21.68 per FVC preventing from 8 dangerous infected diseases found in this study is higher than that of threshold of WHO per FVC only for 6 vaccines of EPI in some developing countries. Key words: Expanded program on immunization, vaccine, cost items, basis health level

scholarly journals Scaling up newborn care technologies from tertiary- to secondary-level hospitals in Malawi: an implementation case study of health professional perspectives on bubble CPAP

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Mai-Lei Woo Kinshella ◽  
Sangwani Salimu ◽  
Tamanda Hiwa ◽  
Mwai Banda ◽  
Marianne Vidler ◽  
...  
Keyword(s):  
Health Workers ◽  
Health Management ◽  
Scale Up ◽  
Newborn Care ◽  
Secondary Level ◽  
Scaling Up ◽  
Tertiary Hospital ◽  
District Health ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background While Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge. There has, therefore, been a push to strengthen the capacity for quality newborn care at district hospitals through the implementation of innovative neonatal technologies such as bubble continuous positive airway pressure (CPAP). This study investigates tertiary- versus secondary-level hospital differences in capacities for bubble CPAP use and implications for implementation policies. Methods A secondary analysis of interviews was conducted with 46 health workers at one tertiary hospital and three secondary hospitals in rural Southern Malawi. Grounded theory was utilized to explore the emerging themes according to health worker cadres (nurse, clinician, district health management) and facility level (tertiary- and secondary-level facilities), which were managed using NVivo 12 (QSR International, Melbourne, Australia). Results We identified frequent CPAP use and the availability of neonatal nurses, physicians, and reliable electricity as facilitators for CPAP use at the tertiary hospital. Barriers at the tertiary hospital included initiation eligibility disagreements between clinicians and nurses and insufficient availability of the CPAP machines. At secondary-level hospitals, the use was supported by decision-making and initiation by nurses, involving caretakers to assist in monitoring and reliable availability of CPAP machines. Bubble CPAP was hindered by unreliable electricity, staffing shortages and rotation policies, and poor systems of accountability. Conclusion While this study looked at the implementation of bubble CPAP in Malawi, the findings may be applicable for scaling up other novel neonatal technologies in low-resource settings. Implementation policies must consider staffing and management structures at different health services levels for effective scale-up.

scholarly journals The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia

2021 ◽  
Author(s):  
Cheryl Hendrickson ◽  
Lawrence Long ◽  
Craig van Rensburg ◽  
Cassidy Claassen ◽  
Mwansa Njelesani ◽  
...  
Keyword(s):  
Service Delivery ◽  
Hiv Infection ◽  
Annual Cost ◽  
Scale Up ◽  
User Support ◽  
Delivery Costs ◽  
Program Support ◽  
Prep Implementation ◽  
The Cost ◽  
Delivery Models

Introduction: Pre-exposure prophylaxis (PrEP) is effective at preventing HIV infection, but PrEP cost-effectiveness is sensitive to PrEP implementation and program costs. Preliminary studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and user support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Methods: Taking a guidelines-based approach for visits, labs and drugs assuming fidelity to the expanded 2018 Zambian PrEP guidelines, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within the HIV counselling and testing service at primary healthcare centres). Program start-up, provider, and user support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (in 2018 USD). Results: The annual cost per PrEP client varied greatly by program type, from $394 (AGYW) to $760 in an integrated program. Cost differences were driven largely by volume (i.e. the number of clients initiated/model/site) which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs, including staff and overheads, labs and monitoring, drugs and consumables ranged narrowly from $208-217/PrEP-user. Service delivery costs were a key component in the cost of PrEP, representing 36-65% of total costs. Reductions in service delivery costs per PrEP client are expected with further scale-up. Conclusions: The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and user support. Improved data on individual client resource usage (e.g. drugs, labs, visits) and outcomes (e.g. initiation, persistence) is required to get a better understanding of the true resource utilization, cost and expected outcomes and annual costs of different PrEP programs in Zambia.

Exploration-Stage Implementation Variation

2014 ◽  
Vol 222 (1) ◽  
pp. 37-48 ◽  
Author(s):  
Stephanie Romney ◽  
Nathaniel Israel ◽  
Danijela Zlatevski
Keyword(s):  
Parent Training ◽  
Average Cost ◽  
Cost Savings ◽  
Training Group ◽  
Group Differences ◽  
Triple P ◽  
Community Based ◽  
Parent Training Program ◽  
A Site ◽  
The Cost

The present study examines the effect of agency-level implementation variation on the cost-effectiveness of an evidence-based parent training program (Positive Parenting Program: “Triple P”). Staff from six community-based agencies participated in a five-day training to prepare them to deliver a 12-week Triple P parent training group to caregivers. Prior to the training, administrators and staff from four of the agencies completed a site readiness process intended to prepare them for the implementation demands of successfully delivering the group, while the other two agencies did not complete the process. Following the delivery of each agency’s first Triple P group, the graduation rate and average cost per class graduate were calculated. The average cost-per-graduate was over seven times higher for the two agencies that had not completed the readiness process than for the four completing agencies ($7,811 vs. $1,052). The contrast in costs was due to high participant attrition in the Triple P groups delivered by the two agencies that did not complete the readiness process. The odds of Triple P participants graduating were 12.2 times greater for those in groups run by sites that had completed the readiness process. This differential attrition was not accounted for by between-group differences in participant characteristics at pretest. While the natural design of this study limits the ability to empirically test all alternative explanations, these findings indicate a striking cost savings for sites completing the readiness process and support the thoughtful application of readiness procedures in the early stages of an implementation initiative.

Economic Aspects of Mustard Cultivation in Lakhimpur Kheri District of Uttar Pradesh

2020 ◽  
pp. 520-523
Keyword(s):  
Average Cost ◽  
Uttar Pradesh ◽  
Net Income ◽  
Economic Aspects ◽  
Positive Relation ◽  
Input Output ◽  
Output Ratio ◽  
Gross Income ◽  
Average Size ◽  
The Cost

The results revealed that on an overall average size of landholding was estimated to be 0.97 ha. The total cultivated area at all categories of sample farms were found to be irrigated. Overall average, cost of cultivation was estimated `27819.43 per ha. The cost of cultivation showed positive relation with size of holding. The cost of cultivation was highest on medium farms (`32549.25) followed by small (`31528.40 and marginal (`29171.74), respectively. Overall average, cost of production was estimated `2446.44 per hectare. On an average input-output ratio on the basis Costs A1/A2, B1, B2, C1, and C2 were recorded 1:2.86, 1:2.77, 1:1.91, 1:1.89 and 1:1.46, respectively. On the basis of Cost C2 input-output ratio was highest on marginal farms (1:1.47) followed by small (1:1.44) and medium (1:1.43), respectively. Overall average, net income and gross income were found `9859.33 and 40028.69 per ha, respectively.

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

scholarly journals Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Cost Effective ◽  
Economic Incentives ◽  
Additional Patient ◽  
Incentive Scheme ◽  
The Cost ◽  
The Impact

Abstract Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

scholarly journals A Theoretical Study on Reversible Solid Oxide Cells as Key Enablers of Cyclic Conversion between Electrical Energy and Fuel

Energies ◽  
2021 ◽  
Vol 14 (15) ◽  
pp. 4517
Author(s):  
Saheli Biswas ◽  
Shambhu Singh Rathore ◽  
Aniruddha Pramod Kulkarni ◽  
Sarbjit Giddey ◽  
Sankar Bhattacharya
Keyword(s):  
Energy Demand ◽  
Electrode Materials ◽  
Scale Up ◽  
High Capacity ◽  
Electrical Energy ◽  
Solid Oxide ◽  
Lower Efficiency ◽  
Internal Reforming ◽  
Fuels And Chemicals ◽  
The Cost

Reversible solid oxide cells (rSOC) enable the efficient cyclic conversion between electrical and chemical energy in the form of fuels and chemicals, thereby providing a pathway for long-term and high-capacity energy storage. Amongst the different fuels under investigation, hydrogen, methane, and ammonia have gained immense attention as carbon-neutral energy vectors. Here we have compared the energy efficiency and the energy demand of rSOC based on these three fuels. In the fuel cell mode of operation (energy generation), two different routes have been considered for both methane and ammonia; Routes 1 and 2 involve internal reforming (in the case of methane) or cracking (in the case of ammonia) and external reforming or cracking, respectively. The use of hydrogen as fuel provides the highest round-trip efficiency (62.1%) followed by methane by Route 1 (43.4%), ammonia by Route 2 (41.1%), methane by Route 2 (40.4%), and ammonia by Route 1 (39.2%). The lower efficiency of internal ammonia cracking as opposed to its external counterpart can be attributed to the insufficient catalytic activity and stability of the state-of-the-art fuel electrode materials, which is a major hindrance to the scale-up of this technology. A preliminary cost estimate showed that the price of hydrogen, methane and ammonia produced in SOEC mode would be ~1.91, 3.63, and 0.48 $/kg, respectively. In SOFC mode, the cost of electricity generation using hydrogen, internally reformed methane, and internally cracked ammonia would be ~52.34, 46.30, and 47.11 $/MWh, respectively.

Prescribing costs

1993 ◽  
Vol 31 (22) ◽  
pp. 87-87
Keyword(s):  
General Practitioners ◽  
Average Cost ◽  
Department Of Health ◽  
Cost Of Drugs ◽  
The Cost

The cost of drugs prescribed by general practitioners in England rose by 13.4% between 1991 and 1992, bringing the total amount spent on medicines prescribed in the community last year to £2858 million. In the same period the number of items dispensed rose by 4.6%, or 4.2% per head of population, and the average cost per item increased by 8.5%, from £6.20 to £6.72. These figures are contained in the latest issue of the Statistical Bulletin,1 published annually by the Department of Health.

Building back smarter—part one: the case for more modular facilities in the NHS

2021 ◽  
Vol 27 (9) ◽  
pp. 1-9
Author(s):  
Isobel Clough
Keyword(s):  
Service Delivery ◽  
Physical Space ◽  
Cost Effective ◽  
Healthcare Services ◽  
Business Case ◽  
Care Quality ◽  
Healthcare Facilities ◽  
Building Maintenance ◽  
Cost Implications ◽  
The Cost

The NHS is facing an unprecedented backlog in both patient care and building maintenance, with severe implications for service delivery, finance and population wellbeing. This article is the first in a series discussing modular healthcare facilities as a potential solution to these issues, providing flexible and cost-effective spaces to allow services to increase capacity without sacrificing care quality. The first of three instalments, this paper will outline the problems facing the NHS estate, many of which have been exacerbated to critical levels by the COVID-19 pandemic, and what this means for service delivery. It will then make the case for modular infrastructure, outlining the potential benefits for healthcare services, staff and patients alike. Using modern methods of construction, this approach to creating physical space in healthcare can provide greater flexibility and a reduced impact on the environment. The next two articles in this series will go on to provide detailed case studies of successful modular implementation in NHS trusts, an analysis of the cost implications and guidance on the commissioning process and building a business case.

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