scholarly journals Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system is unknown, particulary in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Cost were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services was US$185,282 under the focused model and the cost increased by about 90% at health centres and 97% at dispensaries to US$358,290 for the standard model. Personnel cost accounted for more than one third of the total cost for both models. With the standard model, costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries Conclusion Introduction of a standard ANC model at primary healthcare facilities in Tanzania will double resources use compared to current practice. While resources availability has been one of the challenge to effective implementation of the focused ANC model, more research is required, to consider whether these costs are reasonable compared to the additional value for maternal and child health.

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries. Conclusion Introduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.


2019 ◽  
Vol 4 ◽  
pp. 141 ◽  
Author(s):  
Simon Arunga ◽  
Naome Kyomugasho ◽  
Teddy Kwaga ◽  
John Onyango ◽  
Astrid Leck ◽  
...  

Background: Microbial keratitis (MK) frequently leads to sight-loss, especially when the infection is severe and/or appropriate treatment is delayed. The primary health system as an entry point plays a central role in facilitating and directing patient access to appropriate care. The purpose of this study was to describe the capacity of primary health centres in Uganda in managing MK. Methods: We carried out a rigorous assessment of primary health centres and mid-cadre training schools in South Western Uganda. Through interviews, checklists and a picture quiz, we assessed capacity and knowledge of MK management. In addition, we interviewed the heads of all the mid-cadre training schools to determine the level of eye health training provided in their curricula. Results: In total, 163 health facilities and 16 training schools were enrolled. Of the health facilities, only 6% had an Ophthalmic Clinical Officer. Only 12% of the health workers could make a diagnosis of MK based on the clinical signs in the picture quiz. Although 35% of the facilities had a microscope, none reported doing corneal scraping. None of the facilities had a stock of the recommended first line treatment options for MK (ciprofloxacin and natamycin eye drops). Among the training schools, 15/16 had an eye health component in the curriculum. However, the majority (56%) of tutors had no formal expertise in eye health. In 14/16 schools, students spent an average of two weeks in an eye unit. Conclusions: Knowledge among health workers and capacity of health facilities in diagnosis and management of MK was low. Training for eye health within mid-cadre training schools was inadequate. More is needed to close these gaps in training and capacity.


2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.


2020 ◽  
Author(s):  
M. Arantxa Colchero ◽  
Rousellinne Gómez ◽  
Ruy López-Ridaura ◽  
Daniel López-Hernández ◽  
Iyari Sánchez-Díaz ◽  
...  

Abstract Background. Despite the high health and financial burden imposed by diabetes in Mexico, few studies have estimated the cost per patient treated. The objective of this study was to estimate the average annual cost per patient (unit cost) with diabetes among 60 primary health facilities in Mexico comparing comprehensive diabetes management medical offices (MIDE) and those from general practice (Non-MIDE). Methods. We described the variation in unit costs across these two types of medical offices and explored factors associated. Unit costs were the sum of staff, medications, laboratory tests, and equipment. We show descriptive statistics to analyze the heterogeneity of unit costs, and the distribution of total costs by input and the distribution of staff costs by personnel all by medical office. We estimated a multivariate linear regression model to explore factors associated with the unit costs. Results. Unit costs vary from $267.2 USD in Non-MIDE offices to $410.6 for MIDE. Unit costs were negatively associated with scale, Non-MIDE offices, medical competence, patient knowledge of diabetes and positively associated with comorbidities. Conclusions. Results from this study might help design more efficient programs for diabetes care in primary health facilities to reduce the burden of diabetes in the system. Investing in staff training and educational interventions to increase patient knowledge of diabetes could be promising interventions to reduce diabetes care costs in primary care settings.


Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 290
Author(s):  
Khabo Mahlangu ◽  
Perpetua Modjadji ◽  
Sphiwe Madiba

The study determined the nutritional status of adult antiretroviral therapy (ART) recipients, and investigated the association between the duration on ART and the nutritional status. This study was based in primary health facilities in Gauteng, South Africa. The data collected included sociodemographic variables; the duration of the treatment; and the body mass index (BMI), classified as undernutrition (<18.5 kg/m2), normal (18.5–24.9 kg/m2), or overweight/obesity (≥25 kg/m2). ART recipients (n = 480) had a mean age of 35 (± 8.4SD) years. All had taken ART for six months or more (range 6–48 months). The data were analyzed using STATA 13.0. The overall prevalence of overweight/obesity was 39%, it was higher in females (46%) than in males (30%), 26% were overweight, and 13% were obese. Underweight was 13%, and was higher in males (18%) than females (9%). Being overweight was more likely in those aged ≥35 years and those in smaller households. Being obese was less likely in males, in the employed, and in those with a higher income, but was more likely in those with a longer duration on ART. Abdominal obesity was high, but less likely in males. Interventions to prevent overweight/obesity should be integrated into routine HIV care, while at the same time addressing the burden of undernutrition among ART recipients.


2021 ◽  
Vol 24 (1) ◽  
pp. 11-19
Author(s):  
Eka Fitria Sari ◽  
Faihatul Mukhbitin ◽  
Ernawaty Ernawaty

Head of Surabaya City Health Department Decree No.440/19547/436.3/2016 is based on Indonesian Minister of Health Decree No.HK.02.02/MENKES/514/2015. The regulation explains the need for the management of 195 clinical diagnoses in primary health facilities because it is related to the primary health facilities' capability to handle 195 clinical diagnoses. The RRNS achievement table in January-May 2017 shows that primary care clinics were primary health facilities that occupy the unsafe zone (RRNS>5%) namely 16.68% in Surabaya City. The research objective is to analyze the primary care clinics' capability in Surabaya City to handle the 195 clinical diagnoses. This research used a descriptive cross-sectional design in four primary care clinics with 20 people sampled. The results showed that all clinics had not been able to provide complete services. Clinical doctors had good capabilities in accordance with the Head of Surabaya City Health Department Decree No.440/19547/436.3/2016 but were not supported by the completeness of supply following the Indonesia Minister of Health Decree No.HK.02.02/MENKES/514/2015. In conclusion, only 65 (≤33%) clinical diagnoses can be handled properly with the imbalance between the doctors' capabilities and completeness of supply. This research suggests the regulation makers must also review the primary care clinics' capability to provide supplies and clinics can determine the right cost-containment strategy to handle 195 clinical diagnoses. Abstrak SK Kadinkes Kota Surabaya No.440/19547/436.3/2016 didasari oleh Kepmenkes RI No.HK.02.02/MENKES/514/2015. Peraturan yang menjelaskan tentang kebutuhan penatalaksanaan penanganan 195 diagnosis klinis di FKTP karena berkaitan dengan kemampuan FKTP melakukan penanganan. Tabel pencapaian RRNS bulan Januari-Mei 2017 menunjukkan klinik pratama merupakan jenis FKTP yang paling banyak menempati zona tidak aman (RRNS>5%) yakni 16,68% di Surabaya. Penelitian bertujuan menganalisis kemampuan klinik pratama di Kota Surabaya dalam menangani 195 diagnosis klinis. Penelitian menggunakan desain crosssectional deskriptif di empat klinik pratama dengan sampel 20 orang. Hasil menunjukkan semua klinik yang diteliti belum mampu menyediakan pelayanan secara lengkap. Dokter klinik memiliki kemampuan yang baik sesuai SK Kadinkes Kota Surabaya No.440/19547/436.3/2016 tetapi tidak didukung dengan kelengkapan supply yang dibutuhkan sesuai Kepmenkes RI No.HK.02.02/MENKES/514/2015. Kesimpulannya, diagnosis klinis yang dapat ditangani dengan baik hanya sebanyak 65 (≤33%) dengan hambatan ketidakseimbangan antara kemampuan dokter dan kelengkapan supply. Penelitian ini menyarankan pembuat kebijakan juga meninjau kemampuan klinik dalam menyediakan supply dan klinik dapat menentukan strategi cost containment yang tepat untuk menangani 195 diagnosis klinis.


Sign in / Sign up

Export Citation Format

Share Document