Researchers from the Centre for Maternal and Newborn Health have used an innovative approach to assess the value for money of emergency obstetric care (EmOC) training in Kenya. Overall, they found that investing in this training was a good use of resources, and that it was the women receiving care who benefitted most from investments made in implementing the training (73% of the value of all benefits).
Their findings are published in BMJ Global Health: Social return on investment of emergency obstetric care training in Kenya.
Interventions aimed at building the capacity of healthcare providers to deliver critical care to pregnant women in emergency situations has been shown to lead to increased knowledge and skills among healthcare providers, and, improved pregnancy outcomes for women who receive care from them. However, while there has been a strong case for continued investment in such trainings, there has been limited evidence on whether investments made to implement such trainings are worthwhile and if they broadly represent good value-for-money (VfM). Using an innovative approach that allows capture of broader social outcomes of interventions and a wide range of research methods, we aimed to fill this knowledge gap by assessing the social impact and VfM of implementing this kind of training in Kenya.
We assessed the value for money of EmOC training workshops held over one year in Kenya. In total 93 five-day workshops were implemented in this time period, at a cost of I$745,000. Through these workshops, 2,965 healthcare providers were trained. The financial value of benefits accrued amongst all stakeholder groups was estimated at I$9.5 million, bringing a return on investment of I$12.74 for every $1 spent on implementing the intervention, meaning that the training represents good VfM. We found that the training guaranteed good VfM in all scenarios except when trainers are paid consultancy fees and when the least amount of possible outcomes of the training occurred.
Ultimately, we concluded that investments made in implementing this training is a good use of resources. To increase the VfM derived from it, options such as converting daily subsistence allowance (DSA)/per diem budgets to financial aid for improving salaries and working conditions of healthcare providers, and payment of DSA/per diems based on actual need rather than hierarchy, are some of the alternatives that can be explored. Use of volunteer trainers, particularly those who work locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.
Dr Banke-Thomas said:
“It’s really exciting to be able to share findings from this research, as it provides a first broad economic evaluation of EmOC training from a societal perspective. We can now take lessons learnt from its conduct to guide future Value for Money assessments in maternal and newborn health.”