Improving maternal and newborn care: cost-effectiveness of an innovation to rebrand traditional birth attendants in Sier
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ORIGINAL ARTICLE
Improving maternal and newborn care: cost-effectiveness of an innovation to rebrand traditional birth attendants in Sierra Leone Jean Christophe Fotso1 • Ashley Ambrose2 • Paul Hutchinson3 • Disha Ali4 Received: 30 April 2018 / Revised: 22 August 2018 / Accepted: 20 September 2020 The Author(s) 2020
Abstract Objectives This paper evaluates the cost-effectiveness of rebranding former traditional birth attendants (TBAs) to conduct health promotion activities and refer women to health facilities. Methods The project used 200 former TBAs, 100 of whom were also enrolled in a small income generating business. The evaluation had a three-arm, quasiexperimental design with baseline and endline household surveys. The three arms were: (a) Health promotion (HP) only; (b) Health promotion plus business (HP?); and (c) the comparison group. The Lives Saved Tool is used to estimate the number of lives saved. Results The HP? intervention had a statistically significant impact on health facility delivery and four or more antenatal care (ANC) visits during pregnancy. The cost-effectiveness ratio was estimated at US$4130 per life year saved in the HP only arm, and US$1539 in the HP? arm. Therefore, only the HP? intervention is considered to be cost-effective. Conclusions It is critical to prioritize cost-effective interventions such as, in the case of rural Sierra Leone, communitybased strategies involving rebranding TBAs as health promoters and enrolling them in health-related income generating activities. Keywords Maternal and newborn Innovations Traditional birth attendant Social enterprise Cost-effectiveness Sierra Leone
Introduction Jean Christophe Fotso and Ashley Ambrose was with Concern Worldwide U.S’ Innovations for Maternal, Newborn and Child Health Program at the time of the study and the writing of the manuscript. & Jean Christophe Fotso [email protected]
In Sierra Leone, where about 40% of births are conducted without a skilled health provider, maternal mortality is estimated to be highest in the world, at 1360 deaths per 3
School of Public Health and Tropical Medicine, Tulane University New Orleans, New Orleans, LA, USA
4
JSI Research and Training Institute, Inc., Rosslyn, VA, USA
Ashley Ambrose [email protected] Paul Hutchinson [email protected] Disha Ali [email protected] 1
EVIHDAF (Evidence for Sustainable Human Development Systems in Africa), BP 35328, Yaounde´, Cameroon
2
CPC Community Health, Denver, CO, USA
123
J. C. Fotso et al.
100,000 live births (WHO 2015a, b). Neonatal mortality also remains among the highest in the world at 33.2 neonatal deaths per 1000 live births (UN IGME 2017; Statistics Sierra Leone and ICF International 2014). Of the births unattended by a skilled health professional, over 90% are assisted by a traditional birth attendant (TBA). Yet reductions in both maternal and newborn mortality require access to skilled attendance during labor and delivery (WHO 2015a, b). In many rural settings, TBAs are
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