Cargando…

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda

BACKGROUND: Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 201...

Descripción completa

Detalles Bibliográficos
Autores principales: Manzi, Anatole, Mugunga, Jean Claude, Iyer, Hari S., Magge, Hema, Nkikabahizi, Fulgence, Hirschhorn, Lisa R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856263/
https://www.ncbi.nlm.nih.gov/pubmed/29547624
http://dx.doi.org/10.1371/journal.pone.0194187
_version_ 1783307273103212544
author Manzi, Anatole
Mugunga, Jean Claude
Iyer, Hari S.
Magge, Hema
Nkikabahizi, Fulgence
Hirschhorn, Lisa R.
author_facet Manzi, Anatole
Mugunga, Jean Claude
Iyer, Hari S.
Magge, Hema
Nkikabahizi, Fulgence
Hirschhorn, Lisa R.
author_sort Manzi, Anatole
collection PubMed
description BACKGROUND: Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. METHODS: We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. RESULTS: The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. CONCLUSIONS: The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.
format Online
Article
Text
id pubmed-5856263
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-58562632018-03-28 Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda Manzi, Anatole Mugunga, Jean Claude Iyer, Hari S. Magge, Hema Nkikabahizi, Fulgence Hirschhorn, Lisa R. PLoS One Research Article BACKGROUND: Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. METHODS: We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. RESULTS: The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. CONCLUSIONS: The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread. Public Library of Science 2018-03-16 /pmc/articles/PMC5856263/ /pubmed/29547624 http://dx.doi.org/10.1371/journal.pone.0194187 Text en © 2018 Manzi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Manzi, Anatole
Mugunga, Jean Claude
Iyer, Hari S.
Magge, Hema
Nkikabahizi, Fulgence
Hirschhorn, Lisa R.
Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda
title Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda
title_full Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda
title_fullStr Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda
title_full_unstemmed Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda
title_short Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda
title_sort economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural rwanda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856263/
https://www.ncbi.nlm.nih.gov/pubmed/29547624
http://dx.doi.org/10.1371/journal.pone.0194187
work_keys_str_mv AT manzianatole economicevaluationofamentorshipandenhancedsupervisionprogramtoimprovequalityofintegratedmanagementofchildhoodillnesscareinruralrwanda
AT mugungajeanclaude economicevaluationofamentorshipandenhancedsupervisionprogramtoimprovequalityofintegratedmanagementofchildhoodillnesscareinruralrwanda
AT iyerharis economicevaluationofamentorshipandenhancedsupervisionprogramtoimprovequalityofintegratedmanagementofchildhoodillnesscareinruralrwanda
AT maggehema economicevaluationofamentorshipandenhancedsupervisionprogramtoimprovequalityofintegratedmanagementofchildhoodillnesscareinruralrwanda
AT nkikabahizifulgence economicevaluationofamentorshipandenhancedsupervisionprogramtoimprovequalityofintegratedmanagementofchildhoodillnesscareinruralrwanda
AT hirschhornlisar economicevaluationofamentorshipandenhancedsupervisionprogramtoimprovequalityofintegratedmanagementofchildhoodillnesscareinruralrwanda