Banke-Thomas Aduragbemi, Madaj Barbara, van den Broek Nynke
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Health Policy, London School of Economics and Political Science, London, UK.
BMJ Glob Health. 2019 Jan 29;4(1):e001167. doi: 10.1136/bmjgh-2018-001167. eCollection 2019.
Emergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology.
Mixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions.
Trained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred.
EmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.
紧急产科护理（EmOC）培训被视为降低孕产妇和围产期发病率及死亡率的关键策略。尽管通常认为该培训有效，但关于其更广泛的社会影响和/或性价比（VfM）的证据却很少。本研究采用社会投资回报率（SROI）方法评估了肯尼亚EmOC培训的社会影响和VfM。
采用混合方法，包括访谈（n = 21）、纳入价值博弈的焦点小组讨论（n = 18）、二手数据分析和文献综述，以获取SROI分析的所有相关数据。研究结果被纳入影响图，并用于估计SROI比率。进行敏感性分析以检验假设。
接受培训的医疗保健提供者以及接受这些提供者护理的妇女及其婴儿被确定为主要受益者。EmOC培训提高了知识和技能，并改善了对患者的态度。然而，一些医疗保健提供者报告称工作量增加是负面结果。接受护理的妇女预期并体验到了积极结果，包括降低孕产妇和新生儿发病率及死亡率。在考虑外部影响后，1年内93个为期5天的EmOC培训工作坊的总社会影响价值为950万国际美元，其中妇女从干预中受益最多（73%）。培训2965名医疗保健提供者的直接实施总成本为74.5万国际美元。每位接受培训的医疗保健提供者每天的成本为50.23国际美元，SROI比率为12.74:1。基于多项单向敏感性分析，除了培训师收取咨询费且培训成果最少的情况外，EmOC培训在所有情况下都保证了VfM。
EmOC培训工作坊是一项值得的投资。实施方式会影响实现VfM的程度。使用志愿主持人，特别是当地的志愿主持人来开展EmOC培训，是增加社会影响和实现投资VfM的关键驱动因素。
