Chamani Amisa Tindamanyile, Mori Amani Thomas, Robberstad Bjarne
Department of Global Public Health and Primary Care, Section for Ethics and Health Economics, University of Bergen, Bergen, Norway.
Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Cost Eff Resour Alloc. 2021 Dec 7;19(1):79. doi: 10.1186/s12962-021-00325-0.
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.
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$.
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.
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.
自2002年以来，坦桑尼亚一直在实施重点产前保健（ANC）模式，该模式建议进行四次产前检查。2016年，世界卫生组织（WHO）重新引入了标准ANC模式，增加了更多干预措施，包括至少八次接触。然而，这些变化对卫生系统的成本影响尚不清楚，特别是在坦桑尼亚这样未能最佳实施更简单的重点ANC模式的国家。我们比较了在坦桑尼亚初级卫生设施中，按照重点模式和标准模式提供ANC的卫生系统成本。
我们采用微观成本核算方法，确定并量化2018年7月至2019年6月在坦桑尼亚六个初级卫生设施实施重点ANC模式所使用的资源。我们还使用标准ANC实施手册来确定并量化所需的额外资源。我们用基本工资和津贴来评估人员时间价值，而医疗用品部门价格目录和当地市场价格则用于其他资源。成本以坦桑尼亚先令收集，并换算成2018年美元。
在重点模式下，六个设施（2个保健中心和4个诊疗所）提供ANC服务的卫生系统成本为185,282美元。我们估计，通过引入标准模式，保健中心的成本将增加约90%，诊疗所的成本将增加97%，达到358,290美元。人员成本占总成本的三分之一以上，标准模式下每个设施还需要额外两名以上护士。每个孕期的成本在保健中心从约33美元增加到63美元，在诊疗所从约37美元增加到72美元。
与目前的做法相比，在坦桑尼亚初级卫生设施引入标准ANC模式可能使资源需求增加一倍。资源可用性一直是有效实施当前重点ANC模式的挑战之一。需要进行更多研究，以考虑与母婴健康的额外价值相比，额外成本是否合理。
