Directorate General for Disease Control and Epidemiological Surveillance, Supervisor of the COVIS-19 Hotline Operation, Yemen Ministry of Public Health and Population, Sana'a, Yemen
TEPHINET - The Task Force for Global Health, Program Evaluation Consultant in Yemen, Sana'a, Yemen.
BMJ Open. 2022 Mar 28;12(3):e056866. doi: 10.1136/bmjopen-2021-056866.
To estimate the cost saving for utilisation of vaginal delivery (VD), antenatal care (ANC) and an intrauterine device (IUD) services at primary health level facilities (PHLF) instead of tertiary health level facilities (THLF) in Sana'a.
A comparative cross-sectional study.
Eight PHLF in Sana'a governorate and three THLF in Sana'a city.
A total of 180 women aged (15-45 years) were enrolled equally from PHLF and THLF. Sixty women attended for each reproductive health service (VD, ANC and IUD services).
The direct and indirect costs of services at PHLF and THLF, and the cost saving for utilisation of PHLF instead of THLF.
The median of direct medical cost (DMC) of VD, ANC and IUD services were US$43.86, US$14.77 and US$9.07 at THLF compared with US$19.54, US$0.93 and US$11.17 at PHLF, respectively. The DMC difference of VD, ANC and IUD services between THLF and PHLF was US$24.32, US$13.84 and US$-2.1, respectively. Regarding the direct non-medical costs (DNMC), the median of VD, ANC and IUD services were US$43.05, US$19.07 and US$17.27 at THLF compared with US$13.96, US$0.00 and US$0.00 at PHLF, respectively. The DNMC difference of VD, ANC and IUD service between THLF and PHLF was US$29.09, US$18.07 and US$16.27, respectively. Moreover, the median of indirect cost (INDC) for VD, ANC and IUD services were US$23.93, US$9.49 and US$10.44 at THLF compared with US$7.90, US$1.59 and US$1.06 at PHLF, respectively. The INDC difference of VD, ANC and IUD service between THLF and PHLF was US$16.03, US$7.90 and US$9.38, respectively.
The study found the utilisation of VD, ANC and IUD services at PHLF instead of THLF is a considerable cost saving for families. Therefore, shifting the utilisation of services from THLF to PHLF reduces the financial burden affecting individuals, families and their productivity.
估计在萨那利用阴道分娩（VD）、产前护理（ANC）和宫内节育器（IUD）服务于基层医疗保健设施（PHLF）而非三级医疗保健设施（THLF）的成本节约。
比较性横断面研究。
萨那省的 8 个 PHLF 和萨那市的 3 个 THLF。
总共纳入了 180 名年龄在（15-45 岁）之间的妇女，在 PHLF 和 THLF 中平均各有 60 名妇女接受了每个生殖健康服务（VD、ANC 和 IUD 服务）。
PHLF 和 THLF 的服务的直接和间接成本，以及利用 PHLF 替代 THLF 的成本节约。
THLF 与 PHLF 相比，VD、ANC 和 IUD 服务的直接医疗成本（DMC）中位数分别为 43.86 美元、14.77 美元和 9.07 美元，而 PHLF 则分别为 19.54 美元、0.93 美元和 11.17 美元。VD、ANC 和 IUD 服务在 THLF 和 PHLF 之间的 DMC 差异分别为 24.32 美元、13.84 美元和-2.1 美元。关于直接非医疗成本（DNMC），VD、ANC 和 IUD 服务的中位数在 THLF 分别为 43.05 美元、19.07 美元和 17.27 美元，而在 PHLF 则分别为 13.96 美元、0 美元和 0 美元。VD、ANC 和 IUD 服务在 THLF 和 PHLF 之间的 DNMC 差异分别为 29.09 美元、18.07 美元和 16.27 美元。此外，VD、ANC 和 IUD 服务的间接成本（INDC）中位数在 THLF 分别为 23.93 美元、9.49 美元和 10.44 美元，而在 PHLF 则分别为 7.90 美元、1.59 美元和 1.06 美元。VD、ANC 和 IUD 服务在 THLF 和 PHLF 之间的 INDC 差异分别为 16.03 美元、7.90 美元和 9.38 美元。
本研究发现，利用 PHLF 提供的 VD、ANC 和 IUD 服务而非 THLF 服务可为家庭带来可观的成本节约。因此，将服务的利用从 THLF 转移到 PHLF 可以减轻影响个人、家庭及其生产力的经济负担。
