The Gambia: cost and effectiveness of a mobile maternal health care service, West Kiang.

A relatively small body of knowledge has been generated in the past to identify the cost-effectiveness of mobile versus static clinics, or combinations thereof. The changes introduced by the new mobile maternal health care service offered an opportunity to address the issue of cost-effectiveness of changes introduced to a specific geographical area. Considerably higher total costs were incurred, particularly as a result of increased training and staffing. However, evidence (Foord, 1993) has shown that several key measures of process eg. number of haemoglobin tests taken and haemoglobin levels increased significantly. Therefore the extra expenditure created clear service improvements. Linking such changes to reductions in mortality was more difficult as the population size and rarity of maternal deaths made it difficult to show statistically significant differences. The results should only provide part of the information required by decision makers, for a number of reasons. First, this cost-effectiveness analysis provided no information regarding any form of equity. Secondly, many factors affect cost-effectiveness ratios and further investigation of the organisation and management of the mobile service may highlight further room for improvement within the service itself, thus improving the efficiency. In this case there were grounds for re-assessing costs in relation to training, undertaking an assessment of staffing needs and increasing accountability in the use of resources. This study gives detailed information on the structure of costs for a mobile unit. It is unusual in its consideration of how a mobile team fits into the structure of existing health services and implications of provision on other levels of service.(ABSTRACT TRUNCATED AT 250 WORDS)