Reproductive System & Sexual Disorders: Current Research
Open Access
ISSN: 2161-038X
+44 1300 500008
ISSN: 2161-038X
+44 1300 500008
John Kiragu
University of Nairobi, Kenya
Scientific Tracks Abstracts: Reprod Syst Sex Disord
Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub- Saharan African countries as part of an internet-based capacity building program for quality improvement in midwifery care. Sustainability of this initiative is primarily based on costs. Costs of implementing the three evidence based midwife-led care practices under the MIDWIZE framework in a single facility in Kenya were estimated by a pre- and post-test implementation design. Data on intermediate outcomes (measured in number of births adopting the care practices) were obtained through daily birth observations at baseline for 1 week continued during the 11 weeks of the training intervention. Three cost scenarios were developed based on facility (scenario 1 and 2) or funder programmatic (scenario 3) perspectives: 1) Only facility staff participation costs scenario ($515 USD), 2) the staff participation costs plus training material and logistical service costs, ($1318 USD) and 3) Staff participation costs and total capacity building midwifery program costs ($8548 USD). The average hourly wage of the facility midwife was $4.7 USD.From baseline, there observed adoption of DBP practice (by 36% ,N=111 births) and SSC practice (by 79%,N=241 births) without any change for the DCC practice. Major cost drivers under scenarios 1 was staff participation time costs (72%), scenario 2 was trainers’ service and logistic costs(55%) and scenario 3 was capacity building program costs for a trainer (94%). The costs of adoption included $2.3 USD per birth adopting DBP and $0.5 USD per birth adopting SSC in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2 ; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario3. Findings on major costs drivers, staff time costs and training logistical costs for health facilities, and capacity building trainer costs for program funders, can inform the planning of future similar collaboratives on quality improvement initiatives and scale up of the midwifery-led care practices. Adoption of DBP and SSC practices, which are proven in literature to be beneficial in advancing better maternal outcomes, can be done feasibly at reasonable facility costs. However, more knowledge is needed on strategies to enhance improved adoption of DCC practice in the study setting. Higher costs are required to achieve the similar intermediate outcomes from a funder or programmatic perspective, hence, collaborative financing for implementation of midwifery-led initiative (MIDWIZE) is recommended with resource-constraints.