Dataset Information

Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis.

ABSTRACT: Limited evidence exists on the value for money of mHealth information programs in low resource settings.This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017.Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant's first birthday. Program costs, incremental costs to users, and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages. Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years (DALYs) averted by scaling up program activities over 5 years to reach 60% of pregnant women across Gauteng province. Uncertainty was characterized using one-way and probabilistic uncertainty analyses.Five-year program costs were estimated to be US $1.2 million, 17% of which were incurred by costs on program development and 31% on SMS text message delivery costs. Costs to users were US $1.66 to attend clinic-based services, nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register users (US $0.08) and to provide antenatal care (US $4.36) and postnatal care (US $3.08) services. Incremental costs per DALY averted from a societal perspective ranged from US $1985 in the first year of implementation to US $200 in the 5th year. At a willingness-to-pay threshold of US $2000, the project had a 40% probability of being cost-effective in year 1 versus 100% in all years thereafter.Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost-effective strategy for bolstering antenatal care and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results.

SUBMITTER: LeFevre A

PROVIDER: S-EPMC6086931 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis.

LeFevre Amnesty A Cabrera-Escobar Maria A MA Mohan Diwakar D Eriksen Jaran J Rogers Debbie D Neo Parsons Annie A Barre Iman I Jo Youngji Y Labrique Alain A Coleman Jesse J

JMIR mHealth and uHealth 20180727 7

<h4>Background</h4>Limited evidence exists on the value for money of mHealth information programs in low resource settings.<h4>Objective</h4>This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017.<h4>Methods</h4>Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on ...[more]

PMID: 30054263

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Project description:BackgroundReliable basic infrastructure, particularly electricity, is a critical enabling factor in improving health systems and consequently achieving the health sustainable development goals (SDGs). Yet, there is no systematic and rigorous study examining the effect of reliable electricity on health systems in a developing country context. In this study, we examine the effect of Jyotigram Yojana (JGY), a rural electrification program providing 24-h electricity to rural non-agricultural users in Gujarat, India, on core components of health systems including health facilities, health information, and health services utilization.MethodsWe match data from the District Level Household and Facility Survey (DLHS-II and DLHS-III) and administrative data from electricity distribution companies on JGY implementation. Matching survey data with administrative data allows us to precisely identify the relevant sample from Gujarat for our data analysis. We then apply a difference-in-differences framework to address potential bias in JGY implementation by comparing the sample from Gujarat (treatment group) with that from Maharashtra (control group). Our key independent variable is a dummy indicating JGY implementation, which operationalizes access to reliable electricity. It takes value 1 if the PHC/eligible woman/child is located or residing in the state of Gujarat and 0 if located or residing in the state of Maharashtra. Our outcome variables cover three core components of health systems-health facilities, health information, and child and maternal health services utilization. Each outcome is a binary variable. We therefore estimate probit models with appropriate control variables.ResultsWe find that JGY implementation significantly improved the operational capacity of health facilities, in particular primary health centers (PHCs), by increasing the availability and functionality of a wide range of essential devices and equipment. JGY also significantly increased access to health information through television. Further, JGY increased utilization of health services; in particular, it increased the probability of children receiving critical vaccinations and pregnant women receiving antenatal care. Our results are robust to alternate specifications and analysis using alternate data.ConclusionReliable electricity can be an effective tool in improving core components of health systems. In addition to targeting direct factors within the health systems such as health workforce and health financing, investments in supporting infrastructure are warranted to achieve the health SDGs.

Project description:BackgroundEvidence is limited on the effectiveness of mobile health programs which provide stage-based health information messages to pregnant and postpartum women. Kilkari is an outbound service that delivers weekly, stage-based audio messages about pregnancy, childbirth, and childcare directly to families in 13 states across India on their mobile phones. In this protocol we outline methods for measuring the effectiveness and cost-effectiveness of Kilkari.MethodsThe study is an individually randomized controlled trial (iRCT) with a parallel, partially concurrent, and unblinded design. Five thousand pregnant women will be enrolled from four districts of Madhya Pradesh and randomized to an intervention or control arm. The women in the intervention arm will receive Kilkari messages while the control group will not receive any Kilkari messages as part of the study. Women in both arms will be followed from enrollment in the second and early third trimesters of pregnancy until one year after delivery. Differences in primary outcomes across study arms including early and exclusive breastfeeding and the adoption of modern contraception at 1 year postpartum will be assessed using intention to treat methodology. Surveys will be administered at baseline and endline containing modules on phone ownership, geographical and demographic characteristics, knowledge, practices, respectful maternity care, and coverage for antenatal care, delivery, and postnatal care. In-depth interviews and focus group discussions will be carried out to understand user perceptions of Kilkari, and more broadly, experiences providing phone numbers and personal health information to health care providers. Costs and consequences will be estimated from a societal perspective for the 2018-2019 analytic time horizon.DiscussionKilkari is the largest maternal messaging program, in terms of absolute numbers, currently being implemented globally. Evaluations of similar initiatives elsewhere have been small in scale and focused on summative outcomes, presenting limited evidence on individual exposure to content. Drawing upon system-generated data, we explore linkages between successful receipt of calls, user engagement with calls, and reported outcomes. This is the first study of its kind in India and is anticipated to provide the most robust and comprehensive evidence to date on maternal messaging programs globally.Trial registrationClinicaltrials.gov, 90075552, NCT03576157 . Registered on 22 June 2018.

Project description:Poor quality of health services and socio-cultural dynamics may severely limit utilization of health services. Facility health committees were established in several states in northern Nigeria to reduce these barriers. The committees were charged with mobilizing communities, improving quality of health services, and promoting utilization of maternal and child health services. This study assessed this intervention.To obtain a comprehensive picture of facility health committees' influence on maternal and child health services, we selected 33 facilities in three states in northern Nigeria (Jigawa, Kaduna, Kano) where the intervention was active. For each of these facilities we interviewed committee members (n =?399), conducted focus group discussions with a subset of committee members (18 focus groups), interviewed facility health providers (two providers from each facility), and conducted client exit interviews (n =?501).Facility health committees appear to have a positive influence on quality of maternal and child health services in the selected facilities. Committee members, health providers, and facility clients all agree that the committees have a tangible positive effect. The most important roles of the committees are to mobilize the community and increase demand for maternal and child health services, in a region where demand is very low. Committee activities further improve health services in many ways, including advocacy, community-facility coordination, fund raising, money donation, and problem mitigation.Facility health committees can be invaluable in contributing to improved demand for and access to quality maternal and child health services in health facilities in northern Nigeria. They provide strong linkages between community members and the health facilities, directly work to increase demand for services, and address supply-side challenges that often limit utilization of services in health facilities. The intervention can be improved by more broadly communicating committee activities in the community, and by incentivizing facility health committee members.

Project description:BACKGROUND:Ghana is among African countries not likely to achieve the Sustainable Development Goal (SDG) three (3) target of reducing maternal mortality to 70 per 100,000 live births by the year 2030 if maternal and child health services utilization are not improved. Community engagement in health is therefore advocated to help address this challenge. This study evaluated the impact of a community engagement intervention on maternal and child health services utilization in Ghana. METHODS:This study was a cluster randomised trial among primary healthcare facilities (n = 64) in the Greater Accra and Western regions in Ghana. Multivariate multiple regression analysis and paired-ttest were used to determine impact of the community engagement intervention on maternal and child health indicators at baseline and follow-up. RESULTS:Intervention health facilities recorded significant improvements over control facilities in terms of average spontaneous vaginal deliveries per month per health facility (baseline mean = 15, follow-up mean = 30, p = 0.0013); child immunizations (baseline mean = 270, follow-up mean = 455, p = 0.0642) and female condoms distribution (baseline mean = 0, follow-up mean = 2, p = 0.0628). Other improved indicators in intervention facilities were average number of Human Immunodeficiency Virus (HIV) tests for non-pregnant women (baseline mean = 55, follow-up 104, p = 0.0213); HIV tests for pregnant women (baseline mean = 40, follow-up mean = 119, p = 0.0067) and malaria tests (baseline mean = 43, follow-up mean = 380, p = 0.0174). Control facilities however performed better than intervention facilities in terms of general laboratory tests, voluntary counselling and testing, treatment of sexually transmitted infections, male child circumcisions and other minor surgical procedures. CONCLUSION:Community engagement in health has the potential of improving utilization of maternal and child health services. There is the need for multi-stakeholder dialogues on complementing existing quality improvement interventions with community engagement strategies.

Project description:BackgroundAbout 75.5% of women in Nepal's urban areas receive at least four ANC visits, compared to 61.7% of women in the country's rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016.MethodsInequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods.ResultsInequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women's literacy, place of living, mother's employment status, and problem of distance to reach nearest health facility were the main contributors.ConclusionWe find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women's education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services.

Dataset Information

Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis.

Publications

Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis.

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