Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites.

Callander, EJ; Scarf, V; Nove, A; Homer, C; Carrandi, A; Abdullah, AS; Clow, S; Halim, A; Mbalinda, SN; Nabirye, RC; Rahman, AF; Rasheed, SI; Turk, AM; Bazirete, O; Turkmani, S; Forrester, M; Mandke, S; Pairman, S; Boyce, M

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites.

Callander, EJ Scarf, V Nove, A Homer, C

Carrandi, A Abdullah, AS Clow, S Halim, A Mbalinda, SN Nabirye, RC Rahman, AF Rasheed, SI Turk, AM Bazirete, O Turkmani, S

Forrester, M Mandke, S Pairman, S Boyce, M

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ Glob Health, 2024, 9, (3), pp. e013643
Issue Date:: 2024-03-28

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Field	Value	Language
dc.contributor.author	Callander, EJ
dc.contributor.author	Scarf, V
dc.contributor.author	Nove, A
dc.contributor.author	Homer, C https://orcid.org/0000-0002-7454-3011
dc.contributor.author	Carrandi, A
dc.contributor.author	Abdullah, AS
dc.contributor.author	Clow, S
dc.contributor.author	Halim, A
dc.contributor.author	Mbalinda, SN
dc.contributor.author	Nabirye, RC
dc.contributor.author	Rahman, AF
dc.contributor.author	Rasheed, SI
dc.contributor.author	Turk, AM
dc.contributor.author	Bazirete, O
dc.contributor.author	Turkmani, S https://orcid.org/0000-0001-7819-5061
dc.contributor.author	Forrester, M
dc.contributor.author	Mandke, S
dc.contributor.author	Pairman, S
dc.contributor.author	Boyce, M
dc.date.accessioned	2024-08-06T03:20:36Z
dc.date.available	2024-02-26
dc.date.available	2024-08-06T03:20:36Z
dc.date.issued	2024-03-28
dc.identifier.citation	BMJ Glob Health, 2024, 9, (3), pp. e013643
dc.identifier.issn	2059-7908
dc.identifier.issn	2059-7908
dc.identifier.uri	http://hdl.handle.net/10453/180108
dc.description.abstract	INTRODUCTION: Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes. METHODS: The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars. RESULTS: Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted. CONCLUSION: MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation.ispartof	BMJ Glob Health
dc.relation.isbasedon	10.1136/bmjgh-2023-013643
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	4203 Health services and systems
dc.subject.classification	4206 Public health
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Pregnancy
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Birthing Centers
dc.subject.mesh	Midwifery
dc.subject.mesh	Uganda
dc.subject.mesh	Bangladesh
dc.subject.mesh	Pakistan
dc.subject.mesh	Humans
dc.subject.mesh	Midwifery
dc.subject.mesh	Pregnancy
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Birthing Centers
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Uganda
dc.subject.mesh	Bangladesh
dc.subject.mesh	Pakistan
dc.subject.mesh	Female
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Pregnancy
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Birthing Centers
dc.subject.mesh	Midwifery
dc.subject.mesh	Uganda
dc.subject.mesh	Bangladesh
dc.subject.mesh	Pakistan
dc.title	Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites.
dc.type	Journal Article
utslib.citation.volume	9
utslib.location.activity	England
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	University of Technology Sydney/Strength - WHO CC
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2024-08-06T03:20:33Z
pubs.issue	3
pubs.publication-status	Published online
pubs.volume	9
utslib.citation.issue	3

Abstract:

INTRODUCTION: Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes. METHODS: The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars. RESULTS: Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted. CONCLUSION: MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.

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http://hdl.handle.net/10453/180108