dc.contributor.author | Kiragu, John M | |
dc.contributor.author | Friberg, Ingrid O | |
dc.contributor.author | Erlandsson, Kerstin | |
dc.contributor.author | Wells, M B | |
dc.contributor.author | Wagoro, Miriam C A | |
dc.contributor.author | Blomgren, Johanna | |
dc.contributor.author | Helena, Lindgren | |
dc.date.accessioned | 2023-09-11T06:04:43Z | |
dc.date.available | 2023-09-11T06:04:43Z | |
dc.date.issued | 2023 | |
dc.identifier.citation | Kiragu JM, Osika Friberg I, Erlandsson K, Wells MB, Wagoro MCA, Blomgren J; Nairobi County participants and QI Coordinators; Lindgren H. Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya. Sex Reprod Healthc. 2023 Sep;37:100893. doi: 10.1016/j.srhc.2023.100893. Epub 2023 Jul 24. PMID: 37586305. | en_US |
dc.identifier.uri | https://pubmed.ncbi.nlm.nih.gov/37586305/ | |
dc.identifier.uri | http://erepository.uonbi.ac.ke/handle/11295/163766 | |
dc.description.abstract | Background: 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 after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability.
Methods: We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD).
Results: At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives' participation time costs (56 %) for scenario 1 (collaborative), trainers' material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively 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 scenario 3. The average hourly wage of the facility midwife was $4.7 USD.
Conclusion: Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.subject | Costs; Evidence-based; Intermediate outcomes; MIDWIZE; Midwife-led care; Quality improvement; Resource mobilization. | en_US |
dc.title | Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya | en_US |
dc.type | Article | en_US |