1. 1 Economic Analysis of a Maternal and Neonatal Health Improvement Intervention in Niger Edward Broughton, PhD, MPH EnCompass, LLC ebroughton@urc-chs.com www.hciproject.org

2. USAID HEALTH CARE IMPROVEMENT PROJECT Objectives What question we were asking Outline intervention to improve MNH Results Limitations What’s next 2

3. USAID HEALTH CARE IMPROVEMENT PROJECT Distribution of labor 3 Implementers: Dr. Maina Boucar and Niger team Researcher

4. USAID HEALTH CARE IMPROVEMENT PROJECT Intervention Implement active management of 3 rd stage of labor Implement essential newborn care Collaborative improvement among 33 facilities MOH partnership 2 years 89,000 vaginal deliveries 4

5. USAID HEALTH CARE IMPROVEMENT PROJECT Research Question Is it cost-effective to not allow mothers and babies to die? What does it mean to be “cost-effective”? Compared to what? What is the cost-effectiveness of intervening compared to going nothing? From perspective of: – funders (USAID & MOH) –MOH 5

6. USAID HEALTH CARE IMPROVEMENT PROJECT Pre-intervention: 1 in 7 women die in childbirth (lifetime risk) 1 Post-partum hemorrhage is leading cause of death 2 1 : World Bank 2005 2 : WHO, 2006 6

7. USAID HEALTH CARE IMPROVEMENT PROJECT Changes associated with intervention 7

8. USAID HEALTH CARE IMPROVEMENT PROJECT 8 Attributability

9. USAID HEALTH CARE IMPROVEMENT PROJECT Changes associated with intervention 9

10. USAID HEALTH CARE IMPROVEMENT PROJECT Costs per delivery (HCI implementing) 10 Pre PostIntervention 2006 2008 MOH $ 35 + $ 0.81$ 28 USAID/HCI $ 2.12 $ 6.53 Additional cost per patient for intervention = $2.45

11. USAID HEALTH CARE IMPROVEMENT PROJECT Costs per delivery (MOH implementing) 11 Pre PostIntervention 2006 2008 MOH $ 35 + $ 0.81$ 28 MOH (intervention) $ 4.58 Additional cost per patient for intervention = --$1.67

12. USAID HEALTH CARE IMPROVEMENT PROJECT Cost-effectiveness Analysis Incremental cost-effectiveness ratio = Added costs Added effects ICER (HCI intervention) = $ 2.45 = $286 / DALY 0.0086 ICER (MOH intervention) = -$1.67= Dominated 0.0086 12

13. USAID HEALTH CARE IMPROVEMENT PROJECT Limitations Weak case for attributability Assuming MOH can do intervention Didn’t include newborn outcomes Some cost data questionable 13

14. USAID HEALTH CARE IMPROVEMENT PROJECT Publishing (IJHCQA)? 14

15. USAID HEALTH CARE IMPROVEMENT PROJECT Thank you ! 15

16. USAID HEALTH CARE IMPROVEMENT PROJECT ebroughton@urc-chs.com www.hciproject.org 16