Cost-effectiveness of a mentorship and quality improvement intervention to enhance the quality of antenatal care at rural health centers in Rwanda

Abstract

ABSTRACT Objective To estimate cost-effectiveness of Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) intervention to strengthen the quality of antenatal care at rural health centers in rural Rwanda. Design Cost-effectiveness analysis of the MESH-QI intervention using the provider perspective. Setting Kirehe and Rwinkwavu District Hospital catchment areas, Rwanda. Intervention MESH-QI. Main outcome measures Incremental cost per antenatal care visit with complete danger sign and vital sign assessments. Results The total annual costs of standard antenatal care supervision was 10 777.21 USD at the baseline, whereas the total costs of MESH-QI intervention was 19 656.53 USD. Human resources (salary and benefits) and transport drove the majority of program expenses, (44.8% and 40%, respectively). Other costs included training of mentors (12.9%), data management (6.5%) and equipment (6.5%). The incremental cost per antenatal care visit attributable to MESH-QI with all assessment items completed was 0.70 USD for danger signs and 1.10 USD for vital signs. Conclusions MESH-QI could be an affordable and effective intervention to improve the quality of antenatal care at health centers in low-resource settings. Cost savings would increase if MESH-QI mentors were integrated into the existing healthcare systems and deployed to sites with higher volume of antenatal care visits.