Background
Low-dose, high-frequency (LDHF) training
Study objectives
Methods
Study setting
Program description
Program Activity Category by Phase | Description | Inputs | Time |
---|---|---|---|
Development | 4 months | ||
Curriculum adaptation | Format BEmONC materials into Learning Resource Package for LDHF format | Copy editing fees, technical assistance for adapting curricula | 4 months |
Start Up | 8 months | ||
Health Information Officer Training | 3-day course for HIOs of participating health facilities to train on data collection and validation of maternal and newborn health indicators | Transportation, Accommodation, materials, food, facilitator costs | 3 days per training |
Master Mentor: Training of Trainers | 8-day course to review and confirm expertise in content; held one centralized training in each region for which 10 MMs selected by Regional Health Team | Transportation, Accommodation, materials, food, facilitator costs | 8 days per training |
Regional Health Team Meetings | 1-day lunch meeting to share program objectives and target facilities of the region for participation | Transportation, lunch, materials | 1 month for all 3 regions |
Training Equipment | Procurement of patient models, data collection tools, medical equipment, printed manuals and training materials | Items needed per training team | 3 months |
Implementation | 6 months per Wave | ||
LDHF 1 facility based training | First LDHF workshop: basic delivery and newborn care; Peer Practice Coordinator training | Transportation, Accommodation, materials, food, facilitator costs | 1 week |
LDHF 2 facility based training | Second LDHF workshop: emergency and delivery complications for maternal and newborn care | Transportation, Accommodation, materials, food, facilitator costs | 1 week, 1 month after LHDF1 |
mMentoring Phonecalls | Hierarchy of phone calls to discuss skills practice, cases, and any questions that arise by trainees | Phone calls made to recipients, duration of call | 6 months |
mMentoring Text Messages | Automated practice reminders and interactive SMS based quiz questions on trained content | Telerivet system license, phone for sending messages, phone calls | 6 months |
Master Mentor: Refresher Training | 8-day workshop refresher course on content, education, and mentorship skills | Transportation, Accommodation, materials, food, facilitator costs | 8 days per training |
Recurrent | |||
Personnel | Staff time during each phase separate from activity specific valued inputs for travel and trainings to separate indirect personnel cost from activity cost | Recurrent | |
Buildings & Maintenance | Local office and overhead costs such as utilities | Recurrent | |
Furniture & Equipment | Office furniture and equipment used for program activities by staff | Recurrent |
Cost data
Health effects data
Analysis
Essential LDHF program model and comparison to workshop training
Results
Cost Category | Wave 1 (USD) | Wave 2 (USD) | Wave 3 (USD) | Wave 4 (USD) | Total Program Cost | % of Total Cost |
---|---|---|---|---|---|---|
Development | ||||||
Investment Costs | ||||||
Curriculum adaptation | $224 | $358 | $179 | $134 | $896 | 0.11% |
Furniture & Equipment | $275 | $439 | $220 | $165 | $1099 | 0.13% |
Recurrent Costs | ||||||
Personnel Salaries | $384 | $615 | $301 | $226 | $1527 | 0.19% |
Buildings, Maintenance, Overhead | $261 | $417 | $209 | $157 | $1044 | 0.13% |
Total Development Costs
|
$1144
|
$1830
|
$909
|
$682
|
$4564
|
0.55%
|
Start Up | ||||||
Investment Costs | ||||||
Curriculum adaptation | $448 | $716 | $358 | $269 | $1791 | 0.22% |
Regional Health Team Meetings | $29 | $46 | $23 | $17 | $115 | 0.01% |
Master Mentor: Training of Trainers | $952 | $1523 | $762 | $571 | $3808 | 0.46% |
Health Information Officer Training | $168 | $268 | $134 | $101 | $671 | 0.08% |
Furniture & Equipment | $549 | $879 | $439 | $330 | $2197 | 0.27% |
Training Equipment | $788 | $1261 | $631 | $473 | $3153 | 0.38% |
Recurrent Costs | ||||||
Personnel Salaries | $2791 | $4465 | $2186 | $1639 | $11,080 | 1.35% |
Buildings, Maintenance, Overhead | $1250 | $2000 | $1000 | $750 | $5000 | 0.61% |
Total Start Up Costs
|
$6975
|
$11,159
|
$5533
|
$4150
|
$27,816
|
3.38%
|
Implementation | ||||||
Investment Costs | ||||||
Curriculum adaptation | $3895 | $3895 | $3895 | $3895 | $15,582 | 1.89% |
Regional Health Team Meetings | $251 | $251 | $251 | $251 | $1002 | 0.12% |
Master Mentor: Training of Trainers | $8282 | $8282 | $8282 | $8282 | $33,128 | 4.02% |
Health Information Officer Training | $1459 | $1459 | $1459 | $1459 | $5836 | 0.71% |
Furniture & Equipment | $4779 | $4779 | $4779 | $4779 | $19,116 | 2.32% |
Training Equipment | $2365 | $2365 | $2365 | $2365 | $9460 | 1.15% |
Recurrent Costs | ||||||
Personnel Salaries | $68,676 | $102,855 | $97,454 | $92,052 | $361,037 | 43.86% |
LDHF 1 facility based training | $42,188 | $66,938 | $34,241 | $23,656 | $167,024 | 20.29% |
LDHF 2 facility based training | $30,981 | $47,212 | $23,585 | $16,700 | $118,478 | 14.39% |
mMentoring Text Messages | $522 | $512 | $513 | $513 | $2061 | 0.25% |
mMentoring Phonecalls | $374 | $366 | $366 | $366 | $1473 | 0.18% |
Master Mentor refresher training | $5564 | $7822 | $4812 | $2257 | $20,456 | 2.49% |
Buildings, Maintenance, Overhead | $8818 | $8818 | $8818 | $8818 | $35,272 | 4.29% |
Total Implementation Costs
|
$178,983
|
$255,555
|
$190,820
|
$165,395
|
$790,753
|
96.07%
|
TOTAL COSTS | $187,101 | $268,545 | $197,261 | $170,226 | $823,134 |
Cost-effectiveness
Sensitivity analyses
Base Scenario | Best Case (high effectiveness, lower limit cost) | Worst case (low effectiveness, upper limit cost) | Probabilistic (95% CI) | Essential LDHF Model | |
---|---|---|---|---|---|
Total LDHF Program Cost | $823,134 | $387,808 | $1,596,116 | $831,575 ($389,041 – $1,542,848) | $224,026 |
Total DALYs averted | 15,510 | 20,313 | 10,707 | 15,562 (10778–20,192) | 10,707 |
Cost per DALY averted | $53.07 | $19.09 | $149.08 | $54.79 ($24.42 - $107.01) | $20.92 |
Parameters | Deterministic Base case (Low – High) | Probabilistic mean value (95% CI) | Distribution Type | α | λ |
---|---|---|---|---|---|
Development | |||||
Investment
| |||||
Curriculum adaptation | $896 ($640 – $1221) | n/a, remain as in base case | |||
Recurrent
| |||||
Personnel Salaries | $1527 ($848 - $2529) | n/a, remain as in base case | |||
Buildings, Maintenance, Overhead | $1044 ($421 - $1769) | n/a, remain as in base case | |||
Furniture & Equipment | $1099 ($632 -$2378) | n/a, remain as in base case | |||
Start Up | |||||
Investment
| |||||
Curriculum adaptation | $1791 ($1279 - $2442) | n/a, remain as in base case | |||
Health Information Officer Training | $671 ($399 - $1389) | n/a, remain as in base case | |||
Master Mentor: Training of Trainers | $3808 ($1854 - $7825) | n/a, remain as in base case | |||
Regional Health Team Meetings | $115 ($55 - $217) | n/a, remain as in base case | |||
Training Equipment | $3153 ($693 - $14,077) | $3024 ($0 - $22,856) | Gamma | 0.20 | 6.21 E-05 |
Recurrent
| |||||
Personnel Salaries | $11,080 ($6042 - $18,561) | $10,930 ($2096 - $24,946) | Gamma | 3.09 | 2.79 E-04 |
Buildings, Maintenance, Overhead | $5000 ($597 - $13,589) | $5032 ($19 - $22,222) | Gamma | 0.57 | 1.15 E-04 |
Furniture & Equipment | $2197 ($1264 - $4756) | n/a, remain as in base case | |||
Implementation | |||||
Investment
| |||||
Curriculum adaptation | $15,582 ($9569 - $23,120) | $15,658 ($4979 - $32,421) | Gamma | 5.27 | 3.38 E-04 |
Health Information Officer Training | $5836 ($2985 - $13,151) | ||||
Master Mentor: Training of Trainers | $33,128 ($13,869 - $74,084) | $33,682 ($1875 - $120,093) | Gamma | 1.16 | 3.50 E-05 |
Regional Health Team Meetings | $1002 ($413 - $2054) | n/a, remain as in base case | |||
Training Equipment | $9460 ($2309 - $39,416) | $9,6129 ($0 – $65,749) | Gamma | 0.23 | 2.44 E-05 |
LDHF 1 facility based training | $167,024 ($85,256 - $309,243) | $173,400 ($21,445 - $745,323) | Gamma | 2.18 | 1.30 E-05 |
LDHF 2 facility based training | $118,478 ($57,877 - $217,833) | $116,992 ($18,514 - $305,365) | Gamma | 2.17 | 1.82 E-05 |
mMentoring Phonecalls | $1473 ($631 - $2941) | n/a, remain as in base case | |||
mMentoring Text Messages | $2061 ($1141 - $3302) | n/a, remain as in base case | |||
Master Mentor: Refresher Training | $20,456 ($10,381 - $46,288) | n/a, remain as in base case | |||
Recurrent
| |||||
Personnel Salaries | $361,037 ($169,236 - $658,141) | $364,675 ($46,819 - $1,005,255) | Gamma | 2.15 | 5.95 E-06 |
Buildings, Maintenance, Overhead | $35,272 ($9417 - $89,609) | $35,060 ($360 – $159,554) | Gamma | 0.74 | 2.11 E-05 |
Furniture & Equipment | $19,116 ($9453 - $45,024) | $19,534 ($596 – $66,203) | Gamma | 1.08 | 5.65 E-05 |
Health Effects | Deterministic Base case (Low – High) | Probabilistic (95% CI) | Distribution Type | Mean | SD |
Reduction in Newborn Mortality rate (per 1000 live births) from baseline compared to 1–6 months after LDHF training | 48% (37% - 60%) | 48.0% (25.5% - 71.7%) | Normal | 48.1% | 11.5% |
Reduction in Newborn Mortality rate (per 1000 live births) from baseline compared to 7–12 months after LDHF training | 56% (39% - 73%) | 56.0% (22.4% - 92.1%) | Normal | 56.0% | 17.1% |
Reduction in Stillbirth Rate (per 1000 births) from baseline compared to 1–6 months after LDHF training | 35% (22% - 48%) | 35.2% (10.8% - 58.8%) | Normal | 34.8% | 12.9% |
Reduction in Stillbirth Rate (per 1000 births) from baseline compared to 7–12 months after LDHF training | 49% (33% - 65%) | 49.1% (18.2% - 79.4%) | Normal | 49.0% | 15.8% |
Essential LDHF program model comparison to workshop training costs
Cost Category LDHF | Cost per trainee (USD) | Cost Category Workshop GCNM | Cost per Trainee (USD) |
---|---|---|---|
Number of Providers Trained | 428 | 64 | |
Development LDHF Training | $2 | Development BEmONC Workshop | $75 |
Start Up | $8 | Start Up | $101 |
Implementation | $497 | Implementation | $724 |
Total program | $506 | TOTAL PROGRAM | $901 |