Cost of the Skilled Care Initiative (Kenya, Tanzania)

Background: In 2001, FCI launched a multi-faceted initiative to increase the use of skilled care in selected project districts. Activities focused on improving the quality and availability of obstetric care and promoting utilization through behavior change communication. The objective of the study is to determine the cost and cost effectiveness of the skilled care package.

Materials and Methods: All input and unit cost data were collected through a retrospective analysis of project financial records, budgets and reports. To supplement and verify the data, interviews with staff were conducted. Effectiveness data were obtained from household and health facility surveys conducted at baseline and endline. The main effectiveness criterion is the percentage of deliveries with a skilled birth attendant.

Results: The annual cost of the SCI packages to the health system of one birth with a skilled attendant ranges from US$6.10 in Migori (Kenya), to US$14.8 in Igunga (Tanzania), and US$21.70 in Homabay (Kenya). The cost variations are due to differences in the number of trained staff, level of coverage, socio-economic factors, and number of births with a skilled attendant in each district. The annual costs are expected to decrease over time because of the higher expense of the initial investment. These costs are comparable to the cost per birth with a skilled attendant of a maternal and perinatal intervention package defined by the World Bank.

Conclusions: The SCI intervention package is affordable and will become cheaper over time as more women deliver with skilled attendants. Knowing the costs and affordability encourages replicability of the interventions by other districts in the project countries.