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Social return on investment of emergency obstetric care training in Kenya

Banke-Thomas, Aduragbemi ORCID: 0000-0002-4449-0131, Madaj, Barbara and Van Den Broek, Nynke (2019) Social return on investment of emergency obstetric care training in Kenya. BMJ Global Health, 4 (1). ISSN 2059-7908

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Identification Number: 10.1136/bmjgh-2018-001167


Introduction Emergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology. Methods Mixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions. Results Trained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred. Conclusion EmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.

Item Type: Article
Additional Information: © 2019 The Authors
Divisions: Health Policy
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Date Deposited: 27 Mar 2019 11:54
Last Modified: 16 May 2024 02:41

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