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Multicenter Study
. 2018 Mar 16;13(3):e0194187.
doi: 10.1371/journal.pone.0194187. eCollection 2018.

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda

Anatole Manzi  1   2 , Jean Claude Mugunga  2 , Hari S Iyer  2   3   4 , Hema Magge  3   5 , Fulgence Nkikabahizi  6 , Lisa R Hirschhorn  2   3   7   8
Affiliations
Multicenter Study

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda

Anatole Manzi et al. PLoS One. .

Abstract

Background: Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010.

Methods: We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume.

Results: The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated.

Conclusions: The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Mentorship and enhanced supervision at health centers: Conceptual framework.
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References

    1. Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ. World Health Organization; 1997;75 Suppl 1: 7–24. Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2486995&tool=p... - PMC - PubMed
    1. Bryce J, Victora CG, Habicht J-P, Black RE, Scherpbier RW. Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. Health Policy Plan. 2005;20 Suppl 1: i5–i17. doi: 10.1093/heapol/czi055 - DOI - PubMed
    1. Black R.E., Morris S.S AJB. Where and why are 10 million children dying every year? Lancet. Lancet; 2003; 361(9376): p. 2226–p. 34. Available: Lancet, doi: 10.1016/S0140-6736(03)13779-8 - DOI - PubMed
    1. Armstrong Schellenberg J et al. The effect of Integrated Management of Childhood Illness on observed quality of care of under-fives in rural Tanzania. Health Policy Plan. 2004;19: 1–10. doi: 10.1093/heapol/czh001 - DOI - PubMed
    1. Ragnarsson S, Leifsdóttir L, Kapinga F, Gunnlaugsson G. Health services for children and the implementation of IMCI in Monkey Bay, Malawi. Laeknabladid. 2006;92: 271–279. - PubMed

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