Improving quality of care for sick children in Kenya is cost effective

“The Emergency Triage and Treatment Plus (ETAT +) approach can be a cost effective way of improving the management of serious childhood diseases in Kenya and other low income countries in Africa.”  This was the conclusion of a study by Programme Researchers, Dr Edwine Barasa, Dr Philip Ayieko and Prof Mike English that was published today in the PLoS Medicine Journal.

The ETAT+ approach originates from an earlier study by Programme Researchers which showed the development and implementation of evidence-based clinical practice guidelines (CPGs) linked to health worker training, follow-up supervision, performance feedback, and facilitation can substantially improve the quality of care in rural district hospitals.

The  newly published study therefore set out to assess the cost effectiveness of the ETAT+ strategy as well as whether scaling up the ETAT+ strategy would be a good use of limited resources.

Study results suggested that the absolute costs for scaling up the ETAT+ Approach are comparable to or lower than costs of other major child health interventions. More specifically, the researchers found out that the quality of care was 25% higher in intervention hospitals than in control hospitals. The additional cost per child admission in hospitals receiving the full intervention, including all its development costs, was US$19.64(Kshs 1,468). The estimated annual cost of scaling up the intervention nationally was US$3.6 million (Kshs 269 million), about 0.6% of the annual child health budget in Kenya.

Commenting on the study results, lead author of the study, Dr Edwine Barasa said “As the international community is giving an increasing focus to strengthening health systems, these findings provide a strong case for scaling up this intervention, which improves quality of care and service provision for the major causes of child mortality, in rural hospitals throughout Kenya and other district hospitals in sub-Saharan Africa.”

Also commenting on the study, the other study co-authors said “This work also highlights the need for methodological developments in the economic analysis of complex, system-level interventions. These results are likely to be most usefully generalized to low-income countries beyond Kenya with similar facilities, burden of child mortality, and comparable or worse quality of paediatric care in hospitals.”

As a result of these and previously published research findings, the intervention strategy for improving quality of hospital care for children will be rolled out more widely in East Africa through national paediatric associations or universities as part of a UK government funded Health Partnership Scheme grant awarded to the UK’s Royal College of Paediatrics and Child Health. Read the (RCPCH website) for more information.

Read the Press Release from the Study here for more information. The  study paper  A Multifaceted Intervention to Improve the Quality of Care of Children in District Hospitals in Kenya: A Cost- Effectiveness Analysis   is also available here. 

Photo credit: Barry Blustone, Boston Globe