Social return on investment of emergency obstetric care training in Kenya

Banke-Thomas, Aduragbemi, Madaj, Barbara ORCID: https://orcid.org/0000-0002-4073-3191 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2019) 'Social return on investment of emergency obstetric care training in Kenya'. BMJ Global Health, Vol 4, Issue 1, e001167.

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Abstract

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 I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 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
Subjects:	W General Medicine. Health Professions > W 74 Medical economics. Health care costs WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care WQ Obstetrics > WQ 20 Research (General) WQ Obstetrics > Pregnancy > WQ 200 General works WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General) WQ Obstetrics > Labor > WQ 300 General works WQ Obstetrics > Labor > WQ 330 Complications of labor WQ Obstetrics > WQ 500 Postnatal care
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjgh-2018-001167
Depositing User:	Stacy Murtagh
Date Deposited:	04 Feb 2019 15:31
Last Modified:	21 Jun 2019 08:51
URI:	https://archive.lstmed.ac.uk/id/eprint/10096

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