Cost-effectiveness analysis of an HIV-adapted training and continuous quality improvement supervisory intervention for community caregivers.

Abstract

Background It is argued that supportive supervision increases the performance of community health workers and this is evidenced by an increased uptake of interventions in health facilities located in the CHWs catchment area. Method A retrospective economic evaluation conducted from an implementer’s perspective of a two-arm cluster randomised control trial (RCT) that was implemented during the period May 2012 – November 2013 by the Centre for Rural Health at the University of KwaZulu-Natal (CRH-UKZN) in the Ugu Health District located in the province of KwaZulu-Natal. This RCT compared the cost-effectiveness of the training and supervision of community caregivers (CCGs) provided by the KwaZulu-Natal provincial Department of Health relative to the HIV-adapted community case management (CCM) training and continuous quality improvement (CQI) supervision of community care givers (CCGs) implemented by Centre for Rural Health at the University of KwaZulu-Natal (CRH-UKZN). The behavioural changes under consideration were (i) prevalence of antenatal booking before 20 weeks have lapsed in a woman’s pregnancy; (ii) prevalence of the number of women who present themselves for post-natal care within seven days of delivery; (iii) the prevalence of exclusive breast-feeding practice and the (iv) coverage of Human Immunodeficiency Virus Polymerase Chain Reaction (HIV PCR) testing of babies. Results The uptake of the target interventions were not statistically different between the control group and the intervention group; with the exception of the prevalence of exclusive breastfeeding. The intervention was more costly than the control in addition to being less cost-effective where the former was R19, 942 and the latter R8,389 per mothers practicing exclusive breast feeding., Conclusion The health outcomes achieved did not justify the additional costs of frequent supervision in the intervention, but rather the focus should be on quality and consistency of the supervision.