Evidence map›Paper›PMID 31139447›Full record

ArticleBMJ global health2019

The impact and cost-effectiveness of user fee exemption by contracting out essential health package services in Malawi.

Wu Zeng, Daxin Sun, Henry Mphwanthe, Tianwen Huan, Jae Eun Nam, Pascal Saint-Firmin, Gerald Manthalu, Suneeta Sharma, Arin Dutta

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Wu Zeng *The Schneider Institutes for Health Policy, Brandeis University, Waltham, Massachusetts, USA.
Daxin Sun *School of Transportation and Civil Engineering, Fujian Agriculture and Forestry University, Fuzhou, China.
Henry MphwanthePalladium, Lilongwe, Malawi.
Tianwen HuanUniversity of Rochester, Rochester, New York, USA.
Jae Eun NamBrandeis University, Waltham, Massachusetts, USA.
Pascal Saint-FirminPalladium, Washington, District of Columbia, USA.
Gerald ManthaluThe Ministry of Health of Malawi, Lilongwe, Malawi.
Suneeta SharmaPalladium, Washington, District of Columbia, USA.
Arin DuttaPalladium, Washington, District of Columbia, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo examine the impact and cost-effectiveness of user fee exemption by contracting out essential health package services to Christian Health Association of Malawi (CHAM) facilities through service-level agreements (SLAs) to inform policy-making in Malawi.

methodsThe analysis was conducted from the government perspective. Financial and service utilisation data were collected for January 2015 through December 2016. The impact of SLAs on utilisation of maternal and child health (MCH) services was examined using propensity score matching and random-effects models. Subsequently, the improved services were converted to quality-adjusted life years (QALYs) gained, using the Lives Saved Tool (LiST), and incremental cost-effectiveness ratios (ICERs) were generated.

findingsOver the 2 years, a total of $1.5 million was disbursed to CHAM facilities through SLAs, equivalent to $1.24 per capita. SLAs were associated with a 13.8%, 13.1%, 19.2% and 9.6% increase in coverage of antenatal visits, postnatal visits, delivery by skilled birth attendants and BCG vaccinations, respectively. This was translated into 434 lives saved (95% CI 355 to 512) or 11 161 QALYs gained (95% CI 9125 to 13 174). The ICER of SLAs was estimated at $134.7/QALYs gained (95% CI $114.1 to $164.7).

conclusionsThe cost per QALY gained for SLAs was estimated at $134.7, representing 0.37 of Malawi's per capita gross domestic product ($363). Thus, MCH services provided with Malawi's SLAs proved cost-effective. Future refinements of SLAs could introduce pay for performance, revising the price list, streamlining the reporting system and strengthening CHAM facilities' financial and monitoring management capacity.

Indexed as

cost-effectivenesshealth economicsmaternal and child healthuser fees

Identifiers

PMID31139447
PMCPMC6509600

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.