ArticleBMJ global health2021
Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Decision-analytic models in the economic evaluation of community health worker programmes globally: a systematic review.BMJ global health · 2026Pooled it
- Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review.BMC health services research · 2024Pooled it
- Psychometric Properties of the Mandarin Version of the Quality Improvement Self-Efficacy Inventory Among the Nurses: A Methodological Study.Journal of nursing management · 2026Article
- Article
- A cost analysis of postpartum home visit programming in Kenya: estimates to aid policymakers.Frontiers in health services · 2025Article
- How does community health feature in Global Financing Facility planning documents to support reproductive, maternal, newborn, child and adolescent health and nutrition (RMNAH-N)? insights from six francophone West African countries.Global health action · 2024Article
- Article
- Community participation in the health system: analyzing the implementation of community health committee policies in Kenya.Primary health care research & development · 2023Article
- Artificial Intelligence and Human Psychology in Online Transaction Fraud.Frontiers in psychology · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
introductionImprovements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya.
methodsWe estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses.
resultsWe found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars).
conclusionsThis analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.
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