BMJ Open (Nov 2024)

What does it cost to deliver antenatal care in Papua New Guinea? Results from a health system costing and budget impact analysis using cross-sectional data

  • William Pomat,
  • Rebecca Guy,
  • Handan Wand,
  • John M Kaldor,
  • Nicola Low,
  • Suzanne M Garland,
  • Christopher Morgan,
  • Angela Kelly-Hanku,
  • Sepehr Tabrizi,
  • Lisa Vallely,
  • Andrew Vallely,
  • Virginia Wiseman,
  • Neha Batura,
  • Stanley Luchters,
  • Steven Badman,
  • Moses Laman,
  • Pamela Toliman,
  • David Whiley,
  • Elizabeth Peach,
  • Glen Mola,
  • Grace Kariwiga,
  • Michaela Riddell,
  • John Bolnga,
  • Jacob Morewaya,
  • Wilfred Peter,
  • Stephen J Rogerson,
  • Olga Phoebe Martinella Saweri,
  • Alice Mengi,
  • Delly Babona,
  • Leanne Robinson,
  • Lucy Au,
  • Irene Pukai Gani,
  • Batura Neha,
  • Kelvin Waukave,
  • Peter Siba,
  • Patricia Sengele,
  • Leah Molok,
  • Tessie Clip,
  • Irene Daniels,
  • Crystal Keiwaga,
  • Daniel Hosea,
  • Augustina Aiarak,
  • Lorraine Mua,
  • Valentine Russiat,
  • Anna Davis,
  • Biru Subey,
  • Misilie Padik,
  • Muria Tangal,
  • Esleen Vovono,
  • Konsetta Malava,
  • Ellen Kavang,
  • Vicky Bayagau Wong,
  • Jermimah Garaen,
  • Laniet Eddie,
  • Johnslyne David,
  • Jermimah Garaaen,
  • Diana Malip,
  • Noel Amada,
  • Elisha Jordan,
  • Mosely Viringa,
  • Cosmos Francis,
  • James Makap,
  • Daniel Amin,
  • Ruth Fidelis,
  • Tony Rave,
  • Rebecca Anian,
  • Romalus Tavui,
  • John Kamit,
  • Benedictor Mission,
  • Charity Stanley,
  • Grace Baining,
  • Everlyn Kavang,
  • Sharon Warel,
  • Janeth Kulimbao,
  • Talitha Manie,
  • Dupain Singirok,
  • Carolyn Wokias Augusto,
  • Eunice Jally,
  • Maggie Taupa,
  • Regina Enman,
  • Judith Demie,
  • Pamela Brea,
  • Aileen Jeffrey,
  • Jonathon Warel,
  • Cornelia Duba,
  • George Kuias,
  • Beromina Jano,
  • Michelyn John,
  • Georgina Sengum,
  • Joyce Soalili,
  • Francesca Buran,
  • Cegatha Tawai,
  • Milda Lasu,
  • Tia Marie Badem,
  • Theresa Tivud,
  • Joseph Yamuna,
  • Mathilda Saki,
  • Kelly Masil,
  • Lennie Mal,
  • Yapi Kepea,
  • Paul Romanus,
  • Konnie Patrick

DOI
https://doi.org/10.1136/bmjopen-2023-080574
Journal volume & issue
Vol. 14, no. 11

Abstract

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Objective In Papua New Guinea (PNG), antenatal clinic attendance averaged 50% for one or more visits, and 30% for four visits in the last decade. In 2016, the WHO revised its focused antenatal care (ANC) model recommending eight rather than four visits. If implemented, this new model would require additional resources. This study estimated provider costs of ANC in PNG, including the expected cost of scaling up to universal ANC coverage as well as recommending eight visits.Design and setting Cross-sectional estimation of ANC costs collected from nine health facilities, which were part of a cluster randomised trial. Costs were estimated using both top-down and bottom-up approaches. The cost of the first and follow-up visits were estimated per woman, at the health facility level. Health system and scale-up costs of four visits were calculated by multiplying the aggregate cost of four visits by ANC utilisation rates. A budget impact analysis estimated the expected costs of delivering eight visits over 5 years. Univariate sensitivity analysis was conducted. Discounted costs are reported in local currency and 2019 international dollars using purchasing power parity data.Results The average cost of the first and follow-up visits were $17.66–$30.58 (K42.94–K74.34) in Madang and $11.26–$35.61 (K27.37–K86.56) in East New Britain. Four visits per woman cost $70.65–$122.33 (K171.76–K297.36) in Madang and $45.02–$142.45 (K109.50–K346.4) in East New Britain; and salaries represented the largest share of costs. The annual health system cost was $6.9 million (K16.9 million), the expected cost of scaling up to the universal coverage of four visits was $22.7 million (K55.2 million), and $45.4 million (K110.3 million) over 5 years for eight visits.Conclusion Costs varied with the number of clinicians, infrastructure and ANC coverage, suggesting scaling up requires increasing the financial investment in ANC services. These results provide a template to strengthen health systems by improving the quality of care.