Original ResearchCost savings through implementation of an integrated home-based record: a case study in Vietnam
Introduction
A number of different types of home-based records (HBRs) for maternal and child health (MCH) have been globally operationalized as the self-monitoring tools for pregnant women, mothers, and children. The most commonly implemented HBR for MCH is a child vaccination card which enables mothers to monitor immunization status of their children. It can serve as the reliable data source for estimating child immunization coverage.1 Another HBR commonly implemented is a growth monitoring chart which enables mothers to monitor growth progress of their children. Growth monitoring charts have been implemented in over 150 countries.2 There is also a pregnancy care card exclusively for pregnant women and mothers, which focuses on recording the results of antenatal care checkups, deliveries, and postnatal care checkups.3 Thus, HBRs for MCH are fragmented into several types according to MCH-related vertical programs. This fragmented implementation of HBRs hampers the promotion of continuum of care for pregnant women, mothers, and children, an essential package for reducing maternal and neonatal deaths.4 For this reason, some countries implement the Maternal and Child Health Handbook (MCH Handbook), an integrated HBR for both a mother and her child applicable to all stages of maternal, newborn, and child health, throughout pregnancy, delivery, birth, postnatal, infancy, and childhood.5
Several previous studies conducted international comparisons of the prevalence of nationally representative child vaccination cards between countries.1, 6, 7 Yet, there is only one study that identified and analyzed the prevalence of HBRs at subnational level within a country.8 The study further reported the levels of fragmentation and overlapping among those multiple HBRs between provinces and between MCH-related vertical programs. However, no previous study estimated the magnitude of cost savings to be realized through avoiding overlapping HBR operations.
Vietnam is one of the most successful countries in achieving both Millennium Development Goals 4 and 5.9 Earlier studies reported that HBRs for MCH are likely to have contributed to reductions in the mortality rates, by promoting timely and adequate utilizations of maternal, newborn, and child health services.10, 11 Yet, it was found that parallel operationalization of multiple fragmented HBRs at subnational level has been confusing not only health workers by requiring them to record the same data into several HBRs but also mothers about which HBR they should refer to and rely on at home.8 Thus, it was recommended that HBRs for MCH be standardized and integrated into a single national version, for reduction of confusions, operational efficiency, and financial sustainability of the HBR. In view of the recommendation, the Vietnamese Ministry of Health (MoH) piloted the MCH Handbook to assess the feasibility of its nationwide scaling-up, through implementing the Maternal and Child Health Handbook Project (the Project) during the period from 2011 to 2014.
This study is aimed at estimating the magnitude of cost savings that will be realized through standardizing and integrating HBRs into a single MCH Handbook and replacing it for several existing fragmented HBRs. Note that this is globally the first study that attempts to estimate cost savings to be realized through avoiding overlapping operations of multiple HBRs for MCH.
Section snippets
Methods
The previous study conducted in 28 provinces of Vietnam identified 23 HBRs for MCH that were implemented as of 2014.8 Only part of the 23 HBRs were nationally implemented as the requirement by the central MoH. The others were the province-specific HBRs whose operations were neither required nor controlled by the MoH.8 To estimate the minimum magnitude of cost savings likely to be realized commonly in all provinces of Vietnam, this study targets only HBRs that have been already nationally scaled
Results
Table 1 shows the unit costs of the operation elements overlapping between the three HBRs, i.e., MCH Handbook, Child Vaccination Handbook, and Child Growth Monitoring Chart. The unit costs of production and distribution of Child Vaccination Handbook and Child Growth Monitoring Chart were the same (VND 2000 per copy), while that of the MCH Handbook was 3.45 times higher (VND 6900 per copy).12, 16 This difference is attributed to a greater number of pages in the MCH Handbook (100 pages) than
Financial justification for the HBR integration
Expected effects of cost savings by implementing exclusively the MCH Handbook were estimated at USD 3.01 million per annum. Note that the amount identified in this study is minimum expected cost savings because they were estimated by focusing only on basic recurrent cost elements of the HBR operations. Further cost savings could be expected in health workers' training on data recording and other HBR operations. Yet, training of health workers was excluded from cost-saving estimation in this
Acknowledgements
The authors gratefully thank Japan International Cooperation Agency (JICA) for its funding support to the study. This work is sincerely dedicated to the late Dr. Tran Huynh Phu Hung and all pregnant women, mothers, children, and health workers in Vietnam.
Ethical approval
It was not necessary to get ethical clearance, as this study employed exclusively secondary data.
Funding
This study was funded by Japan International Cooperation Agency (JICA).
Competing interests
None declared.
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