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Indian Pediatr 2013;50:
829-830 |
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How Cost-Effective is Facility-Based Newborn
Care in India?
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Sutapa Bandyopadhyay Neogi
Indian Institute of Public Health-Delhi, Public
Health Foundation of India, Plot number 34, Sector 44,
Gurgaon -122 002, India.
Email: [email protected]
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F acility-based newborn care is a key strategy to
improve neonatal health. Investment in neonatal care units is a
resource-intensive exercise. Besides the one-time establishment cost,
the operational costs of equipment, personnel, ancillary services,
drugs, consumables, investigations, and care with or without
ventilators, are huge investments. It, however, varies with the setting
and type of unit (level II vs level III) and so do the benefits
for neonates with different needs. In India, the establishment cost of a
12-bedded level II unit (Special Newborn Care unit - SNCU) in a district
hospital is around 41,00,000 INR. This does not include the cost of
training. The running cost (excluding salaries of staff) comes to
10,00,000 INR (20,000 USD) per year [1]. This is much less compared to
what is incurred in developed nations.
The annual health system cost of operating SNCU at
the district level is INR 6.3 million. The average cost of treatment per
neonate is INR 4581, while per bed-day treatment is INR 818, as reported
from a study of four SNCUs [2]. However, there needs to be a careful
cost estimation before generalization, as both the capital and recurrent
cost will vary according to Gross Domestic State Product of states. The
analysis suggests that the overall costs of neonatal intensive care for
all those who require level II care would be around INR 20.4 billion.
This comprises 0.8% of India’s health care spending [2]. While cost has
important implications at the national level, its effectiveness on the
outcome of admission emerges as the key indicator to promote SNCUs at
the district level. To improve the cost effectiveness, the outcome of
admissions needs to be analyzed. The outcome depends heavily on the
input costs and profile of babies admitted [3]. The bulk of admissions
in India are because of birth asphyxia, low birth weight and sepsis.
Birth asphyxia can very well be prevented by strengthening Newborn Care
Corners (NBCC) at every delivery point. Regionalization of neonatal care
is known to be an effective way to reduce costs and improve
effectiveness [4]. Unfortunately, in India, the emphasis on setting up
of SNCUs at district level has not been translated into development of
an integrated system of facility based newborn care [5]. Strengthening
of an integrated model with SNCU at the district hospital and having a
good linkage with Neonatal Stabilization Units (NSU) at 24x7 Primary
Health centers and Community Health centresand NBCCs at each delivery
point has not been accorded an importance.
As the definition of a viable fetus has been changed
to include babies with lower gestational age, the cost of care of such
neonates has increased drastically [6]. But in a situation where most of
the neonates admitted to SNCUs have normal birth weight, these
vulnerable newborns are likely to suffer the most. Laxity of admission
and discharge criteria resulting in over admissions and high bed
occupancy rates often results in lack of attention and care of this
category of neonates [2,5]. This may affect the performance of such
units in an adverse way.
To benefit the families, due consideration should be
given for inclusion of neonatal care at SNCUs under the benefit package
of "Rashtriya Swasthya Bima Yojana (RSBY)", the cashless health
insurance scheme for informal and below poverty line households in
India. The estimates given by Prinja, et al. [2] can be used as a
base to set up the payment rates. High cost of neonatal care may
increase the overall ceiling of benefit package and should be a point of
discourse under RSBY. National Rural Health Mission (NRHM) should focus
on interventions that yield the maximum levels of health gain across
population with judicious use of resources. Previous studies from India
have either analyzed the outcomes or have given an estimate of
approximate costs [4,5].
Cost effectiveness studies are reported from other countries [6].
There is a paucity of data on cost effectiveness
and cost utility analysis for facility based care in India including
regionalization. Such evaluations along with cost minimization analysis
should be undertaken before further scaling up SNCUs in the country.
Acknowledgment: The author acknowledges the
contribution of Mr. Maulik Chokshi and Prof Sanjay Zodpey (IIPHS)
towards finalization of the draft.
Competing interest: None stated; Funding:
Nil.
References
1. UNICEF. Setting up a special care newborn unit in
a district hospital. In: Toolkit for setting up of special care
newborn units, stabilization units and newborn corners. New Delhi:
UNICEF, 2008. p. 29. Available from: http://www.unicef. org/india/SCNU_book1_April_6.pdf.
Accessed on 20 August 2009.
2. Prinja S, Manchada N, Mohan P, Gupta G, Sethy G,
Sen A, et al. Cost of neonatal intensive care delivered through
district level public hospitals in India. Indian Pediatr.
2013;50:839-46.
3. Schmitt SK, Sneed L, Phibbs CS. Costs of newborn
care in California: a population-based study. Pediatrics.
2006;117:154-60.
4. Narang A, Kiran PS, Kumar P. Cost of neonatal
intensive care in a tertiary care centre. Indian Pediatr. 2005;42:
989-97.
5. Neogi S, Malhotra S, Zodpey S, Mohan P. Challenges
in scaling up of Special Care Newborn Units- Lessons from India. Indian
Pediatr. 2011;48:931-5.
6. Profit J, Lee D, Zupancic JA, Papile L, Gutierrez
C, Goldie SJ, et al. Clinical benefits, costs, and
cost-effectiveness of neonatal intensive care in Mexico. PLoS Med.
2010;7:e1000379.
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