Abstract:
Background: Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania.
Potential reason for poor quality of care is the existence of a “know-do gap” where by health workers do not
perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health
care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by
facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal
health care. This study aimed at assessing the cost of installing and operating the system in the health centers.
Methods: This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed
using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software,
transport, personnel, training, supplies and communication. These were grouped into installation and operation
cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and
economic cost implications. We also conducted a sensitivity analysis on the estimations.
Results: Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in
the installation phase and included all the activities in preparation for the actual operation of the system for client
care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost)
followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial
costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of
activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset
useful life and input cost variations.
Conclusions: Our study presents financial and economic cost estimates of installing and operating an electronic
CDSS for maternal health care in six rural health centres. From these findings one can understand exactly what
goes into a similar investment and thus determine sorts of input modification needed to fit their context.
