Table 3.

Cost-effectiveness of training in economic obstetric care (EmOC)

Author(s)	Economic evaluation type	Perspective	Effectiveness metric utilised	Effectiveness	Cost-effectiveness reported	Value for money statement	Sensitivity analysis
Walker et al., 2002	Cost-Effectiveness Analysis	Healthcare provider	Change in scores for skills Cost per additional skilled midwife	All programmes resulted in statistically significant improvements (P = 0.03) in the skills of healthcare providers.	Advanced LSS: US$49.7 per 1% increase in mean skill scores and US$3210.9 per % point increase in the number of competent facility midwives.Basic LSS: US$60.7 per % point increase in mean skill scores and US$5651.5 per % point increase in the numbers of competent village midwives.Village midwives internship: US$154.0 per % point increase in mean skill scores and US$4060.8 per % point increase in the number of competent village midwives.	Not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison.	Done
Osei et al., 2005	Cost-Effectiveness Analysis	Not defined	Knowledge change of provider on how to conduct labour and delivery,Performance with regard to managing obstetric and other complications	Knowledge changeSelf-paced Learning (SPL): 17% change from baseline to endlineResidential (R): −5%Performance changeSPL: 6% performance change from baseline to endlineR: 4% performance change from baseline to endline	Knowledge changeSPL: US$69 per provider per % point change R: Not calculated due to the negative change in the indicator from baseline to endline.Performance changeSPL: US$101 per provider per % point changeR: US$138 per provider per % point change	Not reported	Not done
Boulenger & Dmytraczenko, 2007	Cost-Effectiveness Analysis	Government	Cost of skilled care per delivery	–	The average annual cost of the skilled care per delivery with a skilled birth attendant was US$15.0 for Tanzania, and US$10.6 for Kenya. The cost per capita was US$1.7 for Tanzania, and US$0.6 for Kenya.	Not possible to compare to similar interventions.	Not done
Kruk et al., 2007	Cost-Effectiveness Analysis	Modified societal perspective	Cost of surgeries conducted	–	The resulting cost per surgery for surgical technicians is US$38.87 versus US$144.1 for physicians.	Surgical technicians retained a substantial cost advantage in all the scenarios.	Done
Manasyan et al., 2011	Cost-Effectiveness Analysis, Cost-Utility Analysis	Not defined	Number of lives saved	97 lives saved. All-cause 7-day neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 after training (relative risk: 0.59 (0.48–0.77); P < .001) and was associated with a decrease in deaths caused by birth asphyxia (3.4–1.9 per 1000; P = .02) and infection (2.1–1.0 per 1000; P = .02)	The intervention costs were US$208 per life saved and US$5.24 per disability-adjusted life-year averted.	Considered value for money as Gross Domestic Product (GDP) per person in Zambia was about $1500.	Not done