Cost-Effectiveness Analysis of Training Nurses for Task-shifting in Angola

Abstract

Introduction: The Angolan Ministry of Health is scaling-up HIV treatment and authorized training nurses to expand their role in delivery of care and treatment to HIV patients through task-shifting. A training program was implemented in one province from May to September of 2012, which included didactic training, rotations and mentoring sessions at the work sites of nurse participants. The cost-effectiveness of the program was estimated. Methods:This analysis adopted a societal perspective to calculate the incremental cost-effectiveness ratio (ICER). Costing data were collected from I-TECH's accounting records and estimated from information provided by local government and program participants. Effectiveness was measured through changes in knowledge and clinical competency of nurse participants. A random effects model was used to estimate the relationship between change in knowledge and the number of clinical mentoring sessions. Results: The total cost of the program was US$ 242,393, of which US$ 184,543 were financial and US$ 57,850 economic costs. The average knowledge test score increased by 27.2%, (p <0.000), and the average clinical skills score increased from 1.9 to 2.3 (p=0.0712), raising competency level from "fair" to "good". The ICER for each 1% increase in knowledge and clinical skills was US$ 278 and US$ 947, respectively. Individual knowledge increase was positively associated with the number of clinical mentoring sessions performed (r² =0.52, p<0.001). Discussion:The incremental analysis estimates that it would cost US$ 12,343 per nurse to increase an average participant's knowledge scores to 100% and US$ 51,138 per nurse to increase an average participant's clinical skills a to 100%, reaching the "excellent" category. Technical assistance corresponded to the largest portion of financial costs. Once local capacity to implement the program is developed, costs would drop from US$ 7,574 to US$ 3,214 per nurse if the program is replicated by Ministry of Health in Angola. Conclusion: Despite the significant costs associated with training nurses for task-shifting of HIV care and treatment in Angola, a successful training strategy can generate improvements over time, by achieving productive efficiency of health workforce.